Efficacy of Early Enteral Nutrition versus Parenteral Nutrition for Esophagus Cancer Patients after Esophagectomy: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIShuang ¹ , WANGLi-wei ¹ , HUWen-teng ¹ , LINRui-jiang ¹ , WEINing ² , ZHANGYu ² , MAMin-jie ² ,  HANBiao ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China;
2. Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

HANBiao, Email: hanbiao66@msn.com

Keywords：

Enteral nutrition; Parenteral nutrition; Esophagus cancer; Randomized controlled trial; Meta-analysis

DOI：

10.7507/1672-2531.20160179

Video：

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Objective To systematically review the efficacy of early enteral nutrition (EN) versus parenteral nutrition (PN) for esophagus cancer patients after esophagectomy. Methods The following electronic databases as PubMed, EMbase, The Cochrane Library (Issue 6, 2016), Web of Science, CBM, WanFang Data and CNKI were searched from inception to June 2016 to collect randomized controlled trials (RCTs) on comparing early EN and PN for esophagus cancer patients after esophagectomy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results A total of 14 RCTs involving 2 275 patients were included. The results of meta-analysis showed that, compared with the PN group, the early EN group could improve postoperative levels of albumin (MD=1.12, 95%CI 0.03 to 2.20, P=0.04) and transferrin (MD=10.08, 95%CI 5.41 to 14.76, P<0.000 1), decrease the incidences of pulmonary infection (OR=0.36, 95%CI 0.25 to 0.53, P<0.000 01) and anastomotic leakage (OR=0.57, 95%CI 0.36 to 0.92, P=0.02), but there was no significant difference in postoperative level of prealbumin between two groups (MD=10.04, 95%CI -0.31 to 20.39, P=0.06). Conclusion The early EN could improve the postoperative levels of albumin and transferrin, decrease the incidences of pulmonary infection and anastomotic leakage, but could not improve the postoperative prealbumin level.

Citation： LIShuang, WANGLi-wei, HUWen-teng, LINRui-jiang, WEINing, ZHANGYu, MAMin-jie, HANBiao. Efficacy of Early Enteral Nutrition versus Parenteral Nutrition for Esophagus Cancer Patients after Esophagectomy: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(10): 1176-1182. doi: 10.7507/1672-2531.20160179 Copy

1.	Seike J, Tangoku A, Yuasa Y, et al. The effect of nutritional support on the immune function in the acute postoperative period after esophageal cancer surgery: total parenteral nutrition versus enteral nutrition. J Med Invest, 2011, 58(1): 75-80.
2.	Sakai M, Kuwano H. Endoscopic Therapy for Esophageal Cancer. Kyobu Geka, 2016, 69(8): 718-723.
3.	Guiping Y, Guoqiang Ch, Bin H, et al. Effect of early enteral nutrition on postoperative nutritional status and immune function in elderly patients with esophageal cancer or cardiac cancer. Chin J Cancer Res, 2013, 25(3): 299-305.
4.	Talvas J, Garrait G, Goncalves MN, et al. Immunonutrition stimulates immune functions andantioxidant defense capacities of leukocytes in radiochemotherapy-treated head & neck andesophageal cancer patients: A double-blind randomized clinical trial. Clin Nutr, 2015, 34(5): 810-817.
5.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at: http://handbook.cochrane.org..
6.	Satoshi A, Yutaka Y, Yoshiaki S, et al. Beneficial Effects of Immediate Enteral Nutrition After Esophageal Cancer Surgery. Surg Today, 2001, 31(11): 971-978.
7.	余帅, 王志刚, 黄敏乾, 等. 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对比研究. 中国胸心血管外科杂志, 2014. 21(4): 498-502.
8.	李磊. 食管癌术后患者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.
9.	赵桂彬, 曹守强, 张恺, 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, 17(4): 356-360.
10.	Xiao-Bo Y, Qiang L, Xiong Q, et al. Efficay of early postoperative enteral nutrition in supporting after esophagetomy. Minerva Chir, 2014, 69(1): 37-46.
11.	任志, 王小英, 李康军. 食管癌术后早期肠内营养的疗效观察. 医学信息, 2011, 9(5): 4319.
12.	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.
13.	吴培仁, 许林, 张志明. 等. 食管癌术后早期肠内肠外营养的对比研究. 中华胃肠外科, 2006, 9(4): 320-322.
14.	徐洪波, 黄和平. 食管癌术后早期肠内营养的临床应用. 肿瘤, 2007, 27(10): 832-834.
15.	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.
16.	徐卫华, 钱永跃, 徐忠恒. 食管癌术后早期肠内营养的临床研究. 肠外与肠内营养, 2003, 10(3): 151-153.
17.	Fujita T, Daiko H, Nishimura M. Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy inpatients with esophageal cancer. Eur Surg Res, 2012, 48(2): 79-84.
18.	Tomoko T, Hiroya T, Masaharu O, et al. A Prospective Randomized Trial of Enteral Nutrition After Thoracoscopic Esophagectomy for Esophageal Cancer. Ann Surg Oncol, 2015, 22(3): 802-809.
19.	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.
20.	Png J, Cai J, Niu ZX, et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis. Dis Esophagus, 2016, 29(4): 333-341.

