1
|
Guo CH, Zhong JD, Jin XL, Zhang JE. Optimal time to initiate early oral feeding in postoperative patients with upper gastrointestinal malignancy: A network meta-analysis. Int J Nurs Stud 2024; 151:104680. [PMID: 38228066 DOI: 10.1016/j.ijnurstu.2023.104680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND With the development of enhanced recovery after surgery, early oral feeding is likely to become the preferred mode of nutrition after surgery for upper gastrointestinal tract malignancies. However, the optimal time to initiate early oral feeding remains unknown. OBJECTIVE We aimed to compare the effects of different introduction times of early oral feeding in patients with upper gastrointestinal malignancies in terms of safety, tolerance, and effectiveness and to identify the optimal time for early oral feeding after surgery. METHODS A random-effects meta-analysis was performed to identify evidence from relevant randomized controlled trials. Ten electronic databases were searched for randomized controlled trials from their earliest records to May 2023. Data were analyzed using the Stata 16.0 software. RESULTS A total of 22 randomized controlled trials including 2510 patients and seven time points for oral feeding after surgery were considered. Regarding safety, oral feeding initiated on postoperative day 3 may be the safest (high-quality evidence) compared with other times. Regarding tolerance, oral feeding initiated on postoperative day 5 may be the most well-tolerated (moderate-quality evidence) compared with other times. Regarding effectiveness, oral feeding initiated on postoperative day 3 may be the most effective (moderate-quality evidence) compared with other times. CONCLUSIONS Early oral feeding is safe, tolerable, and effective in postoperative patients with upper gastrointestinal malignancies. The optimal time to initiate early oral feeding after surgery was most likely postoperative day 3. The results of this meta-analysis provide evidence-based guidelines for clinical decision-making.
Collapse
Affiliation(s)
- Cong-Hui Guo
- Postoperative Recovery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China; School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Jiu-di Zhong
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-Lei Jin
- Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Jun-E Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
2
|
Gong L, Zhang C, Zhang M, Wu W. Reply to the letter regarding 'The effect of early oral feeding after esophagectomy on the incidence of anastomotic leakage: an updated review'. Postgrad Med 2023; 135:1. [PMID: 36205094 DOI: 10.1080/00325481.2022.2133825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Longbo Gong
- Department of Surgery, Xuzhou Central Hospital, Southeast University School of Medicine, 199 Jiefang South Road, Xuzhou, People's Republic of China
| | - Chu Zhang
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Miao Zhang
- Department of Surgery, Xuzhou Central Hospital, Southeast University School of Medicine, 199 Jiefang South Road, Xuzhou, People's Republic of China
| | - Wenbin Wu
- Department of Surgery, Xuzhou Central Hospital, Southeast University School of Medicine, 199 Jiefang South Road, Xuzhou, People's Republic of China
| |
Collapse
|
3
|
Deng H, Li B, Qin X. Early versus delay oral feeding for patients after upper gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials. Cancer Cell Int 2022; 22:167. [PMID: 35488274 PMCID: PMC9052660 DOI: 10.1186/s12935-022-02586-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/05/2022] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of early oral feeding (EOF) in patients after upper gastrointestinal surgery through meta-analysis of randomized controlled trials (RCTs). METHODS We analyzed the endpoints of patients including the length of stay (LOS), time of first exhaust, anastomotic leakage and pneumonia from included studies. And we retrieved RCTs from medical literature databases. Weighted mean difference (WMD), risk ratios (RR) and 95% confidence intervals (CI) were calculated to compare the endpoints. RESULTS In total, we retrieved 12 articles (13 trial comparisons) which contained 1771 patients. 887 patients (50.1%) were randomized to EOF group whereas 884 patients (49.9%) were randomized to delay oral feeding group. The result showed that compared with the delay oral feeding group, EOF after upper gastrointestinal surgery significantly shorten the LOS [WMD = - 1.30, 95% CI - 1.79 to - 0.80, I2 = 0.0%] and time of first exhaust [WMD = - 0.39, 95% CI - 0.58 to - 0.20, I2 = 62.1%]. EOF also reduced the risk of pneumonia (RR: 0.74, 95% CI 0.55 to 0.99, I2 = 0.0%). There is no significant difference in the risk of anastomotic leak, anastomotic bleeding, abdominal abscess, reoperation, readmission and mortality. CONCLUSIONS Overall, compared with the traditional oral feeding, EOF could shorten the LOS and time of first exhaust without increasing complications after upper gastrointestinal surgery.
Collapse
Affiliation(s)
- Huachu Deng
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Baibei Li
- Department of Hepatobiliary, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xingan Qin
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
| |
Collapse
|
4
|
He H, Ma Y, Zheng Z, Deng X, Zhu J, Wang Y. Early versus delayed oral feeding after gastrectomy for gastric cancer: A systematic review and meta-analysis. Int J Nurs Stud 2021; 126:104120. [PMID: 34910976 DOI: 10.1016/j.ijnurstu.2021.104120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Early oral feeding has been shown to be safe and effective for most surgeries, while surgeons and nurses are still hesitant to implement it in gastric cancer patients who undergo gastrectomy. OBJECTIVES This review aimed to investigate the safety and feasibility of early versus delayed oral feeding in gastric cancer patients after gastrectomy. DESIGN A systematic review and meta-analysis of randomized controlled trials. DATA SOURCES The literature search was performed in 7 databases from inception to March 7, 2021. REVIEW METHODS Randomized controlled trials that compared the effects of early oral feeding and delayed oral feeding in gastric cancer patients who undergo gastrectomy were included. The primary outcome was hospital days, and secondary outcomes included hospital costs, postoperative complication rates, feeding intolerance rates, annal exhaust time, albumin levels and prealbumin levels. According to the presence of heterogeneity, fixed or random effect meta-analysis was applied. RESULTS Nine trials involving 1087 gastric cancer patients who undergo gastrectomy were pooled in this systemic review and meta-analysis. The results showed that early oral feeding significantly decreased hospital days (mean difference = -1.50, 95% confidence interval = -1.91 to -1.10, P < 0.001) and hospital costs (mean difference = -4.21, 95% confidence interval = -5.00 to -3.42, P < 0.001) compared to delayed oral feeding, while the incidences of postoperative complications (risk ratio = 0.96, 95% confidence interval = 0.72 to 1.26, P = 0.76) and feeding intolerance (risk ratio = 0.95, 95% confidence interval = 0.79 to 1.15, P = 0.62) were comparable between the two groups. In comparison to delayed oral feeding, early oral feeding was associated with shorter annal exhaust time (mean difference = -0.61, 95% confidence interval = -0.81 to -0.40, P < 0.001) and higher levels of albumin (mean difference = 3.77, 95% confidence interval = 2.42 to 5.12, P < 0.001) and prealbumin (mean difference = 18.11, 95% confidence interval = 15.33 to 20.88, P < 0.001). Furthermore, the results of distal gastrectomy subgroup analysis indicated that hospital days were shorter in the early oral feeding group than in the delayed oral feeding group. CONCLUSIONS For gastric cancer patients who undergo gastrectomy, early oral feeding was associated with shorter hospital days and lower hospital costs, but early oral feeding did not increase the incidences of postoperative complications or feeding intolerance. Moreover, early oral feeding also decreased the annal exhaust time but increased the levels of albumin and prealbumin.
