Efficacy and safety of enteral nutrition in preoperative bowel preparation for colorectal cancer: a meta-analysis

Abstract

Objective To systematically evaluate the efficacy and safety of enteral nutrition in preoperative bowel preparation for colorectal cancer. Methods We searched in multiple databases (i.e. CNKI, Wanfang Data, VIP, PubMed, Coehrane Library, and Web of Science) for studies up to March 2017 that compared the efficacy and safety of enteral nutrition vs. mechanical bowel preparation before surgical treatment of colorectal cancer. Meta-analysis was conducted with RevMan 5.3 to compare the two approaches in terms of postoperative lymphocyte count, complications, anal exhaust time, intestinal cleaning rate, and levels of prealbumin, albumin, hemoglobin, and transferrin. Results A total of 12 randomized controlled trials involving 617 patients were included in this study, where 308 patients received enteral nutrition and 309 had mechanical bowel preparation. The results showed that enteral nutrition was comparable to mechanical bowel preparation in bowel cleaning rate (OR=1.54, 95% CI=0.98-2.41, P=0.06) and anal exhaust time (WMD=-8.14, 95% CI=-18.25-2.07, P=0.12), and it could lead to higher levels of lymphocytes (WMD=0.19, 95% CI=0.06-0.32, P<0.01), prealbumin (WMD=20.16, 95% CI=15.77-20.54, P<0.01), albumin (WMD=2.60, 95% CI=1.69-3.51, P<0.01), hemoglobin (WMD=7.18, 95% CI=3.61-10.75, P<0.01), and transferrin(WMD=0.29, 95% CI=0.12-0.47, P<0.01), and reduce the incidence of postoperative complications (OR=0.18, 95% CI=0.11-0.28, P<0.01). Conclusions Current evidence showed that using enteral nutrition for bowel preparation before surgical treatment of colorectal cancer could improve postoperative profiles of lymphocyte count, prealbumin, albumin, hemoglobin, and transferrin, and reduce complications. This approach should be adopted in the clinic. Key words: Enteral nutrition; Bowel preparation; Colorectal neoplasms; Surgical procedures; Meta-analysis