1. Seike J, Tangoku A, Yuasa Y, et al. The effect of nutritional support on the immune function in the acute postoperative period after esophageal cancer surgery: total parenteral nutrition versus enteral nutrition. J Med Invest, 2011, 58(1): 75-80.
2. Sakai M, Kuwano H. Endoscopic Therapy for Esophageal Cancer. Kyobu Geka, 2016, 69(8): 718-723.
3. Guiping Y, Guoqiang Ch, Bin H, et al. Effect of early enteral nutrition on postoperative nutritional status and immune function in elderly patients with esophageal cancer or cardiac cancer. Chin J Cancer Res, 2013, 25(3): 299-305.
4. Talvas J, Garrait G, Goncalves MN, et al. Immunonutrition stimulates immune functions andantioxidant defense capacities of leukocytes in radiochemotherapy-treated head & neck andesophageal cancer patients: A double-blind randomized clinical trial. Clin Nutr, 2015, 34(5): 810-817.
5. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at: http://handbook.cochrane.org..
6. Satoshi A, Yutaka Y, Yoshiaki S, et al. Beneficial Effects of Immediate Enteral Nutrition After Esophageal Cancer Surgery. Surg Today, 2001, 31(11): 971-978.
7. 余帅, 王志刚, 黄敏乾, 等. 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对比研究. 中国胸心血管外科杂志, 2014. 21(4): 498-502.
8. 李磊. 食管癌术后患者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.
9. 赵桂彬, 曹守强, 张恺, 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, 17(4): 356-360.
10. Xiao-Bo Y, Qiang L, Xiong Q, et al. Efficay of early postoperative enteral nutrition in supporting after esophagetomy. Minerva Chir, 2014, 69(1): 37-46.
11. 任志, 王小英, 李康军. 食管癌术后早期肠内营养的疗效观察. 医学信息, 2011, 9(5): 4319.
12. 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.
13. 吴培仁, 许林, 张志明. 等. 食管癌术后早期肠内肠外营养的对比研究. 中华胃肠外科, 2006, 9(4): 320-322.
14. 徐洪波, 黄和平. 食管癌术后早期肠内营养的临床应用. 肿瘤, 2007, 27(10): 832-834.
15. 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.
16. 徐卫华, 钱永跃, 徐忠恒. 食管癌术后早期肠内营养的临床研究. 肠外与肠内营养, 2003, 10(3): 151-153.
17. Fujita T, Daiko H, Nishimura M. Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy inpatients with esophageal cancer. Eur Surg Res, 2012, 48(2): 79-84.
18. Tomoko T, Hiroya T, Masaharu O, et al. A Prospective Randomized Trial of Enteral Nutrition After Thoracoscopic Esophagectomy for Esophageal Cancer. Ann Surg Oncol, 2015, 22(3): 802-809.
19. 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.
20. Png J, Cai J, Niu ZX, et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis. Dis Esophagus, 2016, 29(4): 333-341.

Chinese Journal of Evidence-Based Medicine

Efficacy of Early Enteral Nutrition versus Parenteral Nutrition for Esophagus Cancer Patients after Esophagectomy: A Meta-analysis

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