Collapse
Affiliation(s)
- Haiyan He
- Department of Nursing, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuanyuan Ma
- Department of Basic Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Zhiwei Zheng
- Department of Digestion, The 958st Hospital, Chongqing, China
| | - Xiaolian Deng
- Department of Gastrointestinal Colorectal and Anal Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Jingci Zhu
- Department of Basic Nursing, School of Nursing, Army Medical University, Chongqing, China.
| | - Yaling Wang
- Department of Nursing, Daping Hospital, Army Medical University, Chongqing, China.
| |
Collapse
|
5
|
Hao T, Liu Q, Lv X, Qiu J, Zhang HR, Jiang HP. Efficacy and safety of early oral feeding in postoperative patients with upper gastrointestinal tumor: A systematic review and meta-analysis. World J Gastrointest Surg 2021; 13:717-733. [PMID: 34354804 PMCID: PMC8316844 DOI: 10.4240/wjgs.v13.i7.717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/04/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early oral feeding (EOF) is an important measure for early recovery of patients with gastrointestinal tumors after surgery, which has emerged as a safe and effective postoperative strategy for improving clinical outcomes.
AIM To determine the safety and efficacy of early oral feeding in postoperative patients with upper gastrointestinal tumor.
METHODS This meta-analysis was analyzed using Review Manager version 5.3 and Stata version 14. All clinical studies that analyzed efficacy and safety of EOF for postoperative patients with upper gastrointestinal tumor were included.
RESULTS Fifteen studies comprising 2100 adult patients met all the inclusion criteria. A significantly lower risk of pneumonia was presented in the EOF compared with TOF group [relative risk (RR) = 0.63, 95% confidence interval (CI): 0.44–0.89, P = 0.01]. Length of hospital stay was significantly shorter in the EOF group than in the TOF group [weighted mean difference (WMD) = -1.91, 95%CI: -2.42 to -1.40; P < 0.01]. Cost of hospitalization was significantly lower (WMD = -4.16, 95%CI: -5.72 to -2.61; P < 0.01), and CD4 cell count and CD4/CD8 cell ratio on postoperative day 7 were significantly higher in the EOF group than in the TOF group: CD4 count (WMD = 7.17, 95%CI: 6.48–7.85; P < 0.01), CD4/CD8 ratio (WMD = 0.29, 95%CI: 0.23–0.35; P < 0.01). There was no significant difference in risk of anastomotic leak and total postoperative complications.
CONCLUSION EOF as compared with TOF was associated with lower risk of pneumonia, shorter hospital length of stay, lower cost of hospitalization, and significantly improved postoperative immune function of patients.
Collapse
Affiliation(s)
- Tao Hao
- The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Qian Liu
- Department of Cardiology, The Affiliated Hospital of Binzhou Medical College, Binzhou 256600, Shandong Province, China
| | - Xin Lv
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Jun Qiu
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Hao-Ran Zhang
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Hai-Ping Jiang
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
| |
Collapse
|
6
|
Xie J, Deng J, Li L. Letter regarding "The effect of early oral feeding afteresophagectomy on the incidence of anastomotic leakage: An updated review". Postgrad Med 2021; 133:771. [PMID: 34096453 DOI: 10.1080/00325481.2021.1940220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jian Xie
- Department of Cardiology, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Jinling Deng
- Department of Medical Imaging, Guangxi Medical University, Nanning, China
| | - Lang Li
- Department of Cardiology, Guangxi Medical University First Affiliated Hospital, Nanning, China
| |
Collapse
|
7
|
Rattray M, Marshall AP, Desbrow B, von Papen M, Roberts S. Assessment of an integrated knowledge translation intervention to improve nutrition intakes among patients undergoing elective bowel surgery: a mixed-method process evaluation. BMC Health Serv Res 2021; 21:514. [PMID: 34044842 PMCID: PMC8161936 DOI: 10.1186/s12913-021-06493-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 05/06/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A large evidence-practice gap exists regarding provision of nutrition to patients following surgery. The aim of this study was to evaluate the processes supporting the implementation of an intervention designed to improve the timing and adequacy of nutrition following bowel surgery. METHODS A mixed-method pilot study, using an integrated knowledge translation (iKT) approach, was undertaken at a tertiary teaching hospital in Australia. A tailored, multifaceted intervention including ten strategies targeted at staff or patients were co-developed with knowledge users at the hospital and implemented in practice. Process evaluation outcomes included reach, intervention delivery and staffs' responses to the intervention. Quantitative data, including patient demographics and surgical characteristics, intervention reach, and intervention delivery were collected via chart review and direct observation. Qualitative data (responses to the intervention) were sequentially collected from staff during one-on-one, semi-structured interviews. Quantitative data were summarized using median (IQR), mean (SD) or frequency(%), while qualitative data were analysed using content analysis. RESULTS The intervention reached 34 patients. Eighty-four percent of nursing staff received an awareness and education session, while 0% of medical staff received a formal orientation or awareness and education session, despite the original intention to deliver these sessions. Several strategies targeted at patients had high fidelity, including delivery of nutrition education (92%); and prescription of oral nutrition supplements (100%) and free fluids immediately post-surgery (79%). Prescription of a high energy high protein diet on postoperative day one (0%) and oral nutrition supplements on postoperative day zero (62%); and delivery of preoperative nutrition handout (74%) and meal ordering education (50%) were not as well implemented. Interview data indicated that staff regard nutrition-related messages as important, however, their acceptance, awareness and perceptions of the intervention were mixed. CONCLUSIONS Approximately half the patient-related strategies were implemented well, which is likely attributed to the medical and nursing staff involved in intervention design championing these strategies. However, some strategies had low delivery, which was likely due to the varied awareness and acceptance of the intervention among staff on the ward. These findings suggest the importance of having buy-in from all staff when using an iKT approach to design and implement interventions.
Collapse
Affiliation(s)
- Megan Rattray
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport Qld, Gold Coast, 4215, Australia
| | - Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Michael von Papen
- Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport Qld, Gold Coast, 4215, Australia
| | - Shelley Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport Qld, Gold Coast, 4215, Australia
| |
Collapse
|
8
|
Kato K, Omatsu K, Okamoto S, Matoda M, Nomura H, Tanigawa T, Aoki Y, Yunokawa M, Kanao H. Early oral feeding is safe and useful after rectosigmoid resection with anastomosis during cytoreductive surgery for primary ovarian cancer. World J Surg Oncol 2021; 19:77. [PMID: 33722264 PMCID: PMC7962404 DOI: 10.1186/s12957-021-02186-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/04/2021] [Indexed: 12/14/2022] Open
Abstract
Background The aim of this study was to investigate the safety and clinical usefulness of early oral feeding (EOF) after rectosigmoid resection with anastomosis for the treatment of primary ovarian cancer. Methods We performed a retrospective review of all consecutive patients who had undergone rectosigmoid resection with anastomosis for primary ovarian, tubal, or peritoneal cancer between April 2012 and March 2019 in a single institution. Patient-related, disease-related, and surgery-related data including the incidence of anastomotic leakage and postoperative hospital stay were collected. EOF was introduced as a postoperative oral feeding protocol in September 2016. Before the introduction of EOF, conventional oral feeding (COF) had been used. Results Two hundred and one patients who underwent rectosigmoid resection with anastomosis, comprised of 95 patients in the COF group and 106 patients in the EOF group, were included in this study. The median number of postoperative days until the start of diet intake was 5 (range 2–8) in the COF group and 2 (range 2–8) in the EOF group (P < 0.001). Postoperative morbidity was equivalent between the groups. The incidence of anastomotic leakage was similar (1%) in both groups. The median length of the postoperative hospital stay was reduced by 6 days for the EOF group: 17 (range 9–67) days for the COF group versus 11 (8–49) days for the EOF group (P < 0.001). Conclusion EOF provides a significant reduction in the length of the postoperative hospital stay without an increased complication risk after rectosigmoid resection with anastomosis as a part of cytoreductive surgery for primary ovarian cancer.
