Effects of a stepwise, local patient-specific early oral feeding schedule after gastric cancer surgery: a single-center retrospective study from China

Ji Chen, Ming Xu, Yunpeng Zhang, Chun Gao, Peng Sun, Ji Chen, Ming Xu, Yunpeng Zhang, Chun Gao, Peng Sun

Abstract

Nowadays, early oral feeding after gastrectomy has been gradually accepted and applied in the clinical practice, but there is still no specific uniform feeding regimen available which works best for patients in different regions with different races and eating habits. Aiming to establish an early oral feeding schedule suitable for local Chinese patients after gastric surgery, from May 2014 to May 2018, 87 gastric cancer patients undergoing various types of gastric resections were enrolled in an early feeding protocol and their clinical course was reviewed retrospectively. A stepwise, local patient-specific, early oral feeding schedule was proposed, implemented within an early recovery after surgery (ERAS) protocol and accessed in terms of its safety and tolerability. The primary surgical outcomes included: a median (interquartile range; IQR) postoperative hospital stay of 6 (3) days; 67 (77%) patients were well tolerant of this schedule from postoperative day (POD) 1 to POD 4; 20 (23%) patients had mild I/II grade complications (Clavien-Dindo classification); 3 (3%) patients had IIIB complications, zero cases of hospital mortality. Compared to similar studies in the past, our early oral feeding program is also safe and beneficial, and it can shorten the postoperative hospital stay without causing any increase in postoperative complications. In summary, our work herein reported the establishment of a detailed early oral feeding schedule embedded within an ERAS protocol which was found to be suitable for local Chinese patients after gastric surgery. Accordingly, this early oral feeding schedule is worth further research and promotion.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Compliance with ERAS protocol elements.

