Patient‐controlled Dietary Schedule Improves Clinical Outcome after Gastrectomy for Gastric Cancer

Abstract

Although studies have shown that early oral feeding after abdominal surgery is feasible, the optimal dietary schedule has not been established. This study was conducted prospectively to compare the clinical outcome of patient-controlled dietary schedule with that of conventional dietary schedule after gastric resection for early cancer. Patients in the patient-controlled diet (PC) group (n = 53) received a solid diet on demand; patients in the conventional regimen (CR) group (n = 50) received a solid diet from postoperative day (POD) 10. All patients underwent distal gastrectomy for early gastric cancer. A liquid diet was tolerated by the PC group on POD 2, and a solid diet was taken on POD 6 after gastrectomy, earlier than in the CR group. The postoperative hospital stay was 18.5 +/- 5.9 days (10-40) in the PC group, versus 21.7 +/- 8.8 days (14-57) in the CR group (p = 0.02). Patients in the PC group had a higher daily oral intake of calories on POD 10 than those in the CR group (p = 0.02). Changes in body weight and serum albumin during the postoperative period and after discharge, and the incidence of complications and variances from clinical pathways did not show significant differences between the two groups. The PC schedule was feasible after distal gastrectomy for early gastric cancer. It improved the clinical outcome, with a shorter postoperative hospital stay and a higher oral energy intake on early phase, compared with the CR schedule. Moreover, the PC approach was useful for establishing the optimal dietary schedule and improving the clinical pathway.

The safety and feasibility of early postoperative oral nutrition on the first postoperative day after gastrectomy for gastric carcinoma

“…In 2004, Suehiro et al [13] first reported early oral feeding within 48 h of gastrectomy reduced hospital stay as compared with conventional postoperative fasting; postoperative morbidities and mortalities, including nausea, vomiting, anastomotic leakage, and wound infections were similar in their two groups. In 2005, Hirao et al [12] introduced the ''patient-controlled diet schedule'' for patients that undergo gastrectomy, according to which a solid diet is supplied on patient demand from the third postoperative day. As compared with a fixed diet regimen requiring that a solid diet be started on the 10th postoperative day, patients showed shorter hospital stays and no increase in morbidity or mortality.…”

“…Furthermore, proponents of traditional postoperative fasting after gastrectomy often cite concerns of anastomosis safety and aspiration pneumonia. Recently, small retrospective studies [12,13] and a randomized controlled trial [14] have found that early oral nutrition after gastrectomy is both beneficial and feasible. However, few studies have examined an immediate oral nutrition starting on the first postoperative day after gastrectomy.…”

Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancer

“…Dietitians, clinicians, and nurse clinicians are all involved. Prior to surgery, patients receive a high-protein diet with supplements whenever possible, as early satiety and malnutrition are common after gastrectomy [13]. Upon discharge from surgery, detailed counseling and visual information on diet are given to patients and their families.…”

General perioperative management of gastric cancer patients at high-volume centers

“…Although many studies have shown that early oral feeding is feasible after gastrectomy, the optimal dietary schedule has not been established [14,15]. Traditionally, postoperative oral intake after abdominal surgery was slowly and carefully introduced, due to anstomotic leakage and postoperative paralytic ileus.…”