Collapse
Affiliation(s)
- Kazuyoshi Kato
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo, 135-8550, Japan. .,Present address: Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Kohei Omatsu
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo, 135-8550, Japan
| | - Sanshiro Okamoto
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo, 135-8550, Japan
| | - Maki Matoda
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo, 135-8550, Japan
| | - Hidetaka Nomura
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo, 135-8550, Japan
| | - Terumi Tanigawa
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo, 135-8550, Japan
| | - Yoichi Aoki
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo, 135-8550, Japan
| | - Mayu Yunokawa
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo, 135-8550, Japan
| | - Hiroyuki Kanao
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo, 135-8550, Japan
| |
Collapse
|
9
|
Singh R, Karantanis W, Fadhil M, Dow C, Fuzi J, Robinson R, Jacobson I. Meta-analysis on the rate of pharyngocutaneous fistula in early oral feeding in laryngectomy patients. Am J Otolaryngol 2021; 42:102748. [PMID: 33068955 DOI: 10.1016/j.amjoto.2020.102748] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/13/2020] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laryngectomy remains a common operation in head and neck units. The operation holds significant risk of post-operative morbidity including swallowing dysfunction. The most significant post-operative concern is the formation of a pharyngocutaneous fistula [PCF], the reported incidence of which is between 3% and 65%. The purpose of this systematic review and meta-analysis was to assess the safety of initiating early oral feeding following laryngectomy and the risk of PCF formation. METHODS A literature search was conducted through online databases: MEDLINE, EMBASE and PubMed. Eligible studies were included which contained cohorts of patients who had undergone laryngectomy, with early oral feeding commencing within seven days compared to late oral feeding. The primary outcome assessed was the incidence of PCF. Studies were excluded if cohorts had not included laryngectomy or if no comment was made on PCF formation. Meta-analysis was used to examine associations between oral feeding and PCF formation using Fixed Effect models. RESULTS Twelve studies and 1883 patients were included after systematic review. Six studies were non-interventional whereas the remaining were randomized clinical trials. Exposure included those with early oral feeding (before seven days) or late feeding oral feeding (after seven days) and the outcome assessed was the risk of PCF formation. Results from observational studies showed a higher risk of PCF formation for early feeders compared to late feeders [RR = 1.56, 95% CI: 1.15, 2.11]. Higher risk was also observed for RCT but was not significant [RR = 1.40, 95% CI: 0.85, 2.30]. Overall, there was a 50% greater risk of PCF formation for early oral feeding compared to late oral feeding [RR = 1.51, 95% CI: 1.17, 1.96]. CONCLUSION While early oral feeding can reduce post-laryngectomy patients' hospital stay and improve psychological wellbeing, there is a significant relative risk of PCF development within this group. However, this must be taken in context of the significant heterogeneity that exists within the literature.
Collapse
Affiliation(s)
- Ravjit Singh
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, NSW, Australia; Department of Otolaryngology, Prince of Wales Hospital, Sydney, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - William Karantanis
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Fadhil
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cassie Dow
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jordan Fuzi
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, NSW, Australia; Department of Otolaryngology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Rachelle Robinson
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, NSW, Australia; Department of Speech Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Ian Jacobson
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group, Sydney, NSW, Australia; Department of Otolaryngology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| |
Collapse
|
10
|
Lu YX, Wang YJ, Xie TY, Li S, Wu D, Li XG, Song QY, Wang LP, Guan D, Wang XX. Effects of early oral feeding after radical total gastrectomy in gastric cancer patients. World J Gastroenterol 2020; 26:5508-5519. [PMID: 33024401 PMCID: PMC7520607 DOI: 10.3748/wjg.v26.i36.5508] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/10/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023] Open
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 5th 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.
Collapse
Affiliation(s)
- Yi-Xun Lu
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yan-Jun Wang
- Department of Surgical Intensive Care Unit, Children’s Hospital Affiliated to Zhengzhou University, Children’s Hospital of Henan Provence, Zhengzhou 450018, Henan Province, China
| | - Tian-Yu Xie
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Shuo Li
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Di Wu
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiong-Guang Li
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Ying Song
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Li-Peng Wang
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Da Guan
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xin-Xin Wang
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|
11
|
Rattray M, Desbrow B, Marshall AP, von Papen M, Roberts S. Evaluation of an intervention to improve nutrition intake in patients undergoing elective colorectal surgery: A mixed-methods pilot study. Nutrition 2020; 84:111015. [PMID: 33183898 DOI: 10.1016/j.nut.2020.111015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/20/2020] [Accepted: 08/29/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Timely and adequate nutrition after surgery is important. The aim of this study was to evaluate the effects of an intervention, developed using an integrated knowledge translation approach, designed to improve oral intake among postoperative colorectal patients. METHODS A pre/post, mixed-methods pilot study was undertaken at a tertiary teaching hospital in Australia. Patients who had undergone elective colorectal surgery and were admitted to the ward where 10 nutrition-related strategies had been implemented were included. Quantitative data, including patient demographics, timing and type of nutrition consumed, and protein and energy intake were collected pre- and post-intervention via chart audits, direct observations, and verbal clarification. Qualitative data on patient (n = 18) responses to the intervention were collected through one-on-one, semistructured interviews and analyzed using inductive content analysis. RESULTS Sixty-four patients were observed (30 pre- and 34 post-intervention). Significant improvements were seen for the following outcomes (presented as median [interquartile range], pre- versus post-intervention): time (h) to first dietary intake (15.7 [7.4-22.5] versus 4.9 [3.7-14.2]); patient energy intakes (kJ) on day 1 (1719 [947-2200] versus 3530 [2192-5169]) and day 2 (2506 [1071-3749] versus 4144 [2987-5889]); and patient protein intake (g) on day 1 (3.3 [1.8-11.2] versus 30.3 [20-45]) and day 2 (10.8 [3.5-29.9] versus 39.6 [30.7-59]). Prescription of free fluids as first diet type increased from 13% to 79% pre- and post-intervention, respectively. There were no significant differences in time (h) to first solid dietary intake (86.1 [60.1-104] versus 69.2 [46.1-115.5]) and overall proportion of patients who met both their estimated energy and protein requirements while in hospital pre- and post-intervention (22 versus 37%). Patients reported positive experiences with the intervention. CONCLUSION A multifaceted intervention developed using an integrated knowledge translation approach has the potential to improve oral intake in patients who undergo colorectal surgery. A larger-scale trial is required to confirm these findings and assess the effects of the intervention on clinical outcomes and costs.
