Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis

Abstract

Early postoperative enteral nutrition (EN) after esophagectomy in esophageal cancer patient has been reported to be correlated with a better rehabilitation than parenteral nutrition (PN). However, a robust conclusion has not been achieved. Therefore, we performed a meta-analysis to compare the postoperative EN and PN in patients with esophageal cancer undergoing esophagectomy. Three electronic databases were searched for eligible studies to be included in the meta-analysis. The summary relative risk/weighted mean difference (RR/WMD) estimates and corresponding 95% confidence interval (CI) were calculated using fixed- and random-effects models. Ten studies met the inclusion criteria. The analysis demonstrated that the early postoperative EN could significantly decrease the pulmonary complications (RR = 0.37, 95% CI = 0.22-0.62, P = 0.00, test for heterogeneity: I(2) = 0.0%, P = 0.89) and anastomotic leakage (RR = 0.46, 95% CI = 0.22-0.96, P = 0.04, test for heterogeneity: I(2) = 0.0%, P = 0.66) compared with PN. On the eighth postoperative day, the EN group had a higher levels of albumin (WMD = 1.84, 95% CI = 0.47-3.21, P = 0.01, test for heterogeneity: I(2) = 84.5%, P = 0.00) and prealbumin (WMD = 12.96, 95% CI = 3.63-22.29, P = 0.01, test for heterogeneity: I(2) = 0.0%, P = 0.63) compared with the PN group. However, there was no difference in digestive complications between these two approaches (RR = 1.30, 95% CI = 0.79-2.13, P = 0.30, test for heterogeneity: I(2) = 0.0%, P = 0.97). For patients with esophageal cancer following esophagectomy, the early postoperative EN support could decrease the morbidity of severe complications, such as pulmonary complications and anastomotic leakage, and maintain patients at a better nutritional status than parenteral nutrion support.

Nutritional Management of Esophageal Cancer Patients

“…No difference was observed in digestive complications between these two approaches. However, this meta-analysis is characterized by heterogeneity issues, especially regarding the postoperative nutritional status [70]. Furthermore, others suggest that combination of enteral and parenteral feeding is more beneficial, since total parenteral nutrition (TPN) could lead to hyperglycemia in stressed patients.…”

Prognostic Impact of Postoperative Complications following Salvage Esophagectomy for Esophageal Cancer after Definitive Chemoradiotherapy

“…However, in this study, we could not find any association between preservation of the bronchial arteries and postoperative complications. Regarding perioperative management, preoperative respiratory rehabilitation [22], oral care [23], smoking cessation [24], early enteral nutrition after surgery [25], and use of corticosteroids [26] or sivelestat sodium hydrate [27,28] are possible ways to prevent postoperative complications. Cox proportional-hazards models were used for the univariate and multivariate analyses of overall survival in the 73 patients who underwent salvage esophagectomy.…”

Routes of early enteral nutrition following oesophagectomy

“…Table 3 summarises studies on EN after oesophagectomy. 3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Although the use of EN is not without its disadvantages, the benefits outweigh the risks. Early EN was compared with delayed nutrition by Wang et al, and was found to be associated with a short LOS, fewer incidences of pneumonia and better nutrition outcomes.…”

“…3 Early EN has been found to decrease the length of hospital stay (LOS) and lead to a better outcome than parenteral nutrition (PN), in addition to reducing the total cost of patient care. 4,5 Early EN following oesophagectomy is usually maintained via a nasojejunal tube (NJT), a jejunostomy tube (JT) or a pharyngostomy tube (PT). The use of a NJT for EN after oesophagectomy was first reported by Page et al; however, this method was compared only with PN.…”