Tweed Thaís, van Eijden Yara, Tegels Juul, Brenkman Hylke, Ruurda Jelle, van Hillegersberg Richard, Sosef Meindert, Stoot Jan
Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands.
Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands.
Surg Oncol. 2019 Mar;28:88-95. doi: 10.1016/j.suronc.2018.11.017. Epub 2018 Nov 19.
Early oral feeding (EOF) is believed to be a crucial item of Enhanced Recovery After Surgery (ERAS) programs. Though this is widely accepted for colorectal surgery, evidence for early oral feeding after gastrectomy is scarce. The aim of this review is to assess the evidence of safety and benefits of early oral feeding after gastrectomy in patients with gastric cancer.
A systematic literature search of Pubmed, Embase and Cochrane was performed for eligible studies published till September 2018. Studies were analyzed and selected by predetermined criteria.
After having assessed 23 eligible articles, a total of four randomized controlled trials (RCT) remained who fully met all requirements to be included in this review. All four RCTs compared early oral feeding (n = 320) with conventional care (n = 334) after gastrectomy. In all four studies, EOF was associated with a decreased length of hospital stay ranging from -1.3 to -2.5 days when compared to conventional care. A faster time to first flatus was recorded in all four studies in the EOF group, ranging from -6.5 hours to -1.5 days. Furthermore, EOF does not increase postoperative complication risk when compared to conventional care.
Current evidence for early oral feeding after gastrectomy is promising, proving its safety, feasibility and benefits. However, most studies have been conducted amongst an Asian population. Well powered and larger randomized controlled trials performed amongst a Western population is needed.
早期经口进食（EOF）被认为是术后加速康复（ERAS）计划的关键项目。尽管这在结直肠癌手术中已被广泛接受，但关于胃癌根治术后早期经口进食的证据却很少。本综述的目的是评估胃癌患者胃癌根治术后早期经口进食的安全性和益处的证据。
对PubMed、Embase和Cochrane进行系统文献检索，以查找截至2018年9月发表的符合条件的研究。根据预定标准对研究进行分析和筛选。
在评估了23篇符合条件的文章后，共有四项随机对照试验（RCT）完全符合纳入本综述的所有要求。所有四项RCT均比较了胃癌根治术后早期经口进食（n = 320）与传统护理（n = 334）的效果。在所有四项研究中，与传统护理相比，早期经口进食使住院时间缩短了1.3至2.5天。在所有四项研究中，早期经口进食组首次排气时间均更快，缩短了6.5小时至1.5天。此外，与传统护理相比，早期经口进食不会增加术后并发症风险。
目前关于胃癌根治术后早期经口进食的证据很有前景，证明了其安全性、可行性和益处。然而，大多数研究是在亚洲人群中进行的。需要在西方人群中进行更有力、更大规模的随机对照试验。
