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

Table 1 Dietary protocol of the early oral feeding group

Time point	Protocol
Day of surgery	Attempt to drink warm water (< 50 mL/h) 6 h after surgery was encouraged
Postoperative day 1	Total oral fluid intake increased up to 500 mL, enteral nutrition preparation was given
Postoperative day 2	Total oral fluid intake increased up to 1000 mL, liquid diet (such as small amounts of rice soup) started
Postoperative day 3	Total oral fluid intake increased up to 1500 mL gradually, intravenous fluid volume gradually reduced
Postoperative day 4	Frequent small amounts of oral fluids, small amounts of semi-liquid foods (such as porridge, noodles or other soft foods), intravenous fluids stopped if possible
Postoperative day 5	Frequent small amounts of oral fluids with gradual transition to total semi-liquid diet and soft foods

Table 2 Baseline data of the two groups

Baseline data	EOF group, n = 105	Control group, n = 101	t value	P value
Gender, male/female, n	88/17	86/15	0.005	0.942
Age, yr	61.69 ± 10.80	61.36 ± 11.72	1.387	0.167
BMI, kg/m2	22.86 ± 4.70	23.15 ± 4.32	-0.797	0.426
NRS-2002 score , < 3 or ≥ 3, n	41/64	38/63	0.034	0.872
Preoperative serum PALB, mg/L	227.50 ± 28.20	225.41 ± 23.60	1.269	0.264
Preoperative serum ALB, g/L	39.24 ± 4.36	38.58 ± 3.85	1.833	0.076
Preoperative serum gastrin, ng/L	212.40 ± 57.50	211.70 ± 53.80	1.512	0.134
Preoperative serum motilin, ng/L	358.40 ± 67.10	360.20 ± 68.70	-1.946	0.071
Operating time, min	228.70 ± 31.20	225.90 ± 29.47	1.228	0.219
Blood loss, mL	155.68 ± 51.35	152.85 ± 52.46	1.294	0.211
Pathological stage, n (%)			0.014	0.913
Stage I	13 (12.38)	11 (10.89)
Stage II	48 (45.71)	45 (44.55)
Stage III	44 (41.91)	45 (44.55)
Differentiation, n (%)			0.008	0.930
Poor	52 (49.52)	33 (49.25)
Moderate	36 (34.29)	23 (34.33)
Well	17 (16.19)	11 (16.42)
Borrmann types, n (%)			0.221	0.694
I	8 (7.62)	9 (8.91)
II	34 (32.38)	33 (32.67)
III	47 (44.76)	45 (44.56)
IV	16 (15.24)	14 (13.86)
Lauren types, n (%)			0.675	0.407
Intestinal type	81 (77.14)	74 (73.27)
Diffuse type	24 (22.86)	27 (26.73)

EOF: Early oral feeding; BMI: Body mass index; NRS: Nutritional risk screening; PALB: Prealbumin; ALB: Albumin.

Table 3 Comparison of postoperative clinical data between the two groups

Group	EOF group, n = 105	Control group, n = 101	t value	P value
Postoperative gastrointestinal function recovery
First exhaust time, d	2.48 ± 1.17	3.37 ± 1.42	-63;4.46	0.001
First defecation time, d	3.83 ± 2.41	5.32 ± 2.70	-63;3.76	0.004
Postoperative hospitalization and expenses
Postoperative hospital stay, d	5.85 ± 1.53	7.71 ± 1.56	-63;5.32	< 0.001
Hospitalization expenses, K¥	16.60 ± 5.10	21.00 ± 7.50	-63;3.55	0.014
Postoperative nutritional status on the 5th day after surgery
Postoperative PALB, mg/L	214.52 ± 22.47	204.17 ± 20.62	2.85	0.018
Postoperative ALB, g/L	36.24 ± 5.93	35.16 ± 4.78	1.744	0.079
Postoperative gastrointestinal hormone level on the 5th day after surgery
Postoperative serum gastrin, ng/L	246.30 ± 57.10	223.60 ± 55.70	7.405	0.001
Postoperative serum motilin, ng/L	424.60 ± 68.30	409.30 ± 61.70	6.946	0.002
Tolerance of oral feeding after surgery
Abdominal distension	8	6
Postoperative nausea	10	9
Reinsertion of nasogastric tube1	4	3
Total, %	22 (20.95)	18 (17.82)	0.664	0.507

¹Annotation: Patients with abdominal distension or nausea and reinsertion of nasogastric tube. EOF: Early oral feeding; PALB: Prealbumin; ALB: Albumin.

Table 4 Comparison of postoperative complications between the two groups

Group	EOF group, n = 105	Control group, n = 101	t value	P value
Postoperative complications
Anastomotic bleeding	1	2
Anastomotic or duodenal stump fistula	3	1
Wound infection	4	5
Postoperative pneumonia	3	4
Postoperative ileus	2	1
Others1	5	2
Total, %	18 (17.14)	15 (14.85)	0.422	0.609

¹Annotation: Patients had more than one postoperative complication. EOF: Early oral feeding.

Table 5 Univariate analysis of factors affecting the first exhaust time

Index	OR	95%CI	P value
Age, yr, < 60 or ≥ 60	0.477	0.187-1.221	0.123
Gender, male or female	0.764	0.241-1.165	0.653
BMI, kg/m2, < 24 or ≥ 24	0.236	0.116-0.489	0.006
TNM stage, I or II or III	0.784	0.513-1.148	0.242
Differentiation, poor, moderate, well	0.899	0.543-1.256	0.308
Operation time, min, < 180 or ≥ 180	0.581	0.355-0.953	0.042
Blood loss, mL, < mean or ≥ mean	1.210	0.884-1.597	0.762
Early oral feeding, yes or no	3.862	1.840-9.624	0.000
Postoperative serum gastrin, ng/L, < mean or ≥ mean	0.253	0.151-0.357	0.000
Postoperative serum motilin, ng/L, < mean or ≥ mean	0.630	0.214-1.107	0.163

OR: Odds ratio; CI: Confidence interval; BMI: Body mass index; TNM: Tumor node metastasis.

Table 6 Multivariate analysis of factors affecting the first exhaust time

Index	OR	95%CI	P value
BMI, kg/m2, < 24 or ≥ 24	1.060	0.649-1.733	0.081
Operation time, min, < 180 or ≥ 180	1.519	0.578-3.990	0.396
Early oral feeding, yes or no	2.689	1.289-3.783	< 0.001
Postoperative serum gastrin, ng/L, < mean or ≥ mean	0.476	0.195-1.162	0.103

OR: Odds ratio; CI: Confidence interval; BMI: Body mass index.