Collapse
Affiliation(s)
- Megan Rattray
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia.
| | - Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Gold Coast, Queensland, Australia
| | | | - Shelley Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia; Gold Coast Hospital and Health Service, Queensland, Australia
| |
Collapse
|
12
|
Navez J, Hubert C, Dokmak S, Frick De La Maza I, Tabchouri N, Benoit O, Hermand H, Zech F, Gigot JF, Sauvanet A. Early Versus Late Oral Refeeding After Pancreaticoduodenectomy for Malignancy: a Comparative Belgian-French Study in Two Tertiary Centers. J Gastrointest Surg 2020; 24:1597-1604. [PMID: 31325133 DOI: 10.1007/s11605-019-04316-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/19/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the era of fast-track surgery, because pancreaticoduodenectomy (PD) carries a significant morbidity, surgeons hesitate to begin early oral feeding and achieve early discharge. We compared the outcome of two different approaches to the postoperative management of PD in two tertiary centers. METHODS Of patients having undergone PD for malignancy from 2008 to 2017, 100 patients who received early postoperative oral feeding (group A) were compared to 100 patients from another center who received early enteral feeding and a delayed oral diet (group B). Surgical indication and approach and type of pancreatic anastomosis were similar between both groups. Postoperative outcomes were retrospectively reviewed. RESULTS Patient characteristics were similar between both groups, except significantly more neoadjuvant treatment in group A (A = 20% vs. B = 9%, p < 0.01). Mortality rates were 3% and 4% in groups A and B, respectively (p = 0.71). The rate of severe postoperative morbidity was significantly lower in group A (13% vs. 26%, p = 0.02), resulting in a lower reoperation rate (p < 0.01). Delayed gastric emptying and clinically relevant pancreatic fistula were similar between both groups but chyle leaks were more frequent in group A (10% vs. 3%, p = 0.04). The median hospital stay was shorter in group A (16 vs. 20 days, p < 0.01). CONCLUSION In the present study, early postoperative oral feeding after PD was associated with a shorter hospital stay and did not increase severe postoperative morbidity or the rate of pancreatic fistula. However, it resulted in more chyle leaks and did not prevent delayed gastric emptying.
Collapse
Affiliation(s)
- Julie Navez
- Hepato-Biliary and Pancreatic Surgery Division, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.,Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France
| | - Catherine Hubert
- Hepato-Biliary and Pancreatic Surgery Division, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Safi Dokmak
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France
| | - Isadora Frick De La Maza
- Hepato-Biliary and Pancreatic Surgery Division, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Nicolas Tabchouri
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France
| | - Olivier Benoit
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France
| | - Hélène Hermand
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France
| | - Francis Zech
- Institute of Experimental and Clinical Research, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Jean-François Gigot
- Hepato-Biliary and Pancreatic Surgery Division, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Alain Sauvanet
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
| |
Collapse
|
13
|
Ho CY, Ibrahim Z, Abu Zaid Z, Mat Daud Z'A, Md Yusop NB. Fast-track- recovery surgery with a whey-protein-infused carbohydrate-loading drink pre-operatively and early oral feeding post-operatively among surgical gynaecological cancer patients: study protocol of an open-labelled, randomised controlled trial. Trials 2020; 21:533. [PMID: 32546217 PMCID: PMC7298941 DOI: 10.1186/s13063-020-04462-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/27/2020] [Indexed: 02/04/2023] Open
Abstract
Introduction There has been growing evidence on the favourable outcomes of fast-track-recovery (FTR) surgery; to expedite recovery, minimise complications, and reduce the length of hospital stay for surgical patients. However, there is lack of evidence on the effectiveness of FTR in surgical gynaecological cancer (GC) patients. Most of the previous studies did not focus on feeding composition in the FTR surgery protocol. This study aims to determine the effectiveness of FTR feeding with a whey-protein-infused carbohydrate-loading drink pre-operatively and early oral feeding post-operatively on post-operative outcomes among surgical GC patients. Methods/design This open-labelled, randomised controlled trial (RCT) will randomly allocate patients into intervention and control groups. Ambulated Malaysian aged over 18 years and scheduled for elective surgery for (suspected) GC, will be included in this study. The intervention group will be given whey-protein-infused carbohydrate-loading drinks on the evening before their operation and 3 h before their operation as well as started on early oral feeding 4 h post-operatively. The control group will be fasted overnight pre-operation and only allowed plain water, and return to a normal diet is allowed when bowel sounds return post-operatively. The primary outcomes of study are length of post-operative hospital stay, length of clear-fluid tolerance, solid-food tolerance and bowel function. Additional outcome measures are changes in nutritional status, biochemical profile and functional status. Data will be analysed on an intention-to-treat basis. Trial registration ClinicalTrials.gov, ID: NCT03667755. Retrospectively registered on 12 September 2018; Protocol version: version 3 dated 27 September 2017.
Collapse
Affiliation(s)
- Chiou Yi Ho
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.,Dietetics and Food Service Department, National Cancer Institute, Ministry of Health, Jalan P7, Precint 7, 62250, Putrajaya, Malaysia
| | - Zuriati Ibrahim
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Zalina Abu Zaid
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Zulfitri 'Azuan Mat Daud
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Nor Baizura Md Yusop
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| |
Collapse
|
14
|
Liao M, Xia Z, Huang P, Shi Q, Li H, He R, Bao M, Qiao K. Early enteral feeding on esophageal cancer patients after esophageal resection and reconstruction. Ann Palliat Med 2020; 9:816-823. [PMID: 32312065 DOI: 10.21037/apm.2020.04.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/12/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND In patients under esophagectomy, early postoperative oral feeding has traditionally been contraindicated to minimize the risk of anastomotic leaks. Because early oral feeding preserves the integrity and function of gut mucosa, the aim of this study was to investigate the impact of postoperative early oral feeding on esophagectomy. METHODS Between Oct 2013 and Jan 2016, 41 consecutive patients with esophageal carcinoma (stages I- III), who had undergone minimally invasive Ivor-Lewis surgery, were enrolled in this study. The patients were randomly arranged into the early oral feeding (EOF) group (21 cases) and the simple tube feeding (STF) group (20 cases). The nutritional goal for both groups was 25 kcal/(kg·day). The patients in the EOF group were tube-fed with enteral nutrition and orally fed with 5% glucose in normal saline during the first 4 postoperative days, after that the patients were placed on a liquid diet. The patients in the STF group were postoperatively tube-fed with enteral nutrition for 7 days before being switched to liquid diet. The length of the postoperative hospital stay, rate of perioperative complications, and overall mortality were recorded. Preoperative and postoperative levels of serum albumin (ALB), prealbumin (PA), transferrin (TP), and C reactive protein (CRP) were also monitored. RESULTS There were no significant differences of the incidence of postoperative complications and overall mortality between the EOF group and the STF group, but the duration of hospital stay, interval until the first liquid food, and time of ambulation in the EOF group were lower than those of the STF group (P<0.05). EOF patients also showed significantly lower CRP levels compared with the STF group (P<0.05). CONCLUSIONS EOF might reduce the duration of hospital stays and CRP levels in esophageal cancer patients who underwent esophagectomy while the mortality and complications were not affected.
