Department of Thoracic Surgical Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center/Cancer Hospital, Beijing, China.
Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
Surgery. 2022 Sep;172(3):919-925. doi: 10.1016/j.surg.2022.04.041. Epub 2022 Jul 3.
The impact of early oral feeding after esophagectomy on brain-gut peptide secretion and gut function recovery has not been well investigated. This study aimed to fill this research gap.
This study was based on a randomized clinical trial (ClinicalTrials.gov: NCT01998230). The patients in the early oral feeding group started oral food intake on postoperative day 1. In the late oral feeding group, nasogastric/nasoenteral feeding was applied from postoperative day 1 to 7, after which the patients began oral food intake. Serum brain-gut peptides were selected as the primary end points and tested before surgery and on postoperative days 1, 3, and 5. The time to first flatus and first defecation after surgery were evaluated.
A total of 110 participants undergoing minimally invasive McKeown esophagectomy were prospectively included, with 63 patients in the early oral feeding group and 47 patients in the late oral feeding group. The distribution of clinicopathological characteristics was balanced between the 2 groups. Perioperative dynamic surveillance demonstrated higher serum concentrations of excitatory brain-gut peptides (gastrin P = .021, motilin P = .027, and substance-P P = .023) and lower serum concentrations of inhibitory brain-gut peptides (cholecystokinin P = .004 and somatostatin P = .019) in the early oral feeding group. Perioperative serum levels of brain-gut peptides correlated with postoperative early flatus and defecation. The multivariate analysis showed early oral feeding (versus late oral feeding) to be an independent predictive factor for early flatus and defecation (hazard ratio 2.40, P < .001; hazard ratio 2.73, P < .001, respectively).
The early oral feeding program may accelerate the recovery of gut function by regulating brain-gut peptide secretion. Brain-gut peptides are possible treatment targets to improve early oral feeding benefits and promote personalized early oral feeding programs.
食管切除术后早期口服喂养对脑-肠肽分泌和肠道功能恢复的影响尚未得到充分研究。本研究旨在填补这一研究空白。
本研究基于一项随机临床试验（ClinicalTrials.gov：NCT01998230）。早期口服喂养组的患者在术后第 1 天开始口服进食。晚期口服喂养组从术后第 1 天至第 7 天应用鼻胃/鼻肠喂养，然后患者开始口服进食。血清脑-肠肽被选为主要终点，并在术前和术后第 1、3 和 5 天进行检测。评估术后首次排气和排便的时间。
共有 110 名接受微创 McKeown 食管切除术的患者前瞻性入组，其中 63 名患者在早期口服喂养组，47 名患者在晚期口服喂养组。两组的临床病理特征分布平衡。围手术期动态监测显示，早期口服喂养组血清兴奋性脑-肠肽浓度较高（胃泌素 P =.021，胃动素 P =.027，P物质 P =.023），血清抑制性脑-肠肽浓度较低（胆囊收缩素 P =.004 和生长抑素 P =.019）。围手术期脑-肠肽血清水平与术后早期排气和排便相关。多变量分析显示，早期口服喂养（与晚期口服喂养相比）是早期排气和排便的独立预测因素（危险比 2.40，P <.001；危险比 2.73，P <.001）。
早期口服喂养方案通过调节脑-肠肽分泌可能加速肠道功能恢复。脑-肠肽可能是改善早期口服喂养获益和促进个体化早期口服喂养方案的治疗靶点。
