Impact of early enteral versus parenteral nutrition on postoperative efficacy of esophageal cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Xiaoqing , GAO Linchun , ZHOU Dong ,  LIU Quanxing , ZHENG Hong , LI Jing

Department of Thoracic Surgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, P.R.China;

Corresponding author：

LIU Quanxing, Email: 215584683@qq.com

Keywords：

Esophageal cancer; enteral nutrition; complications; systematic reviews/meta-analysis

DOI：

10.7507/1007-4848.202003027

Video：

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Objective To compare the impact of early enteral nutrition (EN) and parenteral nutrition (PN) on the postoperative efficacy of esophageal cancer through meta-analysis of relevant randomized controlled trial (RCT).Methods PubMed, Medline, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to April 2018 to identify potential RCT which assessed clinical efficacy between EN and PN for postoperative patients with esophageal cancer. According to the inclusion and exclusion criteria, two researchers independently screened and evaluated literature. Meta-analysis was performed by RevMan 5.3 software.Results A total of 30 RCT studies were selected, including 3 969 patients. Meta-analysis results showed that: there was a significant difference between EN and PN in postoperative anastomotic fistulas (I²=0%, OR=0.67, 95%CI 0.45-0.99, P=0.04), postoperative pulmonary infections (I²=0%, OR=0.42, 95%CI 0.32-0.55, P<0.000 1), postoperative albumin levels (I²=38%, MD=0.78, 95%CI 0.51-1.06, P<0.000 01),time of first anal exhaust after operation (I²=0%, MD=–23.16, 95%CI –25.16-21.16, P<0.000 01) and postoperative incision infection (I²=0%, RR=0.36, 95%CI 0.21-0.64, P=0.000 5).Conclusion Compared with PN, early EN can significantly reduce the incidence of major postoperative complications and shorten the time of first anal exhaust after surgery. In addition, EN is superior to PN in improving nutritional status, increasing weight and reducing costs and side effects.

Citation： LIU Xiaoqing, GAO Linchun, ZHOU Dong, LIU Quanxing, ZHENG Hong, LI Jing. Impact of early enteral versus parenteral nutrition on postoperative efficacy of esophageal cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1341-1347. doi: 10.7507/1007-4848.202003027 Copy

