|
1
|
Han L, Zhou Y, Wang Y, Chen H, Li W, Zhang M, Zhou J, Zhang L, Dou X, Wang X. Nutritional status of early oral feeding for gastric cancer patients after laparoscopic total gastrectomy: A retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109379. [PMID: 39580263 DOI: 10.1016/j.ejso.2024.109379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 10/10/2024] [Accepted: 11/10/2024] [Indexed: 11/25/2024]
Abstract
BACKGROUND After Laparoscopic total gastrectomy (LTG), gastric cancer (GC) patients often face malnutrition. Early oral feeding (EOF) has emerged as a key strategy in enhanced recovery after surgery (ERAS) protocols. However, the impact of EOF on post-LTG nutritional status requires further investigation. This study aimed to compare the nutritional status of EOF, nasogastric tube (NGT) and nasojejunal tube (NJT) to figure out the status of EOF. METHODS A retrospective comparative analysis of a single center (Second Hospital of Lanzhou University) of a total of 116 patients with LTG was performed. These included 40 NGT patients, 40 patients with NJT and 36 patients with EOF. Postoperative (7 days after surgery) nutritional status was examined as the primary endpoint, including weight, BMI, total protein, albumin, hemoglobin and total lymphocyte count (TLC). In addition, bowel sounds, abdominal distension and pain were evaluated as secondary endpoints. RESULTS The collective shows no significant differences between the three groups regarding various demographic and clinical information (All, p > 0.05). There was no significant difference in the patients' nutritional status and bowel sound recovery 7 days after surgery (All, p > 0.05). The rate of abdominal distension shows to be significantly reduced with EOF compared to NJT (mean difference = 0.342; p < 0.001). The incidence of abdominal pain was significantly different between EOF and NGT groups (mean difference = 0.228; p < 0.001). CONCLUSION Among GC patients after LTG, EOF and traditional tube feeding had a similar risk of postoperative nutritional status. However, EOF was associated with a lower risk of abdominal distension.
Collapse
Affiliation(s)
- Leyao Han
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yihan Zhou
- Second School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Yingqiao Wang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Haixia Chen
- Department of Oncological Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Weiping Li
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Meishan Zhang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Juanjuan Zhou
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Liping Zhang
- Department of Liver Diseases Branch, Lanzhou University Second Hospital, Lanzhou, China
| | - Xinman Dou
- School of Nursing, Lanzhou University, Lanzhou, China; Department of Nursing, Lanzhou University Second Hospital, Lanzhou, China
| | - Xinglei Wang
- School of Nursing, Lanzhou University, Lanzhou, China; Department of Cardiovascular Medicine, Lanzhou University Second Hospital, Lanzhou, China.
| |
Collapse
|
|
2
|
Liu D, Li SC. Nursing of a patient with multiple primary cancers: A case report and review of literature. World J Clin Oncol 2024; 15:1315-1323. [DOI: 10.5306/wjco.v15.i10.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 08/15/2024] [Accepted: 08/23/2024] [Indexed: 09/29/2024] Open
Abstract
BACKGROUND Although the occurrence of multiple primary cancers (MPC) is not exceedingly common, it is not rare in clinical practice. In recent years, there has been a notable increase in its incidence. The frequent confusion between MPC and tumor metastasis or recurrence often leads to delays in diagnosis and treatment. This study aimed to enhance understanding of MPC, improve diagnostic accuracy, guide precise clinical treatment, and implement a case management nursing model (CMNM) to facilitate quick patient recovery.
CASE SUMMARY A 61-year-old female patient presented with persistent upper abdominal pain lasting over 2 months. Gastroscopy revealed the presence of both gastric and duodenal cancers. Following a thorough evaluation, the patient underwent pancreaticoduodenectomy, cholecystectomy, and total gastrectomy. Post-surgery, an individualized case management nursing approach was applied, leading to a successful recovery. Three months after the surgery, follow-up examinations showed no signs of recurrence.
CONCLUSION The CMNM effectively promoted rapid patient recovery, enhanced the quality of orthopedic nursing services, and accelerated postoperative recovery, ultimately leading to increased patient satisfaction with nursing care.
