Early Oral Feeding Research Articles

Oral feeding commencement following free or pedicle flap reconstruction for oral cancer: Experience from a tertiary referral centre

Head and neck cancer (HNC) resections may include free or pedicle flap reconstruction. Post-operative feeding practices vary and many centres adopt a conservative approach of 6–12 days ‘nil by mouth’ period to allow surgical healing and avoid complications. Recent studies have assessed the safety of early oral feeding, but literature on free flaps is limited. Aim of this study was to examine oral feeding practices in HNC post flap reconstructions. A retrospective consecutive case-series in a tertiary, centralised London centre. Data was collected on demographics (age, gender, tumour site/stage), tracheostomy, type of flap, complications, post-operative days of oral diet initiation and enteral feeding, and length of stay (LOS). Exclusion criteria included previous radiotherapy, ear/nose/throat or non-SCC tumours or lack of reconstructive surgery. 35 patients were included (n = 19 male (54.3%) n = 16 female (45.7%) with a mean age of 61.2 years. 68.6% (n = 24) underwent a free flap and 31.4% (n = 11) pedicle flap. Oral diet initiation was a mean of 11.9 days. Post-operative LOS was a median of 15 days ranging from 3-44 days. Linear regression indicated a weak positive correlation between post-operative oral diet initiation and LOS (R 2 = 0.2937) and between post-operative length of enteral feeding and LOS (R 2 = 0.4542). Traditional approaches for post-operative feeding practices existed in this centre. Weak relationship was observed between earlier commencement of oral diet and shorter LOS. Further research is required to establish a causal relationship between safe early feeding, early discharge and qualitative studies investigating attitudes for early feeding. • Post-operative feeding practices following free flap surgery for head and neck cancer (HNC) vary. • No nationally agreed recommendations exist on when to initiate oral diet post operatively in HNC. • Early oral feeding is gaining momentum as part of enhanced recovery protocols but is not well defined. • A weak relationship was observed between earlier commencement of oral diet and shorter LOS. • Further research is required to establish the efficacy of safe early oral feeding.

The safety of neoadjuvant chemotherapy combined with non-tube nofasting fast-track surgery for esophageal carcinoma.

Our non-tube no fasting (early oral feeding and no nasogastric tube) fast-track surgery (FTS) was safe and effective to combine with neoadjuvant chemotherapy for McKeown minimally invasive esophagectomy. In addition, the two groups were similar in terms of the recovery time, hospital discharge day, and early resumption of oral feeding.ObjectivesTo evaluate the safety of early oral feeding (EOF) combined with neoadjuvant chemotherapy (NAC) of esophagectomy.Summary Background DataOur non-tube no fasting (early oral feeding and no nasogastric tube) fast-track surgery (FTS) was safe and effective for primary surgery esophageal cancer patients.MethodsWe retrospectively evaluated consecutive patients who underwent non-tube no fasting and McKeown minimally invasive (MIE). They were divided into two groups: one received NAC, and the other received primary surgery. Complications after the operation, postoperative CRG complications, operative time, operative bleeding, and length of stay were evaluated.ResultsBetween 01/2014 and 12/2017, there hundred and eighty two consecutive patients underwent MIE with total two-field lymphadenectomy under the non-tube no fasting fast-track surgery program. A total of 137 patients received NAC, and 245 accepted primary surgery. Propensity score matching was used to compare NAC patients with 62 matched patients from each group. The NAC group had a similar number of total complications as the primary surgery group (32.26% in the primary surgery group vs. 25.81% in the NAC group; p=0.429) and had the same median postoperative hospitalization duration (8 days, p=0.723).ConclusionsAfter McKeown MIE, the patients receiving NAC combined with “non-tube no fasting” FTS had a similar incidence of postoperative complications outcomes as those without NAC. In addition, the two groups were similar in terms of the recovery time, hospital discharge day, and early resumption of oral feeding.

Comparison between Early and Standard Oral Feeding After Emergency Bowel Surgery

Background: Laparotomy for small intestinal diseases accounts for a sizable proportion of all emergency operations. The perioperative outcome of these procedures may be enhanced by applying an adapted enhanced recovery after surgery (ERAS) regimen supported by evidence. Aim: This research aimed to appraise the outcomes of near-the-beginning feeding to those of normal eating in patients who had undergone emergency surgery on their digestive tracts (GI) or bowels. Methodology: This study was conducted at the departments of general surgery HMC Peshawar and Nishtar Hospital, Multan. Between November 2021 and April 2022, the data was collected from 84 patients who required emergency intestinal resection and anastomosis. Patients were not eligible if they had short bowel syndrome, intestinal ischemia, protracted bowel perforation, or septic shock. The patients were divided into two groups, those who began eating earlier (group E; n=44) and those who began eating later (group L; n=40). Early feeding entailed starting enteral nutrition within 48 hours of surgery. The surgical and clinical outcomes of the early feeding group were appraised to those of the late feeding cluster. Results: Bowel perforation was the most prevalent reason for surgery, and the miniature intestine was nearly all common areas affected. There was no meaningful difference in the origins, places, or interventions between the two sets of participants. Group L, on the other hand, had a much higher incidence of pulmonary issues (13.6 per cent vs 47.5 per cent, p=0.001) and an extended mean length of stay (LOS) in the ICU (2 days vs 1 day, p=0.038) and hospital (9 days vs 12 days, p=0.012).