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30. doi: 10.3322/caac.21442.
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30. doi: 10.3322/caac.21332.
    1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67:7–30. doi: 10.3322/caac.21387.
    1. Chen W, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–132. doi: 10.3322/caac.21338.
    1. Lassen K, et al. Nutritional support and oral intake after gastric resection in five northern European countries. Dig Surg. 2005;22(discussion 352):346–352. doi: 10.1159/000089770.
    1. Bisgaard, T. & Kehlet, H. Early oral feeding after elective abdominal surgery–what are the issues? Nutrition18, 944–948, S0899900702009905 (2002).
    1. Suehiro T, Matsumata T, Shikada Y, Sugimachi K. Accelerated rehabilitation with early postoperative oral feeding following gastrectomy. Hepatogastroenterology. 2004;51:1852–1855.
    1. Hirao M, Tsujinaka T, Takeno A, Fujitani K, Kurata M. Patient-controlled dietary schedule improves clinical outcome after gastrectomy for gastric cancer. World J Surg. 2005;29:853–857. doi: 10.1007/s00268-005-7760-x.
    1. Hur H, et al. Effect of early oral feeding after gastric cancer surgery: a result of randomized clinical trial. Surgery. 2011;149:561–568. doi: 10.1016/j.surg.2010.10.003.
    1. Jo DH, et al. Feasibility study of early oral intake after gastrectomy for gastric carcinoma. J Gastric Cancer. 2011;11:101–108. doi: 10.5230/jgc.2011.11.2.101.
    1. Jeong O, Ryu SY, Jung MR, Choi WW, Park YK. The safety and feasibility of early postoperative oral nutrition on the first postoperative day after gastrectomy for gastric carcinoma. Gastric Cancer. 2014;17:324–331. doi: 10.1007/s10120-013-0275-5.
    1. Lassen K, Revhaug A. Early oral nutrition after major upper gastrointestinal surgery: why not? Curr Opin Clin Nutr Metab Care. 2006;9:613–617. doi: 10.1097/01.mco.0000241673.17300.87.
    1. Mortensen K, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Br J Surg. 2014;101:1209–1229. doi: 10.1002/bjs.9582.
    1. Pedziwiatr M, et al. Enhanced recovery (ERAS) protocol in patients undergoing laparoscopic total gastrectomy. Wideochir Inne Tech Maloinwazyjne. 2014;9:252–257. doi: 10.5114/wiitm.2014.43076.
    1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–617. doi: 10.1093/bja/78.5.606.
    1. Lassen K, et al. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial. Ann Surg. 2008;247:721–729. doi: 10.1097/SLA.0b013e31815cca68.
    1. Liu X, et al. Is early oral feeding after gastric cancer surgery feasible? A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9:e112062. doi: 10.1371/journal.pone.0112062.
    1. Lassen K, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144:961–969. doi: 10.1001/archsurg.2009.170.
    1. The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection: Results From an International Registry. Ann Surg261, 1153–1159, 10.1097/SLA.0000000000001029 (2015).
    1. Gustafsson UO, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg. 2013;37:259–284. doi: 10.1007/s00268-012-1772-0.
    1. Sugisawa N, et al. A phase II study of an enhanced recovery after surgery protocol in gastric cancer surgery. Gastric Cancer. 2016;19:961–967. doi: 10.1007/s10120-015-0528-6.
    1. Pedziwiatr M, et al. Short hospital stays after laparoscopic gastric surgery under an Enhanced Recovery After Surgery (ERAS) pathway: experience at a single center. Eur Surg. 2014;46:128–132. doi: 10.1007/s10353-014-0264-x.
    1. Yamada T, et al. Feasibility of enhanced recovery after surgery in gastric surgery: a retrospective study. BMC Surg. 2014;14:41. doi: 10.1186/1471-2482-14-41.
    1. Abdikarim I, et al. Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas. World J Gastroenterol. 2015;21:13339–13344. doi: 10.3748/wjg.v21.i47.13339.
    1. Kim JW, et al. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg. 2012;36:2879–2887. doi: 10.1007/s00268-012-1741-7.
    1. Yamada T, et al. Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer. 2012;15:34–41. doi: 10.1007/s10120-011-0057-x.
    1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213. doi: 10.1097/.
    1. Clavien PA, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–196. doi: 10.1097/SLA.0b013e3181b13ca2.
    1. Jemal A, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90. doi: 10.3322/caac.20107.
    1. Cuschieri, A. et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet347, 995–999, S0140-6736(96)90144-0 (1996).
    1. Sano T, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy–Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767–2773. doi: 10.1200/JCO.2004.10.184.
    1. Degiuli M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. Eur J Surg Oncol. 2004;30:303–308. doi: 10.1016/j.ejso.2003.11.020.
    1. Kim HH, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report–a phase III multicenter, prospective, randomized Trial (KLASS Trial) Ann Surg. 2010;251:417–420. doi: 10.1097/SLA.0b013e3181cc8f6b.
    1. Kim HH, et al. Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol. 2014;32:627–633. doi: 10.1200/JCO.2013.48.8551.
    1. Feo CV, et al. Early oral feeding after colorectal resection: a randomized controlled study. ANZ J Surg. 2004;74:298–301. doi: 10.1111/j.1445-1433.2004.02985.x.
    1. Fujii T, et al. Benefit of oral feeding as early as one day after elective surgery for colorectal cancer: oral feeding on first versus second postoperative day. Int Surg. 2014;99:211–215. doi: 10.9738/INTSURG-D-13-00146.1.
    1. Laffitte AM, Polakowski CB, Kato M. Early oral re-feeding on oncology patients submitted to gastrectomy for gastric cancer. Arq Bras Cir Dig. 2015;28:200–203. doi: 10.1590/S0102-67202015000300014.
    1. Pisarska M, et al. Laparoscopic Gastrectomy with Enhanced Recovery After Surgery Protocol: Single-Center Experience. Med Sci Monit. 2017;23:1421–1427. doi: 10.12659/msm.898848.
    1. Hur H, Si Y, Kang WK, Kim W, Jeon HM. Effects of early oral feeding on surgical outcomes and recovery after curative surgery for gastric cancer: pilot study results. World J Surg. 2009;33:1454–1458. doi: 10.1007/s00268-009-0009-3.
    1. Shimizu N, et al. Effect of early oral feeding on length of hospital stay following gastrectomy for gastric cancer: a Japanese multicenter, randomized controlled trial. Surg Today. 2018;48:865–874. doi: 10.1007/s00595-018-1665-4.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren