Effects of early oral feeding after radical total gastrectomy in gastric cancer patients

Abstract

BACKGROUND Gastric cancer (GC) is a heavy burden in China. Nutritional support for GC patients is closely related to postoperative rehabilitation. However, the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce. AIM To prospectively explore the safety, feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients. METHODS This study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China. A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled. Of which, 105 patients were given early oral feeding (EOF group) after surgery, and the other 101 patients were given the traditional feeding strategy (control group) after surgery. Perioperative clinical data were recorded and analyzed. The primary endpoints were gastrointestinal function recovery time and postoperative complications, and the secondary endpoints were postoperative nutritional status, length of hospital stay and expenses, etc . RESULTS Compared with the control group, patients in the EOF group had a significantly shorter postoperative first exhaust time (2.48 ± 1.17 d vs 3.37 ± 1.42 d, P = 0.001) and first defecation time (3.83 ± 2.41 d vs 5.32 ± 2.70 d, P = 0. 004). In addition, the EOF group had a significant shorter postoperative hospitalization duration (5.85 ± 1.53 d vs 7.71 ± 1.56 d, P < 0.001) and lower postoperative hospitalization expenses (16.60 ± 5.10 K¥ vs 21.00 ± 7.50 K¥, P = 0.014). On the 5 th day after surgery, serum prealbumin level (214.52 ± 22.47 mg/L vs 204.17 ± 20.62 mg/L, P = 0.018), serum gastrin level (246.30 ± 57.10 ng/L vs 223.60 ± 55.70 ng/L, P = 0.001) and serum motilin level (424.60 ± 68.30 ng/L vs 409.30 ± 61.70 ng/L, P = 0.002) were higher in the EOF group. However, there was no significant difference in the incidence of total postoperative complications between the two groups ( P = 0.507). CONCLUSION Early oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function, improve postoperative nutritional status, reduce length of hospital stay and expenses while not increasing the incidence of related complications, which indicates its safety, feasibility and potential benefits for gastric cancer patients.

Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

“…Although early initiation of oral or enteral feeding has been recommended to improve clinical outcomes and to reduce surgical complications in GC patients following gastrectomy [23,26], the postoperative nutritional support for patients is quite variable between different surgical teams. And in the statement of the Japanese Gastric Cancer Treatment Guideline, the drink should be offered after postoperative day 1 and a solid diet should begin from postoperative day 2 to 4 regardless of surgery type [27].…”

Estratégias De Acolhimento E Condicionamento Do Paciente Autista No Atendimento Odontológico: Uma Revisão Integrativa

“…No que se refere à realimentação precoce, verificou-se que nenhum dos pacientes iniciou a dieta apropriada precocemente no pós-operatório como recomendado pela Diretriz ACERTO, posto que, mesmo os indivíduos que alimentaram no prazo de 24 horas fizeram uso de dieta composta por líquidos claros. Contudo, há estudos que mostram que os pacientes submetidos à gastrectomia podem receber suporte com nutrição oral ou enteral precocemente no pós-operatório (LAFFITTE, POLAKOWSKI, KATO, 2015;WANG et al, 2019;LU et al, 2020).…”

Construction and validation of a predictive model for the risk of three-month-postoperative malnutrition in patients with gastric cancer: a retrospective case-control study

“…Early EN can stimulate the secretion of gastrointestinal hormones by mucosa, promote the recovery of intestinal peristalsis and digestive function after operation, and shorten the exhaust time (37). In addition, EN includes arginine, glutamine ω-3PUFA, and antioxidant micronutrients that can repair and maintain the intestinal mucosal barrier and ensure structural and functional integrity (38). EN also provides heat and nitrogen sources, promotes the synthesis of total proteins and stress proteins, corrects the negative nitrogen balance, improves immune capacity, and reduces postoperative inflammatory reactions.…”