Collapse
Affiliation(s)
- Di Liu
- Department of Hepatobiliary Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Sheng-Chao Li
- Department of Hepatobiliary Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| |
Collapse
|
|
3
|
Wang B, Han D, Hu X, Chen J, Liu Y, Wu J. Perioperative liberal drinking management promotes postoperative gastrointestinal function recovery after gynecological laparoscopic surgery: A randomized controlled trial. J Clin Anesth 2024; 97:111539. [PMID: 38945059 DOI: 10.1016/j.jclinane.2024.111539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/17/2024] [Accepted: 06/22/2024] [Indexed: 07/02/2024]
Abstract
STUDY OBJECTIVE This study aims to evaluate the effect of perioperative liberal drinking management, including preoperative carbohydrate loading (PCL) given 2 h before surgery and early oral feeding (EOF) at 6 h postoperatively, in enhancing postoperative gastrointestinal function and improving outcomes in gynecologic patients. The hypotheses are that the perioperative liberal drinking management accelerates the recovery of gastrointestinal function, enhances dietary tolerance throughout hospitalization, and ultimately reduces the length of hospitalization. DESIGN A prospective randomized controlled trial. SETTING Operating room and gynecological ward in Wuhan Union Hospital. PATIENTS We enrolled 210 patients undergoing elective gynecological laparoscopic surgery, and 157 patients were included in the final analysis. INTERVENTIONS Patients were randomly allocated in a 1:1:1 ratio into three groups, including the control, PCL, and PCL-EOF groups. The anesthetists and follow-up staff were blinded to group assignment. MEASUREMENTS The primary outcome was the postoperative Intake, Feeling nauseated, Emesis, Examination, and Duration of symptoms (I-FEED) score (range 0 to 14, higher scores worse). Secondary outcomes included the incidence of I-FEED scores >2, and other additional indicators to monitor postoperative gastrointestinal function, including time to first flatus, time to first defecation, time to feces Bristol grade 3-4, and time to tolerate diet. Additionally, we collected other ERAS recovery indicators, including the incidence of PONV, complications, postoperative pain score, satisfaction score, and the quality of postoperative functional recovery at discharge. MAIN RESULTS The PCL-EOF exhibited significantly enhanced gastrointestinal function recovery compared to control group and PCL group (p < 0.05), with the lower I-FEED score (PCL: 0[0,1] vs. PCL-EOF: 0[0,0] vs. control: 1[0,2]) and the reduced incidence of I-FEED >2 (PCL:8% vs. PCL-EOF: 2% vs. control:21%). Compared to the control, the intervention of PCL-EOF protected patients from the incidence of I-FEED score > 2 [HR:0.09, 95%CI (0.01-0.72), p = 0.023], and was beneficial in promoting the patient's postoperative first flatus [PCL-EOF: HR:3.33, 95%CI (2.14-5.19),p < 0.001], first defecation [PCL-EOF: HR:2.76, 95%CI (1.83-4.16), p < 0.001], Bristol feces grade 3-4 [PCL-EOF: HR:3.65, 95%CI (2.36-5.63), p < 0.001], first fluid diet[PCL-EOF: HR:2.76, 95%CI (1.83-4.16), p < 0.001], and first normal diet[PCL-EOF: HR:6.63, 95%CI (4.18-10.50), p < 0.001]. Also, the length of postoperative hospital stay (PCL-EOF: 5d vs. PCL: 6d and control: 6d, p < 0.001), the total cost (PCL-EOF: 25052 ± 3650y vs. PCL: 27914 ± 4684y and control: 26799 ± 4775y, p = 0.005), and postoperative VAS pain score values [POD0 (PCL-EOF: 2 vs. control: 4 vs. PCL: 4, p < 0.001), POD1 (PCL-EOF: 1 vs. control: 3 vs. PCL: 2, p < 0.001), POD2 (PCL-EOF: 1 vs. control:2 vs. PCL: 1, p < 0.001), POD3 (PCL-EOF: 0 vs. control: 1 vs. PCL: 1, p < 0.001)] were significantly reduced in PCL-EOF group. CONCLUSIONS Our primary endpoint, I-FEED score demonstrated significant reduction with perioperative liberal drinking, serving as a protective intervention against I-FEED>2. Gastrointestinal recovery metrics, such as time to first flatus and defecation, also showed substantial improvements. Furthermore, the intervention enhanced postoperative dietary tolerance and expedited early recovery. TRIAL REGISTRATION ChiCTR2300071047(https://www.chictr.org.cn/).
