Early Oral Feeding Following McKeown Minimally Invasive Esophagectomy An Open-label, Randomized, Controlled, Noninferiority Trial
Early Oral Feeding Following McKeown Minimally Invasive Esophagectomy An Open-label, Randomized, Controlled, Noninferiority Trial
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DOI：
10.1097/sla.0000000000002304
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发表时间：
2018-03-01
影响因子：
9
通讯作者：
Chang, Andrew C.
中科院分区：
文献类型：
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作者：
Sun, Hai-Bo;Li, Yin;Chang, Andrew C.
目的：我们的目的是评估早期口服喂养（EOF）对McKeown微创食管癌切除术后心脏、呼吸和胃肠道（CRG）并发症的影响。背景资料：食管切除术后常规采用口服零氧联合肠内管喂养。方法：将患者随机分为术后第1天（EOF组）和术后第7天（LOF组）两组。主要终点是术后CRG并发症的发生，次要终点包括肠功能恢复和短期生活质量（QOL）。结果：2014年2月至2015年10月，280例患者入组。EOF组140例，LOF组140例。对于CRG并发症，EOF并不亚于LOF （EOF组为30.0%，LOF组为32.9%；差异的95%可信区间为-13.8%至8.0%）。与LOF组相比，EOF组出现首次放屁（中位数为2天vs. 3天，P = 0.001）和排便（中位数为3天vs. 4天，P < 0.001）的时间明显缩短。术后两周，EOF组患者总体生活质量和功能评分高于LOF组，症状评分低于LOF组。结论：在McKeown微创食管切除术后的患者中，对于术后CRG并发症的护理标准并不逊色。此外，EOF组患者肠功能恢复较快，短期生活质量改善。
Objective: Our objective was to evaluate the impact of early oral feeding (EOF) on postoperative cardiac, respiratory, and gastrointestinal (CRG) complications after McKeown minimally invasive esophagectomy for esophageal cancer.Summary Background Data: Nil-by-mouth with enteral tube feeding is routinely practiced after esophagectomy.Methods: Patients were randomly allocated to receive oral feeding on the first postoperative day (EOF group) or late oral feeding (LOF group) 7 days after surgery. The primary endpoint was the occurrence of postoperative CRG complications, and the secondary outcomes included bowel function recovery and short-term quality of life (QOL).Results: Between February 2014 and October 2015, 280 patients were enrolled in this study. There were 140 patients in the EOF group and 140 patients in the LOF group. EOF was noninferior to LOF for CRG complications (30.0% in the EOF group vs. 32.9% in the LOF group; 95% confidence interval of the difference: -13.8% to 8.0%). Compared with the LOF group, the EOF group showed significantly shorter time to first flatus (median of 2 days vs. 3 days, P = 0.001) and bowel movement (median of 3 vs. 4 days, P < 0.001). Two weeks after the operation, patients in the EOF group reported higher global QOL and function scores and lower symptom scores than patients in the LOF group.Conclusions: In patients after McKeown minimally invasive esophagectomy is noninferior to the standard of care with regard to postoperative CRG complications. In addition, patients in the EOF group had a quicker recovery of bowel function and improved short-term QOL.