Development of a Perioperative Enteral Nutrition Program for Gastric Cancer Surgery

Abstract

Objective: This study aimed to summarize the current evidence-based approach to perioperative enteral nutritional (EN) program for gastric cancer (GC) surgery and to develop a staged and operable EN management scheme based on the evidence to provide clinical guidance for improving perioperative EN management in patients with GC.

Methods: First, we synthesized expert consensuses, systematic reviews, and guidelines related to GC patients who had undergone surgery, based on a review of the literature and expert meetings. Subsequently, after carefully evaluating and selecting relevant EN management data, we created a preliminary draft of a perioperative EN program. Following Delphi expert consultations, the final version of the perioperative EN program was constructed after revision.

Results: After two rounds of consultation, the expert opinions tended to be consistent. The expert positive coefficient was 1.00, and the expert authority coefficient was 0.90. After the second round of consultation, the coefficient of variation of the importance score ranged from 0.05 to 0.20, and the coefficient of variation of the feasibility score ranged from 0.09 to 0.23. The Kendall harmony coefficients were 0.338 and 0.392, and the difference between them was statistically significant (p < 0.001). The final practice plan includes 4 first-level, 16 s-level, and 64 third-level items.

Conclusions: The perioperative EN program constructed in this study is comprehensive in content, feasible, and evidence-based, and can provide insights for clinical improvement.

Ethics statement

The authors assume full responsibility for all aspects of the work and have ensured that any questions related to the accuracy or integrity of any part of the study are appropriately investigated and resolved. All experts who participated in the study provided informed consent and volunteered to do so. The study adhered to the principles outlined in the Declaration of Helsinki (as revised in 2013) and was approved by the Institutional Review Board of The Affiliated Jiangning Hospital of Nanjing Medical University.

Authors’ contributions

All authors contributed to the study’s conception and design. Preparation of materials, data collection, and analysis were performed by J.Z., X.N., and X.Z. The initial draft of the manuscript was written by Y.J.G. and X.Z. All authors provided valuable input and feedback on previous versions of the manuscript. All authors read and approved the final manuscript.

Fundings and resource acquisition was coordinated by X.Z. The quality of the research was supervised by A.L., H.L., and D.Y. All participants provided signed informed consent regarding publishing their data.

Disclosure statement

The authors declare that they have no conflicts of interest to disclose.

Additional information

Funding

This study was funded by Nanjing Health Science and Technology Development Special Fund Project [YKK21230].