Collapse
Affiliation(s)
- Beibei Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China.
| | - Dong Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Xinyue Hu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Jing Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Yuwei Liu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Jing Wu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| |
Collapse
|
|
4
|
Xu D, Li J, Liu J, Wang P, Dou J. An updated systematic review and meta-analysis of the efficacy and safety of early oral feeding vs. traditional oral feeding after gastric cancer surgery. Front Oncol 2024; 14:1390065. [PMID: 39296982 PMCID: PMC11408281 DOI: 10.3389/fonc.2024.1390065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/29/2024] [Indexed: 09/21/2024] Open
Abstract
Introduction Early oral feeding (EOF) has been shown to improve postoperative recovery for many surgeries. However, surgeons are still skeptical about EOF after gastric cancer surgery due to possible side effects. This updated systematic review and meta-analysis aimed to investigate the efficacy and safety of EOF in patients after gastric cancer surgery. Methods Randomized controlled trials (RCTs) investigating EOF in patients after gastric cancer surgery were searched in the databases of PubMed, Embase, Clinicaltrials.gov, and Cochrane from 2005 to 2023, and an updated meta-analysis was performed using RevMan 5.4 software. Results The results of 11 RCTs involving 1,352 patients were included and scrutinized in this analysis. Hospital days [weighted mean difference (WMD), -1.72; 95% confidence interval (CI), -2.14 to -1.30; p<0.00001), the time to first flatus (WMD, -0.72; 95% CI, -0.99 to -0.46; p<0.00001), and hospital costs (WMD, -3.78; 95% CI, -4.50 to -3.05; p<0.00001) were significantly decreased in the EOF group. Oral feeding tolerance [risk ratio (RR), 1.00; 95% CI, 0.95-1.04; p=0.85), readmission rates (RR, 1.28; 95% CI, 0.50-3.28; p=0.61), postoperative complications (RR, 1.02; 95% CI, 0.81-1.29; p=0.84), anastomotic leakage (RR, 0.83; 95% CI, 0.25-2.78; p=0.76), and pulmonary infection (RR, 0.65; 95% CI, 0.31-1.39; p=0.27) were not significantly statistical between two groups. Conclusion This meta-analysis reveals that EOF could reduce hospital days, the time to first flatus, and hospital costs, but it was not associated with oral feeding tolerance, readmission rates, or postoperative complications especially anastomotic leakage and pulmonary infection, regardless of whether laparoscopic or open surgery, partial or total gastrectomy, or the timing of EOF initiation.
Collapse
Affiliation(s)
- Dong Xu
- Department of General Surgery, Zibo Municipal Hospital, Zibo, Shandong, China
| | - Junping Li
- Department of Oncology, Zibo Municipal Hospital, Zibo, Shandong, China
| | - Jinchao Liu
- Department of General Surgery, Zibo Municipal Hospital, Zibo, Shandong, China
| | - Pingjiang Wang
- Department of General Surgery, Zibo Municipal Hospital, Zibo, Shandong, China
| | - Jianjian Dou
- Department of Radiation, Zibo Municipal Hospital, Zibo, Shandong, China
| |
Collapse
|
|
5
|
Ali W, Dost W, Zaman MN, Rasully MQ, Niazi J, Qasemi F, Dost R, Dost W, Bakht D, Bokhari SFH. Feasibility and Safety of Early Oral Feeding After Radical Gastrectomy in Patients With Gastric Carcinoma: A Systematic Review. Cureus 2024; 16:e66463. [PMID: 39247003 PMCID: PMC11380650 DOI: 10.7759/cureus.66463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 09/10/2024] Open
Abstract
This systematic review examines the feasibility and safety of early oral feeding (EOF) after radical gastrectomy in patients with gastric cancer. A comprehensive literature search identified eight eligible studies, including both clinical trials and cohort studies, conducted between 2011 and 2020. The review analyzed outcomes such as postoperative complications, length of hospital stay, time to first flatus/bowel movement, and changes in nutritional markers. The findings suggest that EOF is generally feasible and well-tolerated, with high adherence rates reported across studies. Most patients successfully initiated oral intake within 72 hours post-surgery without significant protocol deviations. Regarding safety, the studies reported comparable or lower rates of postoperative complications in EOF groups compared to traditional feeding protocols, though some noted non-significant increases in complications with EOF. Several studies observed potential benefits of EOF, including shorter hospital stays, earlier return of gastrointestinal function, and improved nutritional status. However, the results were mixed, with some studies finding no significant differences in these outcomes. While the review suggests EOF is a viable option for postoperative management after radical gastrectomy, it emphasizes the importance of patient-specific factors and close monitoring during implementation. The heterogeneity in study designs, EOF protocols, and outcome measures limits direct comparisons. Future large-scale randomized controlled trials are warranted to establish standardized EOF protocols and provide more robust evidence for this patient population.
