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.	余帥, 王志剛, 黃敏乾, 等. 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對比研究. 中國胸心血管外科雜志, 2014. 21(4): 498-502.
8.	李磊. 食管癌術后患者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.
9.	趙桂彬, 曹守強, 張愷, 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, 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, 李康軍. 食管癌術后早期腸內營養的療效觀察. 醫學信息, 2011, 9(5): 4319.
12.	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.
13.	吳培仁, 許林, 張志明. 等. 食管癌術后早期腸內腸外營養的對比研究. 中華胃腸外科, 2006, 9(4): 320-322.
14.	徐洪波, 黃和平. 食管癌術后早期腸內營養的臨床應用. 腫瘤, 2007, 27(10): 832-834.
15.	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.
16.	徐衛華, 錢永躍, 徐忠恒. 食管癌術后早期腸內營養的臨床研究. 腸外與腸內營養, 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. 食管癌術后早期腸內營養的臨床應用. 中國醫藥指南, 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. 余帥, 王志剛, 黃敏乾, 等. 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對比研究. 中國胸心血管外科雜志, 2014. 21(4): 498-502.
8. 李磊. 食管癌術后患者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.
9. 趙桂彬, 曹守強, 張愷, 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, 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, 李康軍. 食管癌術后早期腸內營養的療效觀察. 醫學信息, 2011, 9(5): 4319.
12. 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.
13. 吳培仁, 許林, 張志明. 等. 食管癌術后早期腸內腸外營養的對比研究. 中華胃腸外科, 2006, 9(4): 320-322.
14. 徐洪波, 黃和平. 食管癌術后早期腸內營養的臨床應用. 腫瘤, 2007, 27(10): 832-834.
15. 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.
16. 徐衛華, 錢永躍, 徐忠恒. 食管癌術后早期腸內營養的臨床研究. 腸外與腸內營養, 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. 食管癌術后早期腸內營養的臨床應用. 中國醫藥指南, 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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