Liu Li, Wang Yu-Cui, Liu Qian-Wen, Zhong Jiu-di, Li Jin-Bo, Wu Xiao-Dan, Qin Hui-Ying
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine.
Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Medicine (Baltimore). 2020 Sep 4;99(36):e21988. doi: 10.1097/MD.0000000000021988.
Not only has the placement rate of enteral feeding tubes during operations for esophageal cancer increased, but also has number of patients who choose to continue enteral feeding at home instead of removing the feeding tube at discharge. The impacts of home enteral nutrition (HEN) after esophagectomy in esophageal cancer patients are analyzed.
A systematic review was conducted in accordance with PRISMA and Cochrane guidelines. English and Chinese databases, including PubMed, Embase, Web of Science, The Cochrane Library, Scopus, CBM, CNKI, and Wan Fang were searched from inception to December 7, 2019. Randomized controlled trials evaluating the short-term outcomes of HEN following esophagectomy in cancer patients were included. The risk of bias of the included studies was appraised according to the Cochrane risk of bias tool. The summary of relative risk/weighted mean difference (WMD) estimates and corresponding 95% confidence interval (95% CI) were calculated using fixed- and random-effects models.
Nine randomized controlled trials involving 757 patients were included in the meta-analysis. Compared with oral diet, HEN was associated with significantly increased body weight (WMD 3 kg, 95% CI 2.36-3.63, P < .001), body mass index (WMD 0.97 kg/m, 95% CI 0.74-1.21, P < .001), albumin (WMD 3.43 g/L, 95% CI 2.35-4.52, P < .001), hemoglobin (WMD 7.23 g/L, 95% CI 5.87-8.59, P < .001), and total protein (WMD 5.13 g/L, 95% CI 3.7-6.56, P < .001). No significant differences were observed in prealbumin and gastrointestinal adverse reactions. Physical (WMD 8.82, 95% CI 6.69-10.95, P < .001) and role function (WMD 12.23, 95% CI 2.72-21.74, P = .01) were also significantly better in the HEN group. The nausea/vomiting (WMD -5.43, 95% CI -8.29 to -2.57, P = .002) and fatigue symptoms (WMD -11.76, 95% CI -16.21 to -7.32, P < .001) were significantly reduced. Appetite loss (WMD -8.48, 95% CI -14.27 to -4.88, P = .001), diarrhea (WMD -3.9, 95% CI -7.37 to -0.43, P = .03), and sleep disturbance (WMD -7.64, 95% CI -12.79 to -2.5, P = .004) in the HEN group were also significantly less than the control group.
HEN improved nutrition status, physical and role function, and reduced nausea/vomiting, fatigue, appetite loss, diarrhea, and sleep disturbance compared with an oral diet in esophageal cancer patients postsurgery. HEN did not increase adverse reactions.
食管癌手术期间肠内喂养管的放置率不仅有所增加，而且选择在家中继续肠内喂养而非出院时拔除喂养管的患者数量也有所增加。分析食管癌患者食管切除术后家庭肠内营养（HEN）的影响。
按照PRISMA和Cochrane指南进行系统评价。检索英文和中文数据库，包括PubMed、Embase、Web of Science、Cochrane图书馆、Scopus、中国生物医学文献数据库（CBM）、中国知网（CNKI）和万方数据库，检索时间从建库至2019年12月7日。纳入评估癌症患者食管切除术后HEN短期结局的随机对照试验。根据Cochrane偏倚风险工具评估纳入研究的偏倚风险。使用固定效应模型和随机效应模型计算相对风险/加权平均差（WMD）估计值的汇总以及相应的95%置信区间（95%CI）。
荟萃分析纳入了9项涉及757例患者的随机对照试验。与口服饮食相比，HEN与体重显著增加（WMD 3 kg，95%CI 2.36 - 3.63，P <.001）、体重指数（WMD 0.97 kg/m²，95%CI 0.74 - 1.21，P <.001）、白蛋白（WMD 3.43 g/L，95%CI 2.35 - 4.52，P <.001）、血红蛋白（WMD 7.23 g/L，95%CI 5.87 - 8.59，P <.001）和总蛋白（WMD 5.13 g/L，95%CI 3.7 - 6.56，P <.001）相关。前白蛋白和胃肠道不良反应未观察到显著差异。HEN组的身体功能（WMD 8.82，95%CI 6.69 - 10.95，P <.001）和角色功能（WMD 12.23，95%CI 2.72 - 21.74，P =.01）也显著更好。HEN组的恶心/呕吐（WMD -5.43，95%CI -8.29至 -2.57，P =.002）和疲劳症状（WMD -11.76，95%CI -16.21至 -7.32，P <.001）显著减轻。HEN组的食欲减退（WMD -8.48，95%CI -14.27至 -4.88，P =.001）、腹泻（WMD -3.9，95%CI -7.37至 -0.43，P =.03）和睡眠障碍（WMD -7.64，95%CI -12.79至 -2.5，P =.004）也显著少于对照组。
与食管癌患者术后口服饮食相比，HEN改善了营养状况、身体和角色功能，并减少了恶心/呕吐、疲劳、食欲减退、腹泻和睡眠障碍。HEN未增加不良反应。