Collapse
Affiliation(s)
- Wahida Ali
- General Surgery, Jamhuriat Hospital, Kabul, AFG
| | - Wahidullah Dost
- Medicine and Surgery, Kabul University of Medical Sciences, Kabul, AFG
- General Surgery, Jamhuriat Hospital, Kabul, AFG
| | | | | | - Jamaluddin Niazi
- Cardiovascular Surgery, Punjab Institute of Cardiology, Lahore, PAK
| | | | - Raisa Dost
- Cardiac Surgery, Kabul University of Medical Sciences, Kabul, AFG
| | - Wahida Dost
- Cardiac Surgery, Kabul University of Medical Sciences, Kabul, AFG
| | - Danyal Bakht
- Medicine and Surgery, Mayo Hospital, Lahore, PAK
| | | |
Collapse
|
|
6
|
Zhang Y, Zhang J, Zhu L, Hao J, He F, Xu T, Wang R, Zhuang W, Wang M. A Narrative Review of Nutritional Therapy for Gastrointestinal Cancer Patients Underwent Surgery. J INVEST SURG 2023; 36:2150337. [DOI: 10.1080/08941939.2022.2150337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Yujie Zhang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Jinglin Zhang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
- Department of Gastrointestinal Surgery, Yibin Second People’s Hospital, Yibin, China
| | - Lili Zhu
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaqi Hao
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Fengjun He
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Xu
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Rui Wang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Zhuang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Mojin Wang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
|
7
|
Xuefen Z, Yuanyuan B, Qin L, Xiaoyang W. Nutritional care in patients undergoing laparoscopic/minimally invasive surgeries for gastrointestinal tumours. Wideochir Inne Tech Maloinwazyjne 2023; 18:625-638. [PMID: 38239578 PMCID: PMC10793145 DOI: 10.5114/wiitm.2023.130468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/24/2023] [Indexed: 01/22/2024] Open
Abstract
The introduction of minimally invasive surgeries for gastrointestinal tumours has been associated with many favourable postoperative outcomes and a reduced impact on nutritional status. The literature review begins by discussing the impact of minimally invasive procedures on the nutritional status of patients with gastrointestinal tumours, followed by indications for enteral nutrition (EN) in this population, including preoperative nutritional support and postoperative nutritional support. The review then examines the evidence that favours the use of EN in this population, including studies demonstrating improved outcomes with preoperative EN and reduced postoperative complications with postoperative EN. It also discusses potential strategies for improving outcomes with EN, such as early initiation of feeding and individualized nutrition plans. Overall, current evidence shows that EN improves outcomes, reduces complications, and enhances the quality of life. However, the optimal timing, composition of EN, and long-term outcomes are still unclear, indicating the need for future investigations.