Collapse
Affiliation(s)
- Mingfeng Liao
- Guangdong Key Lab for Diagnosis & Treatment of Emerging Infectious Diseases, Department of Thoracic Surgery, Shenzhen Third People' s Hospital, Shenzhen 518112, China
| | - Zhaohua Xia
- Department of Thoracic Surgery, Shenzhen Third People' s Hospital, Shenzhen 518112, China
| | - Pilai Huang
- Department of Thoracic Surgery, Shenzhen Third People' s Hospital, Shenzhen 518112, China
| | - Qinlang Shi
- Department of Thoracic Surgery, Shenzhen Third People' s Hospital, Shenzhen 518112, China
| | - Hanwei Li
- Department of Anesthesiology, Shenzhen Third People' s Hospital, Shenzhen 518112, China
| | - Renliang He
- Department of Thoracic Surgery, Shenzhen Third People' s Hospital, Shenzhen 518112, China
| | - Mingwen Bao
- Department of Ultrasonic Diagnosis, Shenzhen Third People' s Hospital, Shenzhen 518112, China
| | - Kun Qiao
- Department of Thoracic Surgery, Shenzhen Third People' s Hospital, Shenzhen 518112, China.
| |
Collapse
|
15
|
Shinohara T, Maeda Y, Koyama R, Minagawa N, Hamaguchi J, Hamada T. Feasibility and Safety of Early Oral Feeding in Patients with Gastric Cancer After Radical Gastrectomy. Indian J Surg Oncol 2020; 11:47-55. [PMID: 32205970 DOI: 10.1007/s13193-019-00999-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/25/2019] [Indexed: 02/08/2023] Open
Abstract
An enhanced recovery after surgery (ERAS) protocol is useful in patients undergoing colorectal surgery. However, its feasibility for gastric surgery remains unclear. This study aimed to evaluate the feasibility and safety of early oral feeding (EOF) for patients with gastric cancer after radical gastrectomy. The EOF protocol was implemented in 397 patients who underwent radical gastrectomy between 2005 and 2014 at our hospital. The protocol was common in 277 patients after distal gastrectomy (DG) and 120 patients after total gastrectomy (TG). The patients were scheduled to start drinking water in the morning of the first postoperative day and to start thin rice gruel with a liquid nutrition supplement on the second postoperative day. We analyzed the incidence of postoperative complications and surgical outcomes in these patients. Furthermore, we analyzed risk factors for dropout from the EOF protocol. All patients started drinking water, while 26 patients were unable to start eating. The EOF protocol was implemented in 371 patients (93%), and 48 patients stopped eating. Specifically, 227 patients (87%) after DG and 96 patients (88%) after TG followed the EOF protocol perfectly. The incidence of postoperative complications, including anastomotic leakage (n = 0), ileus (n = 22), and pneumonia (n = 11), was 15% and that of clinically significant events (≥ grade 3) was 4.3%. Multivariate analysis showed that the male gender, comorbidities, and intra-operative bleeding are independent risk factors for dropout from the EOF protocol. EOF can be safely implemented in patients after radical gastrectomy.
Collapse
|
16
|
Wang Q, Guo BY, Zhao QC, Yan ZD, Shang LF, Yu J, Ji G. Safety of early oral feeding after total laparoscopic radical gastrectomy for gastric cancer (SOFTLY): Study protocol for a randomized controlled trial. Trials 2019; 20:384. [PMID: 31242936 PMCID: PMC6595557 DOI: 10.1186/s13063-019-3493-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 06/05/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gastric cancer is the third most common cause of cancer-related deaths and has the fifth highest incidence worldwide, especially in eastern Asia, central and Eastern Europe, and South America. Currently, surgery is the only curative treatment for gastric cancer; however, there is an increasing trend toward laparoscopic radical gastrectomy. Early oral feeding (EOF) has been shown to benefit clinical outcomes compared with open gastrectomy under conditions of enhanced recovery after surgery. There are a lack of guidelines and evidence for the safety and feasibility of EOF in patients undergoing laparoscopic radical gastrectomy. Thus, a prospective randomized trial is warranted. METHODS/DESIGN The EOF after total laparoscopic radical gastrectomy (SOFTLY) study is a single-center, parallel-arm, non-inferiority randomized controlled trial which will enroll 200 patients who are pathologically diagnosed with gastric cancer and undergo laparoscopic radical gastrectomy. The primary endpoint, incidence of anastomotic leakage, is based on 1.9% in the control group in the CLASS-01 study. The patients will be randomized (1:1) into two groups: the EOF group will receive a clear liquid diet on post-operative day 1 (POD1) and the delayed oral feeding (DOF) group will receive a clear liquid diet on post-operative day 4 (POD4). The demographic and pathologic characteristics will be recorded. Total and oral nutritional intake, general data, total serum protein, serum albumin, blood glucose, and temperature will be recorded before surgery and at the time of hospitalization. Adverse events will also be recorded. The occurrence of post-operative fistulas, including anastomotic leakage, will be recorded as the main severe post-operative adverse event and represent the primary endpoint. DISCUSSION The safety and feasibility of EOF after gastrectomy has not been established. The SOFTLY trial will be the first randomized controlled trial involving total laparoscopic radical gastrectomy, in which the EOF group (POD1) will be compared with the DOF group (POD4). The results of the SOFTLY trial will provide data on the safety and feasibility of EOF after total laparoscopic radical gastrectomy. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IOR-15007660 . Registered on 28 December 2015. The study has full ethical and institutional approval.
Collapse
Affiliation(s)
- Quan Wang
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Bo-Yang Guo
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Qing-Chuan Zhao
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Zun-Dong Yan
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Li-Feng Shang
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Juan Yu
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Gang Ji
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China.
| |
Collapse
|
17
|
Rattray M, Roberts S, Desbrow B, Wullschleger M, Robertson T, Hickman I, Marshall AP. A qualitative exploration of factors influencing medical staffs' decision-making around nutrition prescription after colorectal surgery. BMC Health Serv Res 2019; 19:178. [PMID: 30890125 PMCID: PMC6425714 DOI: 10.1186/s12913-019-4011-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/13/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery. However, studies have demonstrated variations in practice and poor adherence to these recommendations among patients who have undergone colorectal surgery. Given doctors are responsible for prescribing patients' diets after surgery, this study explored factors which influenced medical staffs' decision-making regarding postoperative nutrition prescription to identify potential behaviour change interventions. METHODS This qualitative study involved one-on-one, semi-structured interviews with medical staff involved in prescribing nutrition for patients following colorectal surgery across two tertiary teaching hospitals. Purposive sampling was used to recruit participants with varying years of clinical experience. The Theoretical Domains Framework (TDF) underpinned the development of a semi-structured interview guide. Interviews were audio recorded, with data transcribed verbatim before being thematically analysed. Emergent themes and sub-themes were discussed by all investigators to ensure consensus of interpretation. RESULTS Twenty-one medical staff were interviewed, including nine consultants, three fellows, four surgical trainees and five junior medical doctors. Three overarching themes emerged from the data: (i) Prescription preferences are influenced by perceptions, experience and training; (ii) Modifying prescription practices to align with patient-related factors; and (iii) Peers influence prescription behaviours and attitudes towards nutrition. CONCLUSIONS Individual beliefs, patient-related factors and the social influence of peers (particularly seniors) appeared to strongly influence medical staffs' decision-making regarding postoperative nutrition prescription. As such, a multi-faceted approach to behaviour change is required to target individual and organisational barriers to enacting evidence-based feeding recommendations.