1.	郭明发. 食管癌病人术后早期肠内营养的疗效观察. 肠外与肠内营养, 2011, 18(4): 218-220.
2.	赵桂彬, 曹守强, 张凯, 等. 早期肠内营养对食管癌患者术后免疫功能和临床结局的影响. 中华胃肠外科杂志, 2014, (4): 356-360.
3.	Shen Y, Zhou Y, He T, et al. Effect of preoperative nutritional risk screening and enteral nutrition support in accelerated recovery after resection for esophageal cancer. Nutr Cancer, 2020. [Epub ahead of print].
4.	Takesue T, Takeuchi H, Ogura M, et al. A prospective randomized trial of enteral nutrition after thoracoscopic esophagectomy for esophageal Cancer. Ann Surg Oncol, 2015, (3): 802-809.
5.	Aiko S, Yoshizumi Y, Sugiura Y, et al. Beneficial effects of immediate enteral nutrition after esophageal cancer surgery. Surg Today, 2001, 31(11): 971-978.
6.	吴培仁, 许林, 张志明. 食管癌术后早期肠内肠外营养的对比研究. 中华胃肠外科杂志, 2006, 9(4): 320-322.
7.	Fujita T, Daiko H, Nishimura M. Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer. Eur Surg Res, 2012, 48(2): 79-84.
8.	张卫国, 王晶, 范俊利, 等. 早期肠内营养支持在食管癌患者围手术期中的应用研究. 河南科技大学学报(医学版), 2018, 36(1): 29-33.
9.	李健强, 周星明, 江洪. 食管癌患者术后肠内营养与肠外营养治疗对比研究. 肿瘤学杂志, 2008, 14(12): 1001-1003.
10.	徐洪波, 黄和平, 潘宇. 十二指肠营养管在食管贲门癌术后的临床应用. 湖北民族学院学报(医学版), 2007, 24(1): 53-55.
11.	李小兵. 食管癌术后早期肠内营养的临床应用. 中国医药指南, 2013, 11(24): 506-507.
12.	任志, 王小英, 李康军. 食管癌患者术后早期肠内营养的疗效观察. 医学信息(中旬刊), 2011, 24(9): 4319.
13.	傅俊惠, 郑海波, 吴智勇, 等. 食管癌术中放置肠鼻管术后早期肠内营养的前瞻性研究. 广东医学, 2008, 29(8): 1363-1365.
14.	Braga M, Gianotti L, Gentilini O, et al. Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. Crit Care Med, 2001, 29(2): 242-248.
15.	姜赟, 顾亮. 食管癌患者术后早期肠内营养与肠外营养的比较. 交通医学, 2016, 30(6): 668-670.
16.	王晓凝, 郝志芬. 食管癌围手术期肠内营养支持对患者血红蛋白、血浆白蛋白水平及淋巴细胞计数的影响. 中国卫生标准管理, 2016, 7(4): 1-2.
17.	薛冰. 食管癌术后肠内、肠外营养支持临床疗效比较. 河北医科大学学报, 2017, 38(4): 464-468.
18.	陈剑, 李根水, 周新涛, 等. 食管癌术后早期肠内营养的临床研究. 安徽卫生职业技术学院学报, 2010, 9(3): 30-31.
19.	纪勇, 陈静瑜, 郑明峰, 等. 食管癌病人术后早期肠内营养的临床应用. 肠外与肠内营养, 2012, 19(1): 21-23.
20.	刘骏斌. 食管癌贲门癌术后早期肠内肠外营养的临床研究. 中国现代医学杂志, 2011, 21(17): 2063-2065.
21.	魏飞. 肠内营养与肠外营养在食管癌患者术后的应用探讨. 当代医学, 2014, 20(36): 83, 84.
22.	谢天鹏, 赵雍凡, 刘华英, 等. 早期肠内营养对食管癌术后全身炎性反应及细胞免疫功能的影响. 四川医学, 2005, 26(1): 18-20.
23.	柳硕岩, 陈啸风, 王枫, 等. 食管癌合并糖尿病的围手术期营养支持. 中华胃肠外科杂志, 2013, 16(9): 864-867.
24.	张憬, 秦建伟, 邵永丰. 食管、贲门癌术后早期肠内营养的临床应用. 江苏医药, 2007, 23(11): 1124-1125.
25.	Xiao-Bo Y, Qiang L, Xiong Q, et al. Efficacy of early postoperative enteral nutrition in supporting patients after esophagectomy. Minerva Chir, 2014, 69(1): 37-46.
26.	管宏俊, 陈云琦, 孙长鹏, 等. 食管癌术后病人两种营养支持治疗的比较. 肠外与肠内营养, 2012, 19(1): 24-25, 28.
27.	李莲玉. 食管癌、贲门癌术后早期肠内营养与肠外营养的护理分析. 中国现代药物应用, 2016, 10(4): 198-199, 200.
28.	李磊. 食管癌患者术后早期肠内营养与肠外营养应用比较. 泰山医学院学报, 2014, 35(5): 377-379.
29.	吴志军, 林霞, 项应明, 等. 肠内营养对食管癌手术患者营养状况和胃肠道耐受性的影响. 中国中西医结合消化杂志, 2016, 24(4): 311-313.
30.	童琳, 黄小玲. 胸腹腔镜联合食管癌根治术后早期肠内营养治疗的效果. 护理与康复, 2018, 17(2): 46-48.
31.	杨家恒, 黄代鸿. 食管癌手术后肠内营养与肠外营养对肝、肾功能及胃肠功能影响的研究. 临床医学工程, 2015, 22(11): 1441-1442, 1445.
32.	Ozawa S, Koyanagi K, Ninomiya Y, et al. Postoperative complications of minimally invasive esophagectomy for esophageal cancer. Ann Gastroenterol Surg, 2020, 4(2): 126-134.
33.	Holakouie-Naieni K, Mansournia MA, Doosti-Irani A, et al. Treatment-related complications in patients with esophageal cancer: A systematic review and network meta-analysis. Surgeon, 2020. [Epub ahead of print].
34.	Piwowarczyk P, Kutnik P, Borys M, et al. Influence of early versus late supplemental parenteraL nutrition on long-term quality of life in ICU patients after gastrointestinal oncological surgery (hELPLiNe): study protocol for a randomized controlled trial. Trials, 2019, 20(1): 777.
35.	Ayoub F, Kamel A Y, Ouni A, et al. Pre-operative total parenteral nutrition improves post-operative outcomes in a subset of Crohn's disease patients undergoing major abdominal surgery. Gastroenterol Rep (Oxf), 2019, 7(2): 107-114.