Collapse
Affiliation(s)
- Zhou Xuefen
- Department of Gastrointestinal Surgery, Affiliated Kunshan Hospital to Jiangsu University, Suzhou Jiangsu, China
| | - Bian Yuanyuan
- Department of Gastrointestinal Surgery, Affiliated Kunshan Hospital to Jiangsu University, Suzhou Jiangsu, China
| | - Li Qin
- Department of Gastrointestinal Surgery, Affiliated Kunshan Hospital to Jiangsu University, Suzhou Jiangsu, China
| | - Wu Xiaoyang
- Department of Gastrointestinal Surgery, Affiliated Kunshan Hospital to Jiangsu University, Suzhou Jiangsu, China
| |
Collapse
|
|
8
|
Ripollés-Melchor J, Abad-Motos A, Bruna-Esteban M, García-Nebreda M, Otero-Martínez I, Abdel-Lah Fernández O, Tormos-Pérez MP, Paseiro-Crespo G, García-Álvarez R, A Mayo-Ossorio M, Zugasti-Echarte O, Nespereira-García P, Gil-Gómez L, Logroño-Ejea M, Risco R, Parreño-Manchado FC, Gil-Trujillo S, Benito C, Jericó C, De-Miguel-Cabrera MI, Ugarte-Sierra B, Barragán-Serrano C, García-Erce JA, Muñoz-Hernández H, Río-Fernández SD, Herrero-Bogajo ML, Espinosa-Moreno AM, Concepción-Martín V, Zorrilla-Vaca A, Vaquero-Pérez L, Mojarro I, Llácer-Pérez M, Gómez-Viana L, Fernández-Martín MT, Abad-Gurumeta A, Ferrando-Ortolà C, Ramírez-Rodríguez JM, Aldecoa C. Association between use of enhanced recovery after surgery protocols and postoperative complications after gastric surgery for cancer (POWER 4): a nationwide, prospective multicentre study. Cir Esp 2023; 101:665-677. [PMID: 37094777 DOI: 10.1016/j.cireng.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION The effectiveness of the Enhanced Recovery After Surgery (ERAS) protocols in gastric cancer surgery remains controversial. METHODS Multicentre prospective cohort study of adult patients undergoing surgery for gastric cancer. Adherence with 22 individual components of ERAS pathways were assessed in all patients, regardless of whether they were treated in a self-designed ERAS centre. Each centre had a three-month recruitment period between October 2019 and September 2020. The primary outcome was moderate-to-severe postoperative complications within 30 days after surgery. Secondary outcomes were overall postoperative complications, adherence to the ERAS pathway, 30 day-mortality and hospital length of stay (LOS). RESULTS A total of 743 patients in 72 Spanish hospitals were included, 211 of them (28.4 %) from self-declared ERAS centres. A total of 245 patients (33 %) experienced postoperative complications, graded as moderate-to-severe complications in 172 patients (23.1 %). There were no differences in the incidence of moderate-to-severe complications (22.3% vs. 23.5%; OR, 0.92 (95% CI, 0.59 to 1.41); P = 0.068), or overall postoperative complications between the self-declared ERAS and non-ERAS groups (33.6% vs. 32.7%; OR, 1.05 (95 % CI, 0.70 to 1.56); P = 0.825). The overall rate of adherence to the ERAS pathway was 52% [IQR 45 to 60]. There were no differences in postoperative outcomes between higher (Q1, > 60 %) and lower (Q4, ≤ 45 %) ERAS adherence quartiles. CONCLUSIONS Neither the partial application of perioperative ERAS measures nor treatment in self-designated ERAS centres improved postoperative outcomes in patients undergoing gastric surgery for cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03865810.
Collapse
Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anaesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Ane Abad-Motos
- Department of Anaesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.
| | - Marcos Bruna-Esteban
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, La Fe University Hospital, Valencia, Spain
| | - María García-Nebreda
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain; Department of General Surgery, Infanta Leonor University Hospital, Madrid, Spain
| | - Isabel Otero-Martínez
- Department of General Surgery, Hospital Álvaro Cunqueiro de Vigo (Complejo Hospitalario Universitario de Vigo), Vigo, Spain
| | - Omar Abdel-Lah Fernández
- Department of General Surgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - María P Tormos-Pérez
- Department of Anaesthesia and Perioperative Medicine, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Gloria Paseiro-Crespo
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain; Department of General Surgery, Infanta Leonor University Hospital, Madrid, Spain
| | - Raquel García-Álvarez
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, 12 de Octubre University Hospital, Madrid, Spain
| | - María A Mayo-Ossorio
- Department of General Surgery, Hospital Universitario Puerta del Mar Cádiz, Cádiz, Spain
| | - Orreaga Zugasti-Echarte
- Department of Anaesthesia and Perioperative Medicine, Complejo Hospitalario Navarra, Pamplona, Spain
| | | | - Lucia Gil-Gómez
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Hospital de Sant Joan Despí Moisès Broggi, Spain