Collapse
Affiliation(s)
- Megan Rattray
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD 4222 Australia
| | - Shelley Roberts
- School of Allied Health Sciences, Griffith University and Gold Coast Hospital and Health Service, Griffith, QLD 4222 Australia
| | - Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD 4222 Australia
| | - Martin Wullschleger
- Department of Trauma, Gold Coast University Hospital, Gold Coast, 4222 Australia
| | - Tayla Robertson
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Gold Coast, QLD Australia
| | - Ingrid Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital and Mater Research Institute, University of Queensland, Gold Coast, QLD Australia
| | - Andrea P. Marshall
- Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Gold Coast, 4222 Australia
| |
Collapse
|
18
|
Tweed T, van Eijden Y, Tegels J, Brenkman H, Ruurda J, van Hillegersberg R, Sosef M, Stoot J. Safety and efficacy of early oral feeding for enhanced recovery following gastrectomy for gastric cancer: A systematic review. Surg Oncol 2018; 28:88-95. [PMID: 30851919 DOI: 10.1016/j.suronc.2018.11.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/22/2018] [Accepted: 11/17/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Early oral feeding (EOF) is believed to be a crucial item of Enhanced Recovery After Surgery (ERAS) programs. Though this is widely accepted for colorectal surgery, evidence for early oral feeding after gastrectomy is scarce. The aim of this review is to assess the evidence of safety and benefits of early oral feeding after gastrectomy in patients with gastric cancer. METHODS A systematic literature search of Pubmed, Embase and Cochrane was performed for eligible studies published till September 2018. Studies were analyzed and selected by predetermined criteria. RESULTS After having assessed 23 eligible articles, a total of four randomized controlled trials (RCT) remained who fully met all requirements to be included in this review. All four RCTs compared early oral feeding (n = 320) with conventional care (n = 334) after gastrectomy. In all four studies, EOF was associated with a decreased length of hospital stay ranging from -1.3 to -2.5 days when compared to conventional care. A faster time to first flatus was recorded in all four studies in the EOF group, ranging from -6.5 hours to -1.5 days. Furthermore, EOF does not increase postoperative complication risk when compared to conventional care. CONCLUSION Current evidence for early oral feeding after gastrectomy is promising, proving its safety, feasibility and benefits. However, most studies have been conducted amongst an Asian population. Well powered and larger randomized controlled trials performed amongst a Western population is needed.
Collapse
Affiliation(s)
- Thaís Tweed
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands.
| | - Yara van Eijden
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Juul Tegels
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Hylke Brenkman
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Jelle Ruurda
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Meindert Sosef
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Jan Stoot
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| |
Collapse
|
19
|
Cho J, Kim HM, Song M, Park JS, Lee SM. Application of an early oral feeding protocol after pylorus-preserving pancreaticoduodenectomy. Support Care Cancer 2018; 27:981-990. [PMID: 30112720 DOI: 10.1007/s00520-018-4387-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/27/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE This study evaluates the effect of an enhanced recovery after surgery (ERAS)-based nutrition support protocol on oral intake and weight change in patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD). METHODS A 14-day postoperative nutrition support protocol was developed to initiate oral intake after 1 week of enteral tube feeding and parenteral nutrition (early oral feeding, EOF). Forty-eight patients who underwent PPPD participated in the study (non-EOF, n = 23; EOF, n = 25). General information, nutrition supply route and amount, blood chemistry, and weight changes were tracked. RESULTS The enteral tube feeding duration was 2.7 days shorter in the EOF group than in the non-EOF group. Furthermore, the EOF group started oral liquid and soft diets 1.1 and 2.5 days earlier than the non-EOF group, respectively. Compared with the non-EOF group, the EOF group reported a higher energy intake (22.1%; p = 0.001) and protein intake (17.4%; p = 0.000) via oral route. Although cumulative energy and protein intakes were similar in both groups, weight reduction in the EOF group (3.6 ± 0.1%, 2.2 ± 0.7 kg) was significantly less than the non-EOF group (8.2 ± 0.9%, 5.2 ± 0.5 kg). The blood levels of total protein and transferrin increased and prealbumin decreased, regardless of the EOF application. Serum albumin increased significantly only in the EOF group. CONCLUSION The EOF protocol developed for post-PPPD patients enables the early initiation and increase in the amount of oral intake while significantly alleviating weight loss.
Collapse
Affiliation(s)
- Jungmin Cho
- Clinical Nutrition Program, Graduate School of Human Environmental Sciences, Yonsei University, Seoul, South Korea
| | - Hyung Mi Kim
- Department of Nutrition, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Mina Song
- Department of Food and Nutritional Science, College of Human Ecology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Joon Seong Park
- Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| | - Seung-Min Lee
- Department of Food and Nutritional Science, College of Human Ecology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| |
Collapse
|
20
|
Shimizu N, Oki E, Tanizawa Y, Suzuki Y, Aikou S, Kunisaki C, Tsuchiya T, Fukushima R, Doki Y, Natsugoe S, Nishida Y, Morita M, Hirabayashi N, Hatao F, Takahashi I, Choda Y, Iwasaki Y, Seto Y. Effect of early oral feeding on length of hospital stay following gastrectomy for gastric cancer: a Japanese multicenter, randomized controlled trial. Surg Today 2018; 48:865-874. [PMID: 29721714 DOI: 10.1007/s00595-018-1665-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/05/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE This multicenter, randomized controlled study evaluates the safety of early oral feeding following gastrectomy, and its effect on the length of postoperative hospital stay. METHODS The subjects of this study were patients who underwent distal gastrectomy (DG) or total gastrectomy (TG) for gastric cancer between January 2014 and December 2015. Patients were randomly assigned to the early oral feeding group (intervention group) or the conventional postoperative management group (control group) for each procedure. We evaluated the length of postoperative hospital stay and the incidence of postoperative complications in each group. RESULTS No significant differences in length of postoperative stay were found between the intervention and control groups of the patients who underwent DG. The incidence of postoperative complications was significantly greater in the DG intervention group. In contrast, the length of postoperative stay was significantly shorter in the TG intervention group, although the TG group did not attain the established target sample size. CONCLUSION Early oral feeding did not shorten the postoperative hospital stay after DG. The higher incidence of postoperative complications precluded the unselected adoption of early oral feeding for DG patients. Further confirmative studies are required to definitively establish the potential benefits of early oral feeding for TG patients.
Collapse
Affiliation(s)
- Nobuyuki Shimizu
- Department of Surgery, International University of Health and Welfare, Sanno Hospital, 8-10-16 Akasaka, Minato-ku, Tokyo, 107-0052, Japan.
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yutaka Suzuki
- Department of Gastroenterological Surgery and General Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, 329-2763, Japan
| | - Susumu Aikou
- Department of Gastroenterological Surgery, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, 232-0024, Japan
| | - Takashi Tsuchiya
- Department of Gastroenterological Surgery and General Surgery, Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University, School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yasunori Nishida
- Department of Gastroenterological Surgery, Keiyukai Sapporo Hospital, Kita1-1 Hondori 14 cho-me, Shiroishi-ku, Sapporo, 003-0027, Japan
| | - Masaru Morita
- Department of Gastroenterological Surgery, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan
| | - Naoki Hirabayashi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asa, Kita-ku, Hiroshima, 731-0293, Japan
| | - Fumihiko Hatao
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, 183-8524, Japan
| | - Ikuo Takahashi
- Department of Surgery, Matsuyama Red Cross Hospital, 1 Bunkyo-cho, Matsuyama, 790-8524, Japan
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Yoshiaki Iwasaki
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yasuyuki Seto
- Department of Gastroenterological Surgery, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| |
Collapse
|
21
|
Benton K, Thomson I, Isenring E, Mark Smithers B, Agarwal E. An investigation into the nutritional status of patients receiving an Enhanced Recovery After Surgery (ERAS) protocol versus standard care following Oesophagectomy. Support Care Cancer 2018; 26:2057-2062. [PMID: 29368029 DOI: 10.1007/s00520-017-4038-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/28/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Enhanced Recovery After Surgery (ERAS) protocols have been effectively expanded to various surgical specialities including oesophagectomy. Despite nutrition being a key component, actual nutrition outcomes and specific guidelines are lacking. This cohort comparison study aims to compare nutritional status and adherence during implementation of a standardised post-operative nutritional support protocol, as part of ERAS, compared to those who received usual care. METHODS Two groups of patients undergoing resection of oesophageal cancer were studied. Group 1 (n = 17) underwent oesophagectomy between Oct 2014 and Nov 2016 during implementation of an ERAS protocol. Patients in group 2 (n = 16) underwent oesophagectomy between Jan 2011 and Dec 2012 prior to the implementation of ERAS. Demographic, nutritional status, dietary intake and adherence data were collected. Ordinal data was analysed using independent t tests, and categorical data using chi-square tests. RESULTS There was no significant difference in nutrition status, dietary intake or length of stay following implementation of an ERAS protocol. Malnutrition remained prevalent in both groups at day 42 post surgery (n = 10, 83% usual care; and n = 9, 60% ERAS). A significant difference was demonstrated in adherence with earlier initiation of oral free fluids (p <0.008), transition to soft diet (p <0.004) and continuation of jejunostomy feeds on discharge (p <0.000) for the ERAS group. CONCLUSION A standardised post-operative nutrition protocol, within an ERAS framework, results in earlier transition to oral intake; however, malnutrition remains prevalent post surgery. Further large-scale studies are warranted to examine individualised decision-making regarding nutrition support within an ERAS protocol.
