Faster recovery and bowel movement after early oral feeding compared to late oral feeding after upper GI tumor resections: a meta-analysis

Dóra Lili Sindler; Péter Mátrai; Lajos Szakó; Dávid Berki; Gergő Berke; Armand Csontos; Csenge Papp; Péter Hegyi; András Papp

doi:10.3389/fsurg.2023.1092303

Faster recovery and bowel movement after early oral feeding compared to late oral feeding after upper GI tumor resections: a meta-analysis

Front Surg. 2023 May 25:10:1092303. doi: 10.3389/fsurg.2023.1092303. eCollection 2023.

Authors

Dóra Lili Sindler¹, Péter Mátrai², Lajos Szakó^{2

3

4}, Dávid Berki⁵, Gergő Berke², Armand Csontos^{1

2}, Csenge Papp¹, Péter Hegyi^{2

6

7

8}, András Papp¹

Affiliations

¹ Department of Surgery, Clinical Center, Medical School, University of Pécs, Pécs, Hungary.
² Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
³ János Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.
⁴ Department of Emergency Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁵ First Department of Surgery, Military Hospital Medical Centre, Hungarian Defense Forces, Budapest, Hungary.
⁶ First Department of Medicine, Medical School, University of Szeged, Szeged, Hungary.
⁷ Hungary Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁸ Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.

Abstract

Background: There were more than 1 million new cases of stomach cancer concerning oesophageal cancer, there were more than 600,000 new cases of oesophageal cancer in 2020. After a successful resection in these cases, the role of early oral feeding (EOF) was questionable, due to the possibility of fatal anastomosis leakage. It is still debated whether EOF is more advantageous compared to late oral feeding. Our study aimed to compare the effect of early postoperative oral feeding and late oral feeding after upper gastrointestinal resections due to malignancy.

Methods: Two authors performed an extensive search and selection of articles independently to identify randomized control trials (RCT) of the question of interest. Statistical analyses were performed including mean difference, odds ratio with 95% confidence intervals, statistical heterogeneity, and statistical publication bias, to identify potential significant differences. The Risk of Bias and the quality of evidence were estimated.

Results: We identified 6 relevant RCTs, which included 703 patients. The appearance of the first gas (MD = -1.16; p = 0.009), first defecation (MD = -0.91; p < 0.001), and the length of hospitalization (MD = -1.92; p = 0.008) favored the EOF group. Numerous binary outcomes were defined, but significant difference was not verified in the case of anastomosis insufficiency (p = 0.98), pneumonia (p = 0.88), wound infection (p = 0.48), bleeding (p = 0.52), rehospitalization (p = 0.23), rehospitalization to the intensive care unit (ICU) (p = 0.46), gastrointestinal paresis (p = 0.66), ascites (p = 0.45).

Conclusion: Early postoperative oral feeding, compared to late oral feeding has no risk of several possible postoperative morbidities after upper GI surgeries, but has several advantageous effects on a patient's recovery.

Systematic review registration: identifier, CRD 42022302594.

Keywords: Eras; early oral feeding (EOF); meta-analysis; upper GI cancer; upper GI surgery.

Publication types

Review