| | - Margarita Logroño-Ejea
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Hospital Universitario de Alava, Vitoria, Spain
| | - Raquel Risco
- Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
| | | | - Silvia Gil-Trujillo
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Carmen Benito
- Department of Anaesthesia and Perioperative Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Jericó
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Internal Medicine, Hospital Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain
| | - María I De-Miguel-Cabrera
- Department of Anaesthesia and Perioperative Medicine, Hospital General Universitari Castelló, Castellón de La Plana, Spain
| | - Bakarne Ugarte-Sierra
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, Hospital Galdakao-Usansolo, Spain
| | | | - José A García-Erce
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Banco de Sangre y Tejidos de Navarra, Pamplona, Spain
| | - Henar Muñoz-Hernández
- Department of Anaesthesia and Perioperative Medicine, Hospital Clínico de Valladolid, Spain
| | - Sabela Del- Río-Fernández
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - María L Herrero-Bogajo
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, Hospital General La Mancha Centro, Alcázar de San Juan, Spain
| | - Alma M Espinosa-Moreno
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Vanessa Concepción-Martín
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, Nuestra Señora de Candelaria Hospital Universitario, Spain
| | - Andrés Zorrilla-Vaca
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Vaquero-Pérez
- Department of Anaesthesia and Perioperative Medicine, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Irene Mojarro
- Department of Anaesthesia and Perioperative Medicine, Juan Ramón Jiménez University Hospital, Huelva, Spain
| | - Manuel Llácer-Pérez
- Department of Anaesthesia and Perioperative Medicine, Hospital Costa del Sol, Marbella, Spain
| | - Leticia Gómez-Viana
- Department of Anaesthesia and Perioperative Medicine, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - María T Fernández-Martín
- Department of Anaesthesia and Perioperative Medicine, Hospital Medina del Campo, Medina del Campo, Spain
| | - Alfredo Abad-Gurumeta
- Department of Anaesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Ferrando-Ortolà
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, Lozano Blesa University Hospital, Universidad de Zaragoza, Zaragoza, Spain
| | - César Aldecoa
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| |
Collapse
|
|
9
|
Zhang Y, Tao K, Yu J, Chen C, Zheng Q, Lei S, Zhong X, Liu L, Wang W, Wang Q, Li E, Luo Y, Zhang G, Feng X, Li Y, Wang J. Evaluation of early liquid drinking after radical gastrectomy in gastric cancer: a Chinese multicenter propensity score matching analysis. Gastroenterol Rep (Oxf) 2023; 11:goad029. [PMID: 37304556 PMCID: PMC10250079 DOI: 10.1093/gastro/goad029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/14/2023] [Indexed: 06/13/2023] Open
Abstract
Background Enhanced recovery after surgery is used in gastrointestinal surgery. This study aimed to access the effects of early liquid drinking (ELD) on gastrointestinal function recovery in patients with gastric cancer (GC) who underwent radical gastrectomy, as high-quality evidence on the outcomes of ELD after gastrectomy is currently lacking. Methods Clinicopathological data of patients with GC from 11 centers were retrospectively analysed. Clinical outcomes were investigated in 555 patients, including 225 who started drinking liquid within 48 h (ELD group) of surgery and 330 who started drinking liquid after flatus resumption (traditional liquid drinking [TLD] group). Propensity score matching (PSM) analysis was performed using a match ratio of 1:1 and 201 patients were selected from each group for the analysis. Primary outcome was time to first passage of flatus. Secondary outcomes included time to first defecation, post-operative hospitalization days, occurrence of short-term post-operative complications, and hospitalization costs. Results After PSM, baseline characteristics were not significantly different between the two groups. The time to first flatus (2.72 ± 1.08 vs 3.36 ± 1.39 days), first defecation (4.34 ± 1.85 vs 4.77 ± 1.61 days), and post-operative hospital stay (8.27 ± 4.02 vs 12.94 ± 4.43 days) were shorter in the ELD group than in the TLD group (all P < 0.05). The ELD group had lower hospitalization costs than the TLD group ([7.83 ± 2.44 vs 8.78 ± 3.41] × 104 RMB, P = 0.041). No significant differences were observed in the incidence of post-operative complications. Conclusions Compared with TLD, post-operative ELD could promote rapid recovery of gastrointestinal function and reduce hospitalization costs; moreover, ELD does not increase the risk of post-operative complications.