Collapse
Affiliation(s)
- Katie Benton
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Queensland, 4102, Australia.
| | - Iain Thomson
- Discipline of Surgery, Upper GI and Soft Tissue Unit, Princess Alexandra Hospital, University of Queensland, Ipswich Rd, Woolloongabba, Queensland, Australia
| | - Elisabeth Isenring
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Queensland, 4102, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - B Mark Smithers
- Discipline of Surgery, Upper GI and Soft Tissue Unit, Princess Alexandra Hospital, University of Queensland, Ipswich Rd, Woolloongabba, Queensland, Australia
| | - Ekta Agarwal
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Queensland, 4102, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| |
Collapse
|
22
|
Kathpalia SK. Early Maternal Feeding Versus Traditional Delayed Feeding After Cesarean Section: A Pilot Study. J Obstet Gynaecol India 2017; 67:178-182. [PMID: 28546664 PMCID: PMC5425639 DOI: 10.1007/s13224-016-0949-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 11/10/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cesarean section is on the rise all over the world; it has become a safe surgery due to better anesthesia, asepsis, blood transfusion and antibiotics. Traditionally, the patients are kept nil orally till they pass flatus. This study was performed to find out acceptance and tolerability of early feeding, its side effects and complications if any. METHODS This comparative study was conducted in a service hospital. There were two groups of 70 cases each where one was administered early feeding and the second group was put on standard delayed feeding as is traditionally done in most of the hospitals. Gastrointestinal outcomes and other parameters were noted in both the groups and analyzed. RESULTS During the study period, every alternate willing case without any exclusion criteria was allotted to each group. Early feeding was started 6 h after surgery in the study group, whereas it was withheld till passage of flatus in the control group. Appearance of bowel sounds and passage of flatus were earlier in study group (21.6 and 34.5 h, respectively) as compared with control group (31.7 and 49.2 h, respectively). There were no complications or side effects of early feeding. CONCLUSION There is no justification to withholding oral feeds as is traditionally done. Early feeding should be initiated without fear of any side effects. Patients have an early postoperative recovery; it is cost-effective and results in higher patient satisfaction.
Collapse
Affiliation(s)
- Sukesh Kumar Kathpalia
- Obstetrics and Gynecology, Andaman Nicobar Islands Institute of Medical Sciences, Atalanta Point, Port Blair, 744104 India
| |
Collapse
|
23
|
Fujii T, Morita H, Sutoh T, Yajima R, Yamaguchi S, Tsutsumi S, Asao T, Kuwano H. Benefit of oral feeding as early as one day after elective surgery for colorectal cancer: oral feeding on first versus second postoperative day. Int Surg 2014; 99:211-5. [PMID: 24833141 DOI: 10.9738/INTSURG-D-13-00146.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The optimal timing of early oral intake after surgery has not been fully established. The objective of this study was to compare early oral intake at postoperative day 1 after resection of colorectal cancer with that of day 2 to identify the optimal timing for resumption of oral intake in such patients. Consecutive patients with colorectal cancer who underwent elective colorectal resection were separated into two groups. Sixty-two patients began a liquid diet on the first postoperative day (POD1 group) and 58 patients began on POD2 (POD2 group) and advanced to a regular diet within the next 24 hours as tolerated. As for gastrointestinal recovery, the first passage of flatus was experienced, on average, on postoperative day 3.1 ± 1.0 in the POD2 group and on day 2.3 ± 0.7 in the POD1 group. The first defecation was also significantly earlier in patients in the POD1 group than those in the POD2 group (POD 3.2 ± 1.2 versus 4.2 ± 1.4, respectively). No statistical difference was found between the two groups in terms of postoperative complications. Our results suggest that very early feeding on POD1 after colorectal resection is safe and feasible and that induced a quicker recovery of postoperative gastrointestinal movement in patients.
Collapse
|
24
|
Gerritsen A, Wennink RAW, Busch ORC, Borel Rinkes IHM, Kazemier G, Gouma DJ, Molenaar IQ, Besselink MGH. Feeding patients with preoperative symptoms of gastric outlet obstruction after pancreatoduodenectomy: Early oral or routine nasojejunal tube feeding? Pancreatology 2015; 15:548-553. [PMID: 26235830 DOI: 10.1016/j.pan.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/03/2015] [Accepted: 07/05/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early oral feeding is currently considered the optimal routine feeding strategy after pancreatoduodenectomy (PD). Some have suggested that patients with preoperative symptoms of gastric outlet obstruction (GOO) who undergo PD have such a high risk of developing delayed gastric emptying that these patients should rather receive routine postoperative tube feeding. The aim of this study was to determine whether clinical outcomes after PD in these patients differ between postoperative early oral feeding and routine tube feeding. METHODS We analyzed a consecutive multicenter cohort of patients with preoperative symptoms of GOO undergoing PD (2010-2013). Patients were categorized into two groups based on the applied postoperative feeding strategy (dependent on their center's routine strategy): early oral feeding or routine nasojejunal tube feeding. RESULTS Of 497 patients undergoing PD, 83 (17%) suffered from preoperative symptoms of GOO. 49 patients received early oral feeding and 29 patients received routine tube feeding. Time to resumption of adequate oral intake (primary outcome; 14 vs. 12 days, p = 0.61) did not differ between these two feeding strategies. Furthermore, overall complications and length of stay were similar in both groups. Of the patients receiving early oral feeding, 24 (49%) ultimately required postoperative tube feeding. In patients with an uncomplicated postoperative course, early oral feeding was associated with shorter time to adequate oral intake (8 vs. 12 days, p = 0.008) and shorter hospital stay (9 vs. 13 days, p < 0.001). CONCLUSION Also in patients with preoperative symptoms of GOO, early oral feeding can be considered the routine feeding strategy after PD.
