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Impact of Early Oral Feeding on Anastomotic Leakage Rate After Esophagectomy: A Systematic Review and Meta-analysis

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Abstract

Background

Esophageal cancer occupies a vital position in fatal cancer-related disease, with esophagectomy procedures helping to improve patient survival. The timing when oral intake should be resumed after esophagectomy and whether early oral feeding (EOF) or delayed oral feeding (DOF) should be the optimal regimen are controversial.

Methods

Databases (PubMed, Embase, Cochrane library) were searched. All records were screened by two authors through full-text reading. Data on the anastomotic leakage rate were extracted and synthesized in meta-analyses. Postoperative pneumonia rate and length of hospital stay were also assessed.

Results

Seven studies from 49 records were included after full-text reading; 1595 patients were totally included in the analysis. No significant difference was observed between the EOF and DOF groups (odds ratio [OR] 1.68; 95% confidence interval [CI] 0.70–4.03; p = 0.2495; I2 = 70%). Higher anastomotic leakage rate was observed in EOF compared with DOF (OR 2.89; 95% CI 1.56–5.34; p = 0.0007; I2 = 10%) in the open subgroup. No significant difference was observed in the MIE (OR 0.48; 95% CI 0.22–1.02; p = 0.0564; I2 = 0%). Patients performed similarly in pneumonia (OR 1.12; 95% CI 0.57–2.21; p = 0.745; I2 = 34%). In cervical subgroup, anastomosis leakage may be less in DOF (OR 2.42 95% CI 1.26–4.64; p = 0.0651; I2 = 58%), while in thoracic subgroup, there is no obvious difference (OR 0.86 95% CI 0.46–1.61; p = 0.01; I2 = 84.9%).

Conclusions

Anastomotic leakage related to the timing of oral feeding after open esophagectomy, which is more favorable to the DOF regimen. However, timing of oral feeding did not impair anastomotic healing in patients undergoing MIE.

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Funding

This work was supported by the National Key R&D Program of China (No. 2018YFC0910700), Beijing Municipal Science & Technology Commission (No. Z161100000516063), Beijing Human Resources and Social Security Bureau (Beijing Millions of Talents Project, 2018A05), Beijing Municipal Administration of Hospitals' Youth Programme (QMS20191107), National Natural Science Foundation of China (No. 81972842), Beijing Natural Science Foundation (No. 7192036).

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Author notes

  1. Xiang Li and Shi Yan have contributed equally to this work.

Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, No. 52, Fucheng Avenue, Haidian District, Beijing, 100142, China

    Xiang Li, Shi Yan, Yuanyuan Ma, Shaolei Li, Yaqi Wang, Xing Wang, Yuzhao Wang, Jia Wang, Chao Lv, Yue Yang & Nan Wu

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  1. Xiang Li
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  2. Shi Yan
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Correspondence to Nan Wu.

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Li, X., Yan, S., Ma, Y. et al. Impact of Early Oral Feeding on Anastomotic Leakage Rate After Esophagectomy: A Systematic Review and Meta-analysis. World J Surg 44, 2709–2718 (2020). https://doi.org/10.1007/s00268-020-05489-z

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