Collapse
Affiliation(s)
| | | | | | - Chao Chen
- Department of Gastrointestinal Surgery, Huizhou Municipal Central Hospital, Huizhou, Guangdong, P. R. China
| | - Quan Zheng
- Department of Gastrointestinal Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P. R. China
| | - Sanlin Lei
- Department of Gastrointestinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P. R. China
| | - Xiaogang Zhong
- Department of Surgical Treatment of Gastrointestinal Hernia and Fistula, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, P. R. China
| | - Lixin Liu
- Department of General Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Wei Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, P. R. China
| | - Qiang Wang
- Department of Gastrointestinal Surgery, Guangzhou First People’s Hospital, Guangzhou, Guangdong, P. R. China
| | - En Li
- Department of Gastrointestinal Surgery, Meizhou People’s Hospital, Meizhou, Guangdong, P. R. China
| | - Yuwen Luo
- Department of General Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Guanrong Zhang
- lnformation and Statistics Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Xingyu Feng
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P. R. China
- Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Yong Li
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P. R. China
- Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Junjiang Wang
- Corresponding author. Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Second Street, Yuexiu District, Guangzhou 510080, Guangdong, P. R. China. Tel: +86-20-83827812;
| |
Collapse
|
|
10
|
Dai T, Wu D, Tang J, Liu Z, Zhang M. 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. J Gastrointest Oncol 2023; 14:128-145. [PMID: 36915453 PMCID: PMC10007955 DOI: 10.21037/jgo-22-1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
Background This study analyzed both the influencing factors of malnutrition in patients with gastric cancer and established a multi-dimensional risk model to predict postoperative malnutrition three months after surgery. Methods The clinical data of gastric cancer patients hospitalized for the first time and receiving laparoscopic surgery in the general surgery department of our hospital were retrospectively analyzed through the hospital information system and divided into a training set and a validation set in the ratio of 7:3. Nutritional status was assessed using the Patient Generated Subjective Global Assessment scale and follow-up records three months after surgery. Patients were divided into a non-malnutrition group and a malnutrition group, and a risk prediction model was established and displayed in the form of a nomogram. Results A total of 344 patients were included, with 242 in the training and 102 in the validation set. Tumor node metastasis stage (TNM Stage, P=0.020), cardiac function grading (CFG, P=0.013), prealbumin (PAB, P<0.001), neutrophil-to-lymphocyte ratio (NLR, P=0.027), and enteral nutrition within 48 hours post-operation (EN 48 h post-op, P=0.025) were independent risk factors. We established a prediction model with the above variables and displayed it via a nomogram, then verified its effectiveness through internal and external verification. This revealed a C-index of 0.84 (95% CI: 0.79-0.89), and the area under curve (AUC) areas of 0.840 (training set) and 0.854 (validation set), which was better than the nutritional risk screening 2002 (NRS2002) scale. The calibration curve brier scores were 0.159 and 0.195, and the Hosmer-Lemeshow test chi-square values were 14.070 and 1.989 (P>0.05). The decision curve analysis (DCA) of the training set model indicated the clinical applicability was good and within the threshold probability range of 10%-85%, which was also better than NRS2002. Conclusions A clinical prediction model including multi-dimensional variables was established based on independent risk factors of malnutrition three months after gastrectomy in patients with gastric cancer. The model yields greater prediction accuracy of the risk of three-month-postoperative malnutrition in patients with gastric cancer, helps screen high-risk patients, formulates targeted nutritional prescriptions early, and improves the overall prognosis of patients.
Collapse
Affiliation(s)
- Tian Dai
- Department of General Surgery (Ward one), the Second Hospital of Anhui Medical University, Hefei, China
| | - Dequan Wu
- Nursing Department, the Second Hospital of Anhui Medical University, Hefei, China
| | - Jingjing Tang
- Department of General Surgery (Ward one), the Second Hospital of Anhui Medical University, Hefei, China
| | - Zeyan Liu
- Emergency Internal Medicine, the Second Hospital of Anhui Medical University, Hefei, China
| | - Miao Zhang
- Nursing Department, the Second Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
|
11
|
Is an Early Resumption of a Regular Diet After Laparoscopic Roux-en-Y Gastric Bypass Safe? Obes Surg 2022; 32:3375-3383. [PMID: 35913602 PMCID: PMC9532321 DOI: 10.1007/s11695-022-06224-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022]
Abstract
Background
