Feasibility and Outcomes of Early Oral Feeding After Total Gastrectomy for Cancer

Abstract

BackgroundLittle data are available supporting the feasibility and safety of early oral feeding in patients after total gastrectomy. The aim of this study was to analyze the potential applicability of early provision of oral diet in these settings.MethodsMedical records of 353 patients who underwent total gastrectomy for gastric cancer between 2006 and 2012 were retrospectively analyzed. Early oral feeding was defined as clear liquid diet on postoperative day (POD) 1 followed by gradual introduction of solid diet on POD 2 to 3. Late oral feeding was defined as initiation of liquid diet from POD 4 to 6 and gradually advancing to solid diets.ResultsEarly oral feeding was implemented in 185 of 353 (52 %) patients. Prompt provision of food did not increase the risk of anastomotic failure (odds ratio 0.924, 95 % confidence interval 0.609–1.402, P = 0.709). The number of reoperations and in-hospital mortality rates was unaffected by the timing of nutritional intervention. Early feeding tended to be associated with fewer surgical (15 vs 24 %, P = 0.027) and general (8 vs 23 %, P < 0.001) complications. However, subsequent multivariate regression models failed to confirm significant correlations between timing of oral meals and postoperative morbidity.ConclusionOur findings suggested that early oral feeding is feasible and safe after total gastrectomy for gastric cancer. However, benefits of such early nutritional interventions require further studies.

Patterns and Predictors of Weight Loss After Gastrectomy for Cancer

“…In other series, substantial postoperative weight loss is associated with a lower likelihood of continuation of systemic chemotherapy and worse overall outcome. 7,15 A study of weight loss after gastrectomy by Lee and colleagues aimed to evaluate the association of weight loss with disease recurrence and survival. 8 The majority of patients underwent subtotal gastrectomy (71.9 %) for Stage I (59.3 %) gastric cancer.…”

“…Because the routine use of feeding tubes is not supported by prospective data and may be harmful, we place them only after a complication that prevents oral feeding. 4,5,15,16 Following gastrectomy, concerns about postoperative weight loss and nutritional deficits are motivating factors for the continued study of early postoperative enteral or parenteral nutrition. Our data suggest that not only can we predict significant postoperative weight loss based on the planned operation and baseline BMI, but also that the routine use of enteral feeding tubes is unnecessary.…”

Early Postoperative Oral Feeding After Total Gastrectomy in Gastric Carcinoma Patients: A Retrospective Before–After Study Using Propensity Score Matching

“…In 2013, Feng et al conducted the first RCT in patients undergoing total gastrectomy and demonstrated that ERAS including early oral nutrition could reduce morbidity and hospital stay. Subsequently, Sierzega et al demonstrated the advantages of early oral nutrition, including reduced hospital stay, in their retrospective analysis of 353 patients undergoing total gastrectomy. Our study provides reinforcing evidence that early oral nutrition may be safe and feasible in the subset of gastric cancer patients undergoing total gastrectomy.…”

“…According to a recent meta‐analysis of 6 RCTs of gastric cancer surgery and a combined meta‐analysis of 15 RCTs and non‐RCTs of upper gastrointestinal surgery, early oral feeding (EOF) reduced the length of hospital stay and bowel recovery time, without increasing postoperative complications in patients undergoing gastrectomy. However, previous studies mostly focused on early oral nutrition after partial gastrectomy, and information on early oral nutrition after total gastrectomy is limited . Therefore, further investigation is required to demonstrate the safety and feasibility of early oral nutrition after total gastrectomy for gastric carcinoma.…”

Decreased length of stay and earlier oral feeding associated with standardized postoperative clinical care for total gastrectomies at a cancer center

“…Several recent publications 14–19 have described single institutional experiences with care pathways for gastric surgery patients. With the exception of a single report on total gastrectomies that showed a high rate of non compliance from clinical care pathways 18 , most reports describe decreases in length of stay following institution of standardized post-operative care.…”