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.	郭明發. 食管癌病人術后早期腸內營養的療效觀察. 腸外與腸內營養, 2011, 18(4): 218-220.
2.	趙桂彬, 曹守強, 張凱, 等. 早期腸內營養對食管癌患者術后免疫功能和臨床結局的影響. 中華胃腸外科雜志, 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.	吳培仁, 許林, 張志明. 食管癌術后早期腸內腸外營養的對比研究. 中華胃腸外科雜志, 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.	張衛國, 王晶, 范俊利, 等. 早期腸內營養支持在食管癌患者圍手術期中的應用研究. 河南科技大學學報(醫學版), 2018, 36(1): 29-33.
9.	李健強, 周星明, 江洪. 食管癌患者術后腸內營養與腸外營養治療對比研究. 腫瘤學雜志, 2008, 14(12): 1001-1003.
10.	徐洪波, 黃和平, 潘宇. 十二指腸營養管在食管賁門癌術后的臨床應用. 湖北民族學院學報(醫學版), 2007, 24(1): 53-55.
11.	李小兵. 食管癌術后早期腸內營養的臨床應用. 中國醫藥指南, 2013, 11(24): 506-507.
12.	任志, 王小英, 李康軍. 食管癌患者術后早期腸內營養的療效觀察. 醫學信息(中旬刊), 2011, 24(9): 4319.
13.	傅俊惠, 鄭海波, 吳智勇, 等. 食管癌術中放置腸鼻管術后早期腸內營養的前瞻性研究. 廣東醫學, 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, 顧亮. 食管癌患者術后早期腸內營養與腸外營養的比較. 交通醫學, 2016, 30(6): 668-670.
16.	王曉凝, 郝志芬. 食管癌圍手術期腸內營養支持對患者血紅蛋白、血漿白蛋白水平及淋巴細胞計數的影響. 中國衛生標準管理, 2016, 7(4): 1-2.
17.	薛冰. 食管癌術后腸內、腸外營養支持臨床療效比較. 河北醫科大學學報, 2017, 38(4): 464-468.
18.	陳劍, 李根水, 周新濤, 等. 食管癌術后早期腸內營養的臨床研究. 安徽衛生職業技術學院學報, 2010, 9(3): 30-31.
19.	紀勇, 陳靜瑜, 鄭明峰, 等. 食管癌病人術后早期腸內營養的臨床應用. 腸外與腸內營養, 2012, 19(1): 21-23.
20.	劉駿斌. 食管癌賁門癌術后早期腸內腸外營養的臨床研究. 中國現代醫學雜志, 2011, 21(17): 2063-2065.
21.	魏飛. 腸內營養與腸外營養在食管癌患者術后的應用探討. 當代醫學, 2014, 20(36): 83, 84.
22.	謝天鵬, 趙雍凡, 劉華英, 等. 早期腸內營養對食管癌術后全身炎性反應及細胞免疫功能的影響. 四川醫學, 2005, 26(1): 18-20.
23.	柳碩巖, 陳嘯風, 王楓, 等. 食管癌合并糖尿病的圍手術期營養支持. 中華胃腸外科雜志, 2013, 16(9): 864-867.
24.	張憬, 秦建偉, 邵永豐. 食管、賁門癌術后早期腸內營養的臨床應用. 江蘇醫藥, 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, 陳云琦, 孫長鵬, 等. 食管癌術后病人兩種營養支持治療的比較. 腸外與腸內營養, 2012, 19(1): 24-25, 28.
27.	李蓮玉. 食管癌、賁門癌術后早期腸內營養與腸外營養的護理分析. 中國現代藥物應用, 2016, 10(4): 198-199, 200.
28.	李磊. 食管癌患者術后早期腸內營養與腸外營養應用比較. 泰山醫學院學報, 2014, 35(5): 377-379.
29.	吳志軍, 林霞, 項應明, 等. 腸內營養對食管癌手術患者營養狀況和胃腸道耐受性的影響. 中國中西醫結合消化雜志, 2016, 24(4): 311-313.
30.	童琳, 黃小玲. 胸腹腔鏡聯合食管癌根治術后早期腸內營養治療的效果. 護理與康復, 2018, 17(2): 46-48.
31.	楊家恒, 黃代鴻. 食管癌手術后腸內營養與腸外營養對肝、腎功能及胃腸功能影響的研究. 臨床醫學工程, 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. 郭明發. 食管癌病人術后早期腸內營養的療效觀察. 腸外與腸內營養, 2011, 18(4): 218-220.