1. 郭明发. 食管癌病人术后早期肠内营养的疗效观察. 肠外与肠内营养, 2011, 18(4): 218-220.
2. 赵桂彬, 曹守强, 张凯, 等. 早期肠内营养对食管癌患者术后免疫功能和临床结局的影响. 中华胃肠外科杂志, 2014, (4): 356-360.
3. Shen Y, Zhou Y, He T, et al. Effect of preoperative nutritional risk screening and enteral nutrition support in accelerated recovery after resection for esophageal cancer. Nutr Cancer, 2020. [Epub ahead of print].
4. Takesue T, Takeuchi H, Ogura M, et al. A prospective randomized trial of enteral nutrition after thoracoscopic esophagectomy for esophageal Cancer. Ann Surg Oncol, 2015, (3): 802-809.
5. Aiko S, Yoshizumi Y, Sugiura Y, et al. Beneficial effects of immediate enteral nutrition after esophageal cancer surgery. Surg Today, 2001, 31(11): 971-978.
6. 吴培仁, 许林, 张志明. 食管癌术后早期肠内肠外营养的对比研究. 中华胃肠外科杂志, 2006, 9(4): 320-322.
7. Fujita T, Daiko H, Nishimura M. Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer. Eur Surg Res, 2012, 48(2): 79-84.
8. 张卫国, 王晶, 范俊利, 等. 早期肠内营养支持在食管癌患者围手术期中的应用研究. 河南科技大学学报(医学版), 2018, 36(1): 29-33.
9. 李健强, 周星明, 江洪. 食管癌患者术后肠内营养与肠外营养治疗对比研究. 肿瘤学杂志, 2008, 14(12): 1001-1003.
10. 徐洪波, 黄和平, 潘宇. 十二指肠营养管在食管贲门癌术后的临床应用. 湖北民族学院学报(医学版), 2007, 24(1): 53-55.
11. 李小兵. 食管癌术后早期肠内营养的临床应用. 中国医药指南, 2013, 11(24): 506-507.
12. 任志, 王小英, 李康军. 食管癌患者术后早期肠内营养的疗效观察. 医学信息(中旬刊), 2011, 24(9): 4319.
13. 傅俊惠, 郑海波, 吴智勇, 等. 食管癌术中放置肠鼻管术后早期肠内营养的前瞻性研究. 广东医学, 2008, 29(8): 1363-1365.
14. Braga M, Gianotti L, Gentilini O, et al. Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. Crit Care Med, 2001, 29(2): 242-248.
15. 姜赟, 顾亮. 食管癌患者术后早期肠内营养与肠外营养的比较. 交通医学, 2016, 30(6): 668-670.
16. 王晓凝, 郝志芬. 食管癌围手术期肠内营养支持对患者血红蛋白、血浆白蛋白水平及淋巴细胞计数的影响. 中国卫生标准管理, 2016, 7(4): 1-2.
17. 薛冰. 食管癌术后肠内、肠外营养支持临床疗效比较. 河北医科大学学报, 2017, 38(4): 464-468.
18. 陈剑, 李根水, 周新涛, 等. 食管癌术后早期肠内营养的临床研究. 安徽卫生职业技术学院学报, 2010, 9(3): 30-31.
19. 纪勇, 陈静瑜, 郑明峰, 等. 食管癌病人术后早期肠内营养的临床应用. 肠外与肠内营养, 2012, 19(1): 21-23.
20. 刘骏斌. 食管癌贲门癌术后早期肠内肠外营养的临床研究. 中国现代医学杂志, 2011, 21(17): 2063-2065.
21. 魏飞. 肠内营养与肠外营养在食管癌患者术后的应用探讨. 当代医学, 2014, 20(36): 83, 84.