Collapse
Affiliation(s)
- Arja Gerritsen
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Roos A W Wennink
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olivier R C Busch
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Geert Kazemier
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - I Quintus Molenaar
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc G H Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
25
|
Hwang SE, Jung MJ, Cho BH, Yu HC. Clinical feasibility and nutritional effects of early oral feeding after pancreaticoduodenectomy. Korean J Hepatobiliary Pancreat Surg 2014; 18:84-9. [PMID: 26155256 PMCID: PMC4492322 DOI: 10.14701/kjhbps.2014.18.3.84] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 12/29/2022]
Abstract
Backgrounds/Aims Pancreaticoduodenctomy (PD) is associated with high rates of postoperative morbidity and mortality. Although many studies have shown that early postoperative enteral nutrition improves postoperative outcomes, limited clinical information is available on postoperative early oral feeding (EOF) after PD. The aim of this study was to evaluate the clinical feasibility, safety, and nutritional effects of EOF after PD. Methods Clinical outcomes were investigated in 131 patients who underwent PD between 2003 and 2013, including 81 whose oral feeding was commenced within 48 hours (EOF group) and 50 whose oral feeding was commenced after resumption of bowel movements (traditional oral feeding [TOF] group). Postoperative complications, energy intake, and length of stay (LOS) were reviewed. Results Demographic factors were similar in the two groups. The EOF group had a significantly shorter LOS (25.9±8.5 days vs. 32.3±16.3 days; p=0.01) than the TOF group. The rates of anastomotic leak (1.2% vs. 16%, p=0.00) and reoperation (3.7% vs. 20%, p=0.01) were significantly lower in the EOF group. In the clinically acute phase from postoperative day 1 to day 5, the mean daily calorie intake (847.0 kcal vs. 745.6 kcal; p=0.04) and mean daily protein intake (42.2 g vs. 31.9 g; p=0.00) in the EOF group were significantly higher than that in the TOF group. Conclusions Postoperative EOF is a clinically safe, feasible, and effective method of nutritional support after PD.
Collapse
Affiliation(s)
- Si Eun Hwang
- Department of Surgery, Daejeon Sun Hospital, Daejeon, Korea
| | - Mi Jin Jung
- Department of Nutrition Service, Chonbuk National University Hospital, Jeonju, Korea
| | - Baik Hwan Cho
- Department of Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School, and Research Institute of Clinical Medicine, Jeonju, Korea
| | - Hee Chul Yu
- Department of Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School, and Research Institute of Clinical Medicine, Jeonju, Korea
| |
Collapse
|
26
|
Sun HB, Liu XB, Zhang RX, Wang ZF, Qin JJ, Yan M, Liu BX, Wei XF, Leng CS, Zhu JW, Yu YK, Li HM, Zhang J, Li Y. Early oral feeding following thoracolaparoscopic oesophagectomy for oesophageal cancer. Eur J Cardiothorac Surg 2014; 47:227-33. [PMID: 24743002 DOI: 10.1093/ejcts/ezu168] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Nil-by-mouth with enteral tube feeding is widely practised for several days after resection and reconstruction of oesophageal cancer. This study investigates early changes in postoperative gastric emptying and the feasibility of early oral feeding after thoracolaparoscopic oesophagectomy for patients with oesophageal cancer. METHODS Between January 2013 and August 2013, gastric emptying of liquid food and the feasibility of early oral feeding after thoracolaparoscopic oesophagectomy was investigated in 68 patients. Sixty-five patients previously managed in the same unit who routinely took liquid food 7 days after thoracolaparoscopic oesophagectomy served as controls. RESULTS The mean preoperative half gastric emptying time (GET1/2) was 66.4 ± 38.4 min for all 68 patients, and the mean GET1/2 at postoperative day (POD) 1 and POD 7 was statistically significantly shorter than preoperative GET1/2 (23.9 ± 15.7 min and 24.1 ± 7.9 min, respectively, both P-values <0.001). Of the 68 patients who were enrolled to analyse the feasibility of early oral feeding, 2 (3.0%) patients could not take food as early as planned. The rate of total complication was 20.6% (14/68) and 29.2% (19/65) in the early oral feeding group and the late oral feeding group, respectively (P = 0.249). Compared with the late oral feeding group, time to first flatus and bowel movement was significantly shorter in the early oral feeding group. CONCLUSIONS Compared with preoperative gastric emptying, early postoperative gastric emptying for liquid food after oesophagectomy is significantly faster. Postoperative early oral feeding in patients with thoracolaparoscopic oesophagectomy is feasible and safe.
Collapse
Affiliation(s)
- Hai-bo Sun
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xian-ben Liu
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Rui-xiang Zhang
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zong-fei Wang
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian-jun Qin
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Ming Yan
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Bao-xing Liu
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiu-feng Wei
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Chang-sen Leng
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jun-wei Zhu
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yong-kui Yu
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Hao-miao Li
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jun Zhang
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| |
Collapse
|
27
|
Peng SS, Duan J, Huang HF, Lin J, Xu WG, Huang Z, Su ZT, Zeng Z. Clinical effects of early postoperative oral feeding versus traditional oral feeding after bilioenteric anastomosis. Shijie Huaren Xiaohua Zazhi 2014; 22:1312-1316. [DOI: 10.11569/wcjd.v22.i9.1312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the security and feasibility of early postoperative oral feeding in patients after bilioenteric anastomosis.
METHODS: A randomized controlled trial was performed on 78 patients who underwent bilioenteric anastomosis from January 2010 to December 2012 at the First Affiliated Hospital of Kunming Medical University. The patients were randomized into two groups: early oral feeding (EOF group, n = 42) and traditional oral feeding (TOF group, n = 36). The length of postoperative hospital stay, time to first flatus and defecation, nutritional status and postoperative complications were compared.
RESULTS: The EOF group was associated with significantly shorter post-operative hospital stay, time to first flatus and defecation compared with the TOF group (P < 0.05 for all). The levels of albumin, prealbumin and lymphocyte count were significantly higher in the EOF group than in the TOF group on postoperative days 3 and 7 (P < 0.05 for all). There were no significant differences in patient characteristics and other postoperative complications between the two groups (P > 0.05 for all).
CONCLUSION: Early oral feeding after bilioenteric anastomosis is safe and beneficial, and leads to faster recovery of bowel function and shorter postoperative hospital stay without increasing postoperative complications.
Collapse
|
28
|
Bozzetti F, Mariani L. Perioperative nutritional support of patients undergoing pancreatic surgery in the age of ERAS. Nutrition 2014; 30:1267-71. [PMID: 24973198 DOI: 10.1016/j.nut.2014.03.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/24/2014] [Accepted: 03/01/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The results achieved through the Enhanced Recovery After Surgery (ERAS) approach in gastrointestinal surgery have led to its enthusiastic acceptance in pancreatic surgery. However, the ERAS program also involves an early oral feeding that is not always feasible after pancreatoduodenectomy. The aim of this review was to investigate in the literature whether the difficulty with early oral feeding in these patients was adequately balanced by perioperative enteral or parenteral nutritional support as recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines or whether these recommendations have lost value in the "bundle" of the ERAS. METHODS We reanalyzed both ESPEN guidelines and literature regarding the ERAS program in surgical pancreatic patients. RESULTS There was a high prevalence of malnutrition (and consequently of postoperative complications) in patients with pancreatic cancer, and there is evidence that many of these patients should be candidates for perioperative nutritional support according to ESPEN guidelines. The start of oral fluid and solid feeding was quite variable in literature reporting the use of ERAS in pancreatic cancer surgery, with a consistent gap between the recommended and the effective start of both the feedings. The use of nasogastric/jejunal tube or of a needle-catheter jejunostomy was discouraged by the ERAS guidelines but their use could prove beneficial in patients who are recognized at high risk for postoperative complications according to the scores available in the literature. CONCLUSION The current practice of the ERAS program in these patients appears to neglect some ESPEN recommendations. On the other hand, both ESPEN and ERAS recommendations could be combined for a supplemental benefit for the patient.
Collapse
Affiliation(s)
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| |
Collapse
|