Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2020; 26(36): 5508-5519
Published online Sep 28, 2020. doi: 10.3748/wjg.v26.i36.5508
Effects of early oral feeding after radical total gastrectomy in gastric cancer patients
Yi-Xun Lu, Yan-Jun Wang, Tian-Yu Xie, Shuo Li, Di Wu, Xiong-Guang Li, Qi-Ying Song, Li-Peng Wang, Da Guan, Xin-Xin Wang
Yi-Xun Lu, Tian-Yu Xie, Shuo Li, Di Wu, Xiong-Guang Li, Qi-Ying Song, Li-Peng Wang, Da Guan, Xin-Xin Wang, 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
Author contributions: Lu YX, Wang Y-J and Xie TY contributed equally to this paper; Lu YX and Wang XX designed the research; Li S, Wu D, Li XG, Song QY, Wang LP and Guan D performed the research and collected the data; Wang YJ analyzed the data; Lu YX and Xie TY drafted the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Chinese PLA General Hospital (No. 2017-094).
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any conflict of interest disclosures to make.
Data sharing statement: There is no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xin-Xin Wang, MD, Associate Professor, Department of General Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. 301wxx@sina.com
Received: May 12, 2020
Peer-review started: May 12, 2020
First decision: May 29, 2020
Revised: June 10, 2020
Accepted: August 29, 2020
Article in press: August 29, 2020
Published online: September 28, 2020
Processing time: 134 Days and 19.8 Hours
ARTICLE HIGHLIGHTS
Research background

Gastric cancer (GC) is a heavy burden in China. Nutritional support of GC patients is closely related to postoperative rehabilitation. However, the role of early oral feeding (EOF) after laparoscopic radical total gastrectomy in GC patients is still unclear.

Research motivation

To prospectively explore the safety, feasibility and short-term clinical outcomes of EOF after laparoscopic radical total gastrectomy for GC patients.

Research objectives

The aim of this study was to study the role of EOF after laparoscopic radical total gastrectomy.

Research methods

A prospective cohort study was conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China. Two hundred and six patients who underwent laparoscopic radical total gastrectomy for GC were enrolled. Of which, 105 patients were given EOF (EOF group) after surgery, and the other 101 patients were given traditional feeding strategy (control group) after surgery. Perioperative data were collected. 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.

Research 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). The EOF group had a significantly shorter postoperative hospitalization duration (5.85 ± 1.53 d vs 7.71 ± 1.56 d, P < 0.001) and fewer 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 incidence of total postoperative complications between the two groups (P = 0.609).

Research conclusions

EOF 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 the safety, feasibility and potential benefits of EOF for GC patients.

Research perspectives

In this study, we proved the safety, feasibility and potential benefits of EOF for GC patients after laparoscopic radical total gastrectomy. Considering the limitations of this study, multicenter prospective randomized controlled trials with a large sample size are expected to further validate the conclusions of this study.