Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2021; 13(7): 717-733
Published online Jul 27, 2021. doi: 10.4240/wjgs.v13.i7.717
Efficacy and safety of early oral feeding in postoperative patients with upper gastrointestinal tumor: A systematic review and meta-analysis
Tao Hao, Qian Liu, Xin Lv, Jun Qiu, Hao-Ran Zhang, Hai-Ping Jiang
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, Jun Qiu, Hao-Ran Zhang, Hai-Ping Jiang, Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China
Author contributions: Hao T and Jiang HP conceived and designed the updated meta-analysis; Hao T, Qiu J and Zhang HR carried out the literature search, data extraction and statistical analysis, and drafted the manuscript; Liu Q, Lv X and Jiang HP were responsible for the retrieval strategy and assessment of the risk of bias, and provided critical supervision and revision of this article; all authors conducted detailed review and revision of the data and approved the final version of the manuscript.
Supported by Danone Nutrition Research and Education Foundation, No. DIC2020-03.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: All authors have read the PRISMA 2009 Checklist, and the manuscript was carefully prepared and revised based on the PRISMA 2009 Checklist.
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:
Corresponding author: Hai-Ping Jiang, MD, Chief Doctor, Professor, Surgeon, Department of General Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road, Tianhe District, Guangzhou 510632, Guangdong Province, China.
Received: March 29, 2021
Peer-review started: March 29, 2021
First decision: May 28, 2021
Revised: June 4, 2021
Accepted: June 22, 2021
Article in press: June 22, 2021
Published online: July 27, 2021
Research background

Early oral feeding (EOF) has emerged as a safe and effective postoperative strategy for improving clinical outcomes in patients with lower gastrointestinal tumor. However, controversies exist with regard to EOF practice in postoperative patients with upper gastrointestinal tumor.

Research motivation

The purpose of this systematic and meta-analysis was to evaluate the role and importance of EOF in postoperative patients with upper gastrointestinal tumor.

Research objectives

By comparing the safety and efficacy of EOF and TOF, it provided a valuable evidence and safe choice for early rehabilitation of patients in the future.

Research methods

PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases were searched up to December 2020 for all available randomized controlled trials (RCTs) comparing EOF and traditional oral feeding (TOF) of postoperative patients with upper gastrointestinal tumors. Fifteen RCTs, with a total of 2100 participants, were analyzed in this study, of whom 1042 underwent EOF and 1058 TOF protocols.

Research results

In the meta-analysis of postoperative pneumonia and anastomotic leak, there was no significant heterogeneity (I2 = 0%); therefore, a fixed-effect model was applied. A significantly lower risk of pneumonia was presented (RR = 0.63, 95%CI: 0.44–0.89, P = 0.01). In the meta-analysis of postoperative exhaust time, there was significant heterogeneity among the studies (I2 = 87%). But, after eliminating the studies that did not directly provide mean ± SD and those with high risk bias, the remaining data after combined analysis showed no significant heterogeneity (I2 = 31%), and the results suggested that the EOF group could significantly shorten the exhaust time (WMD = 0.71, 95%CI: 0.80-0.63; P < 0.01). No significant heterogeneity was present in CD4 cell count and CD4/CD8 cell ratio results on POD7: CD4 count (I2 = 48%,), CD4/CD8 (I2 = 33%); accordingly, a fixed-effect model was applied. On POD7, CD4 count and CD4/CD8 in the EOF group were significantly higher than those 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).

Research conclusions

Our unit has been committed to early postoperative rehabilitation for more than 10 years. According to our experience, this meta-analysis is consistent with the clinical situation; therefore, we suggest that EOF can be used for patients with upper gastrointestinal tumors after surgery.

Research perspectives

Early recovery after surgery has always been an important point for patients with gastrointestinal tumors. The present updated meta-analysis and systematic review demonstrate that application of EOF after esophageal and gastric cancer surgery is safe and effective. We consider that choosing appropriate patients and precise surgical operations will help the implementation of EOF. Additionally, we should conduct further high-quality, large-sample and multicenter RCTs with long-term follow-up.