Safety of Early Oral Feeding After Laparoscopic Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis

This meta-analysis aimed to evaluate the safety of early oral feeding for gastric patients undergoing laparoscopic gastrectomy. We searched the PubMed, Embase, Web of Science, CINAHL, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases to collect randomized controlled trials from January 1995 to April 2021. STATA version 15.0 and RevMan version 5.3 were used to analyze the data. The results were presented and analyzed by the weighted mean difference (WMD) and relative risk (RR) and their 95% confidence interval (CI). Finally, sixteen randomized controlled trials with 1567 patients were included in our meta-analysis. The results revealed that early oral feeding decreased the incidence of postoperative complications (RR = 0.71; 95% CI, 0.55 to 0.92; P = 0.009), but did not increase the incidence of anastomotic leakage (RR = 0.57; 95% CI, 0.24 to 1.35; P = 0.20), gastrointestinal intolerance (RR = 0.99; 95% CI, 0.53 to 1.84; P = 0.97), intestinal obstruction (RR = 0.47; 95% CI, 0.20 to 1.08; P = 0.08), or readmission (RR = 2.35; 95% CI, 0.35 to 15.58; P = 0.38) in gastric cancer patients after laparoscopic gastrectomy. A faster time to first exhaust was recorded in fourteen studies, ranging from − 0.15 days to − 3.3 days. The results of the meta-regression analysis showed that there was a significant correlation between operation time and the first defecation time (P = 0.01). A faster time to first defecation was recorded in six studies, ranging from − 0.5 days to − 1.6 days. Early oral feeding was associated with a decreased postoperative hospital stay, ranging from − 0.9 to − 5.1 days. Furthermore, early oral feeding significantly reduced hospital costs (WMD =  − 0.36; 95% CI, − 0.51 to − 0.21; P < 0.00001). The study showed that early oral feeding can reduce the incidence of postoperative complications, promote exhaust and defecation, and shorten the postoperative hospital stay, thus reducing hospital costs without increasing the readmission rate.