22. 谢天鹏, 赵雍凡, 刘华英, 等. 早期肠内营养对食管癌术后全身炎性反应及细胞免疫功能的影响. 四川医学, 2005, 26(1): 18-20.
23. 柳硕岩, 陈啸风, 王枫, 等. 食管癌合并糖尿病的围手术期营养支持. 中华胃肠外科杂志, 2013, 16(9): 864-867.
24. 张憬, 秦建伟, 邵永丰. 食管、贲门癌术后早期肠内营养的临床应用. 江苏医药, 2007, 23(11): 1124-1125.
25. Xiao-Bo Y, Qiang L, Xiong Q, et al. Efficacy of early postoperative enteral nutrition in supporting patients after esophagectomy. Minerva Chir, 2014, 69(1): 37-46.
26. 管宏俊, 陈云琦, 孙长鹏, 等. 食管癌术后病人两种营养支持治疗的比较. 肠外与肠内营养, 2012, 19(1): 24-25, 28.
27. 李莲玉. 食管癌、贲门癌术后早期肠内营养与肠外营养的护理分析. 中国现代药物应用, 2016, 10(4): 198-199, 200.
28. 李磊. 食管癌患者术后早期肠内营养与肠外营养应用比较. 泰山医学院学报, 2014, 35(5): 377-379.
29. 吴志军, 林霞, 项应明, 等. 肠内营养对食管癌手术患者营养状况和胃肠道耐受性的影响. 中国中西医结合消化杂志, 2016, 24(4): 311-313.
30. 童琳, 黄小玲. 胸腹腔镜联合食管癌根治术后早期肠内营养治疗的效果. 护理与康复, 2018, 17(2): 46-48.
31. 杨家恒, 黄代鸿. 食管癌手术后肠内营养与肠外营养对肝、肾功能及胃肠功能影响的研究. 临床医学工程, 2015, 22(11): 1441-1442, 1445.
32. Ozawa S, Koyanagi K, Ninomiya Y, et al. Postoperative complications of minimally invasive esophagectomy for esophageal cancer. Ann Gastroenterol Surg, 2020, 4(2): 126-134.
33. Holakouie-Naieni K, Mansournia MA, Doosti-Irani A, et al. Treatment-related complications in patients with esophageal cancer: A systematic review and network meta-analysis. Surgeon, 2020. [Epub ahead of print].
34. Piwowarczyk P, Kutnik P, Borys M, et al. Influence of early versus late supplemental parenteraL nutrition on long-term quality of life in ICU patients after gastrointestinal oncological surgery (hELPLiNe): study protocol for a randomized controlled trial. Trials, 2019, 20(1): 777.
35. Ayoub F, Kamel A Y, Ouni A, et al. Pre-operative total parenteral nutrition improves post-operative outcomes in a subset of Crohn's disease patients undergoing major abdominal surgery. Gastroenterol Rep (Oxf), 2019, 7(2): 107-114.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Impact of early enteral versus parenteral nutrition on postoperative efficacy of esophageal cancer: A systematic review and meta-analysis

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