Lu Yi-Xun, Wang Yan-Jun, Xie Tian-Yu, Li Shuo, Wu Di, Li Xiong-Guang, Song Qi-Ying, Wang Li-Peng, Guan Da, Wang Xin-Xin
Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China.
Department of Surgical Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Children's Hospital of Henan Provence, Zhengzhou 450018, Henan Province, China.
World J Gastroenterol. 2020 Sep 28;26(36):5508-5519. doi: 10.3748/wjg.v26.i36.5508.
Gastric cancer (GC) is a heavy burden in China. Nutritional support for GC patients is closely related to postoperative rehabilitation. However, the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce.
To prospectively explore the safety, feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients.
This study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China. A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled. Of which, 105 patients were given early oral feeding (EOF group) after surgery, and the other 101 patients were given the traditional feeding strategy (control group) after surgery. Perioperative clinical data were recorded and analyzed. The primary endpoints were gastrointestinal function recovery time and postoperative complications, and the secondary endpoints were postoperative nutritional status, length of hospital stay and expenses, .
Compared with the control group, patients in the EOF group had a significantly shorter postoperative first exhaust time (2.48 ± 1.17 d 3.37 ± 1.42 d, = 0.001) and first defecation time (3.83 ± 2.41 d 5.32 ± 2.70 d, = 0. 004). In addition, the EOF group had a significant shorter postoperative hospitalization duration (5.85 ± 1.53 d 7.71 ± 1.56 d, < 0.001) and lower postoperative hospitalization expenses (16.60 ± 5.10 K¥ 21.00 ± 7.50 K¥, = 0.014). On the 5 day after surgery, serum prealbumin level (214.52 ± 22.47 mg/L 204.17 ± 20.62 mg/L, = 0.018), serum gastrin level (246.30 ± 57.10 ng/L 223.60 ± 55.70 ng/L, = 0.001) and serum motilin level (424.60 ± 68.30 ng/L 409.30 ± 61.70 ng/L, = 0.002) were higher in the EOF group. However, there was no significant difference in the incidence of total postoperative complications between the two groups ( = 0.507).
Early oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function, improve postoperative nutritional status, reduce length of hospital stay and expenses while not increasing the incidence of related complications, which indicates its safety, feasibility and potential benefits for gastric cancer patients.
胃癌在中国是一项沉重负担。胃癌患者的营养支持与术后康复密切相关。然而，腹腔镜根治性全胃切除术后早期经口进食在胃癌患者中的作用尚不清楚，且高质量的研究证据稀缺。
前瞻性探讨腹腔镜根治性全胃切除术后早期经口进食对胃癌患者的安全性、可行性及短期临床结局。
本研究为前瞻性队列研究，于2018年1月至2019年12月在中国一家大型三级医院开展。共纳入206例行腹腔镜根治性全胃切除术的胃癌患者。其中，105例患者术后给予早期经口进食（早期经口进食组），另外101例患者术后给予传统进食策略（对照组）。记录并分析围手术期临床数据。主要终点为胃肠功能恢复时间和术后并发症，次要终点为术后营养状况、住院时间和费用。
与对照组相比，早期经口进食组患者术后首次排气时间（2.48±1.17天对3.37±1.42天，P = 0.001）和首次排便时间（3.83±2.41天对5.32±2.70天，P = 0.004）显著缩短。此外，早期经口进食组术后住院时间显著缩短（5.85±1.53天对7.71±1.56天，P < 0.001），术后住院费用降低（16.60±5.10千元对21.00±7.50千元，P = 0.014）。术后第5天，早期经口进食组血清前白蛋白水平（214.52±22.47mg/L对204.17±20.62mg/L，P = 0.018）、血清胃泌素水平（246.30±57.10ng/L对223.60±55.70ng/L，P = 0.001）和血清胃动素水平（424.60±68.30ng/L对409.30±61.70ng/L，P = 0.002）更高。然而，两组术后总并发症发生率无显著差异（P = 0.507）。
腹腔镜根治性全胃切除术后早期经口进食可促进胃肠功能恢复，改善术后营养状况，缩短住院时间并降低费用，但不增加相关并发症的发生率，这表明其对胃癌患者具有安全性、可行性和潜在益处。