Return to a normal diet is a crucial step after bariatric surgery. Proximal anastomosis is a source of concern for early feeding as the passage of solid food through a recent anastomosis could well increase pressure and the risk of leakage. This study aims to assess the safety of an early normal diet after a laparoscopic Roux-en-Y gastric bypass (LRYGB). Materials and Methods All consecutive patients undergoing primary LRYGB between January 2015 and December 2020 were included prospectively. Three postoperative pureed diets were compared at 4 weeks, 2 weeks, and 1 week. All-cause morbidity at 90 days was the main outcome. Overall complications, severe complications (Clavien-Dindo ≥ grade 3a), length of hospital stay, number of emergency, and unplanned consultations during the 3 postoperative months were recorded for each group. Results Three hundred and sixty-seven patients with a mean BMI of 42.10 kg/m2 (± SD: 4.78) were included. All-cause morbidity at 90 days was 11.7% (43/367) and no significant difference was observed between the 3 groups. Adjustment for patients and operative cofounders did not demonstrate any increased risk of postoperative complications between the 3 groups, with an odds ratio of 1, 1.23(95% CI [0. 55–2.75]), and 1.14 (95% CI [0.49, 2.67]) for groups 1, 2, and 3 respectively. Severe complications (Clavien-Dindo ≥ grade 3a) and emergency or unplanned consultations were also similar in the 3 groups. Conclusion Return to a normal diet 1 week after LRYGB did not increase short-term morbidity and unplanned consultations. It may be safe and contribute to patient comfort. Graphical abstract ![]()
Collapse
|
|
12
|
Zhao X, Liu J, Wang Y, Yang Y, Pan Y, Ge S. Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study. Appl Bionics Biomech 2022; 2022:8263986. [PMID: 35694276 PMCID: PMC9187457 DOI: 10.1155/2022/8263986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer patients. The study is aimed at investigating the prevalence of malnutrition, perioperative nutritional support, and the risk factors associated with delayed discharge of geriatric patients undergoing gastrectomy. Methods A retrospective study of gastric cancer patients (age ≥ 65) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management, were collected and analyzed. Postoperative complications were assessed according to the Clavien-Dindo grading system, and the prognostic nutritional index (PNI) was calculated. The risk factors affecting the prolongation of postoperative hospital stay were analyzed. Results A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The albumin, prealbumin, and hemoglobin levels were lower in the malnutrition group than in the well-nourished group. The proportion of patients who received preoperative total parenteral nutritional support in the malnutrition group was significantly higher than in the well-nourished group (12.4% vs. 3.7%, P < 0.001). All patients received postoperative parenteral nutrition (PN); the proportion of patients who received total nutrient admixture (TNA) in the malnutrition group was lower than in the well-nourished group (22.1% vs. 33.5%, P = 0.001). No significant difference was found in the duration of postoperative nutrition between groups (P > 0.05). The malnutrition group was associated with a higher rate of postoperative complications (P < 0.001). Univariate and multivariate regressions revealed that age > 70 years (OR = 1.216, 95% CI 1.048-1.411, P = 0.010), operation time > 180 min (OR = 1.431, 95% CI 1.237-1.656, P < 0.001), PNI < 44.5 (OR = 1.792, 95% CI 1.058-3.032, P = 0.030), and postoperative complications (OR = 2.191, 95% CI 1.604-2.991, P < 0.001) were significant risk factors associated with delayed discharge. Conclusion Malnutrition is relatively common in elderly patients undergoing gastrectomy. Advanced age, duration of surgery, lower levels of PNI, and postoperative complications were risk factors associated with delay discharge. Elderly gastric cancer patients with risk factors urgently require specific attention for reducing hospital stay.
Collapse
Affiliation(s)
- Xining Zhao
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Jie Liu
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Ying Wang
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Yuying Yang
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Yan Pan
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Shengjin Ge
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| |
Collapse
|
|
13
|
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: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [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
|
|
14
|
Hu Y, Hsu AW, Strong VE. Enhanced Recovery After Major Gastrectomy for Cancer. Ann Surg Oncol 2021; 28:6947-6954. [PMID: 33826004 DOI: 10.1245/s10434-021-09906-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/11/2021] [Indexed: 12/13/2022]
Abstract
Enhanced recovery after surgery (ERAS) protocols have gained increasing popularity over the past 10 years, and its overarching objectives are to improve perioperative morbidity and reduce postoperative length of stay. Consensus guidelines from the ERAS Society specific to major gastrectomy were published in 2014, however since that time, prospective and retrospective studies have expanded the collective evidence for both the content and efficacy of ERAS pathways for gastrectomy. This objective of this review was to summarize recent data pertinent to the preoperative, perioperative, and postoperative management of gastrectomy patients along an ERAS pathway.
Collapse
Affiliation(s)
- Yinin Hu
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, MD, USA
| | - Annie W Hsu
- Division of Pain Medicine and Pain Research, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vivian E Strong
- Division of Gastric and Mixed Tumors, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|