Department of Gastrointestinal Oncology Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Jiangsu, Nanjing, China.
Department of Urology, The Affiliated Jiangning Hospital of Nanjing Medical University, Jiangsu, Nanjing, China.
Nutr Cancer. 2023;75(9):1752-1767. doi: 10.1080/01635581.2023.2237217. Epub 2023 Jul 19.
This study aimed to summarize the current evidence-based approach to perioperative enteral nutritional (EN) program for gastric cancer (GC) surgery and to develop a staged and operable EN management scheme based on the evidence to provide clinical guidance for improving perioperative EN management in patients with GC. First, we synthesized expert consensuses, systematic reviews, and guidelines related to GC patients who had undergone surgery, based on a review of the literature and expert meetings. Subsequently, after carefully evaluating and selecting relevant EN management data, we created a preliminary draft of a perioperative EN program. Following Delphi expert consultations, the final version of the perioperative EN program was constructed after revision. After two rounds of consultation, the expert opinions tended to be consistent. The expert positive coefficient was 1.00, and the expert authority coefficient was 0.90. After the second round of consultation, the coefficient of variation of the importance score ranged from 0.05 to 0.20, and the coefficient of variation of the feasibility score ranged from 0.09 to 0.23. The Kendall harmony coefficients were 0.338 and 0.392, and the difference between them was statistically significant ( < 0.001). The final practice plan includes 4 first-level, 16 s-level, and 64 third-level items. The perioperative EN program constructed in this study is comprehensive in content, feasible, and evidence-based, and can provide insights for clinical improvement.
本研究旨在总结目前胃癌手术围手术期肠内营养（EN）方案的循证方法，并基于证据制定分期和可操作性的 EN 管理方案，为改善胃癌患者围手术期 EN 管理提供临床指导。首先，我们根据文献回顾和专家会议，综合了与接受手术治疗的胃癌患者相关的专家共识、系统评价和指南。随后，在仔细评估和选择相关 EN 管理数据后，我们创建了围手术期 EN 方案的初步草案。经过德尔菲专家咨询后，对方案进行修订，构建围手术期 EN 方案的最终版本。两轮咨询后，专家意见趋于一致。专家积极系数为 1.00，专家权威系数为 0.90。第二轮咨询后，重要性评分的变异系数范围为 0.05 至 0.20，可行性评分的变异系数范围为 0.09 至 0.23。Kendall 和谐系数为 0.338 和 0.392，差异具有统计学意义（ < 0.001）。最终实践方案包括 4 个一级、16 个二级和 64 个三级条目。本研究构建的围手术期 EN 方案内容全面、可行且基于证据，可为临床改善提供思路。
