The effect of early oral feeding after esophagectomy on the incidence of anastomotic leakage: an updated review

ABSTRACT

Objective: Early oral feeding (EOF) is considered to be an important component of enhanced recovery after surgery (ERAS), but raises the concern of increased risk of anastomotic leakage (AL) in patients receiving esophagectomy. This review aimed to elucidate the correlation of EOF and the incidence of AL after esophageal resection.

Methods:: We searched PubMed, Web of Science, Scopus, Cochrane Library and Google Scholar from their inception to February 2020 for published articles that compared AL after EOF (oral feeding initiated within postoperative day [POD] 3) vs. conventional feeding regimen (nil-by-mouth with enteral tube nutrition support, until oral feeding since POD 4 and beyond) following esophagectomy.

Results: A total of 11 full articles were included in this review, including 5 registered randomized controlled trials (RCTs) and 6 observational studies that compared EOF with conventional care after esophagectomy. Meta-analysis was not possible due to significant heterogeneity, bias, and small sample sizes. Among the 11 included studies, 9 (including the 5 RCTs) showed that EOF did not increase AL rate, whereas the other 2 retrospective studies indicated that delayed oral feeding resulted in fewer AL.

Conclusions: EOF after esophagectomy probably does not increase the incidence of AL, and it is a promising strategy in line with the essence of ERAS. However, more and better evidence from high-quality RCTs are still needed.

KEYWORDS:

• Early oral feeding (EOF)
• fast-track surgery
• enhanced recovery after surgery (ERAS)
• pseudo-ERAS
• esophagectomy

Reviewers' disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of Interest

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was funded by Zhejiang Medical and Health Research Fund Project (2018KY171), Zhejiang Science and Technology Agency Experimental Animal Project (2018C37104), and Innovative and Entrepreneurial Talent Introduction Plan of Jiangsu Province (2-2016SC01 and 2-2016SC04).