2. 趙桂彬, 曹守強, 張凱, 等. 早期腸內營養對食管癌患者術后免疫功能和臨床結局的影響. 中華胃腸外科雜志, 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. 吳培仁, 許林, 張志明. 食管癌術后早期腸內腸外營養的對比研究. 中華胃腸外科雜志, 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. 張衛國, 王晶, 范俊利, 等. 早期腸內營養支持在食管癌患者圍手術期中的應用研究. 河南科技大學學報(醫學版), 2018, 36(1): 29-33.
9. 李健強, 周星明, 江洪. 食管癌患者術后腸內營養與腸外營養治療對比研究. 腫瘤學雜志, 2008, 14(12): 1001-1003.
10. 徐洪波, 黃和平, 潘宇. 十二指腸營養管在食管賁門癌術后的臨床應用. 湖北民族學院學報(醫學版), 2007, 24(1): 53-55.
11. 李小兵. 食管癌術后早期腸內營養的臨床應用. 中國醫藥指南, 2013, 11(24): 506-507.
12. 任志, 王小英, 李康軍. 食管癌患者術后早期腸內營養的療效觀察. 醫學信息(中旬刊), 2011, 24(9): 4319.
13. 傅俊惠, 鄭海波, 吳智勇, 等. 食管癌術中放置腸鼻管術后早期腸內營養的前瞻性研究. 廣東醫學, 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, 顧亮. 食管癌患者術后早期腸內營養與腸外營養的比較. 交通醫學, 2016, 30(6): 668-670.
16. 王曉凝, 郝志芬. 食管癌圍手術期腸內營養支持對患者血紅蛋白、血漿白蛋白水平及淋巴細胞計數的影響. 中國衛生標準管理, 2016, 7(4): 1-2.
17. 薛冰. 食管癌術后腸內、腸外營養支持臨床療效比較. 河北醫科大學學報, 2017, 38(4): 464-468.
18. 陳劍, 李根水, 周新濤, 等. 食管癌術后早期腸內營養的臨床研究. 安徽衛生職業技術學院學報, 2010, 9(3): 30-31.
19. 紀勇, 陳靜瑜, 鄭明峰, 等. 食管癌病人術后早期腸內營養的臨床應用. 腸外與腸內營養, 2012, 19(1): 21-23.
20. 劉駿斌. 食管癌賁門癌術后早期腸內腸外營養的臨床研究. 中國現代醫學雜志, 2011, 21(17): 2063-2065.
21. 魏飛. 腸內營養與腸外營養在食管癌患者術后的應用探討. 當代醫學, 2014, 20(36): 83, 84.
22. 謝天鵬, 趙雍凡, 劉華英, 等. 早期腸內營養對食管癌術后全身炎性反應及細胞免疫功能的影響. 四川醫學, 2005, 26(1): 18-20.
23. 柳碩巖, 陳嘯風, 王楓, 等. 食管癌合并糖尿病的圍手術期營養支持. 中華胃腸外科雜志, 2013, 16(9): 864-867.
24. 張憬, 秦建偉, 邵永豐. 食管、賁門癌術后早期腸內營養的臨床應用. 江蘇醫藥, 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, 陳云琦, 孫長鵬, 等. 食管癌術后病人兩種營養支持治療的比較. 腸外與腸內營養, 2012, 19(1): 24-25, 28.
27. 李蓮玉. 食管癌、賁門癌術后早期腸內營養與腸外營養的護理分析. 中國現代藥物應用, 2016, 10(4): 198-199, 200.
28. 李磊. 食管癌患者術后早期腸內營養與腸外營養應用比較. 泰山醫學院學報, 2014, 35(5): 377-379.
29. 吳志軍, 林霞, 項應明, 等. 腸內營養對食管癌手術患者營養狀況和胃腸道耐受性的影響. 中國中西醫結合消化雜志, 2016, 24(4): 311-313.
30. 童琳, 黃小玲. 胸腹腔鏡聯合食管癌根治術后早期腸內營養治療的效果. 護理與康復, 2018, 17(2): 46-48.
31. 楊家恒, 黃代鴻. 食管癌手術后腸內營養與腸外營養對肝、腎功能及胃腸功能影響的研究. 臨床醫學工程, 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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