Study protocol for feasibility and safety of adopting early oral feeding in post total laparoscopic total gastrectomy (overlap esophagojejunostomy): A multicentre randomized controlled trial.

BackgroundTotal laparoscopic total gastrectomy (TLTG) for gastric cancer, especially with overlap esophagojejunostomy, has been verified that it has advantages of minimally invasion, less intraoperative bleeding, and faster recovery. Meanwhile, early oral feeding (EOF) after the operation has been demonstrated to significantly promote early rehabilitation in patients, particularly with distal gastrectomy. However, due to the limited application of TLTG, there is few related research proving whether it is credible or safe to adopt EOF after TLTG (overlap esophagojejunostomy). So, it is urgent to start a prospective, multicenter, randomized clinical trials to supply high level evidence.Methods/designThis study is a prospective, multicenter, randomized controlled trial with 200 patients (100 in each group). These eligible participants are randomly allocated into two different groups, including EOF group and delay oral feeding (DOF) group after TLTG (overlap esophagojejunostomy). Anastomotic leakage will be carefully observed and recorded as the primary endpoints; the period of the first defecation and exhaust, postoperative length of stay and hospitalization expenses will be recorded as secondary endpoints to ascertain the feasibility and safety of adopting EOF after TLTG (overlap esophagojejunostomy).DiscussionRecently, the adoption of TLTG was limited due to its difficult anastomotic procedure, especially in vivo esophagojejunostomy. With the innovation and improvement of operating techniques, overlap esophagojejunostomy with linear staplers simplified the anastomotic steps and reduced operational difficulties after TLTG. Meanwhile, EOF had received increasing attention from surgical clinicians as a nutrition part of enhanced recovery after surgery (ERAS), which had shown better results in patients after distal gastrectomy. Considering the above factors, we implemented EOF protocol to evaluate the feasibility and safety of adopting EOF after TLTG (overlap esophagojejunostomy), which provided additional evidence for the development of clinical nutrition guidelines.Clinical trial registration[www.chictr.org.cn], identifier [ChiECRCT20200440 and ChiCTR2000040692].

Role of intraoperative feeding jejunostomy in esophageal cancer surgery

BackgroundFeeding jejunostomy was routinely placed during esophagectomy to ensure postoperative enteral feeding. Improved anastomosis technique and early oral feeding strategy after esophagectomy has led to question the need for the routine placement of feeding jejunostomy. The aim of this study is to evaluate role of feeding jejunostomy during Ivor Lewis operation.MethodsWe retrospectively reviewed 414 patients who underwent the Ivor Lewis operations from January 2015 to December 2018.Results61 patients (14.7%) received jejunostomy insertion. The most common indication for jejunostomy was neoadjuvant concurrent chemoradiation therapy (CCRT). 48 patients (79%) had jejunostomy removed within 60 days after the surgery and the longest duration of jejunostomy inserted state was 121 days. About two-third of the patients with jejunostomy had never prescribed with an enteral feeding product. Among 353 patients without intraoperative feeding jejunostomy, 11(3.1%) received delayed jejunostomy insertion. Graft-related problems (6 patients), cancer progression (3 patients), acute lung injury (1 patient), and swallowing difficulty (1 patient) were reasons for delayed feeding jejunostomy insertion. Complication rate was relatively high as 24 patients (33.3%) out of 72 patients with jejunostomy insertion had complications and 7 patients (9.7%) visited ER more than twice with jejunostomy-related complications.ConclusionOnly 3.6% patients who underwent the Ivor Lewis operation during 4-year span had anastomosis leakage. Although one-third of the patients with jejunostomy were benefited with alternative method of feeding after discharge, high complication rate regarding jejunostomy should be also considered. We believe feeding jejunostomy should not be applied routinely with prophylactic measures and should be reserved to very carefully selected patients with multiple high-risk factors.

The effect of early oral postoperative feeding on the recovery of intestinal motility after gastrointestinal surgery: Protocol for a systematic review and meta-analysis.

Given the ever-shorter length of hospital stay after surgical procedures, nowadays it is more important than ever to study interventions that may have an impact on surgical patients' wellbeing. According to the ERAS (Enhanced Recovery After Surgery protocols) program, early feeding must be considered one of the key components to facilitate early recovery while improving outcomes and patients' overall experiences. To date, the international literature has reported that early postoperative feeding compared with traditional (or late) timing is safe; nevertheless, small clinical outcomes effects has been reported, also for recovery of gastrointestinal function. Therefore, the effectiveness of early postoperative feeding to reduce postoperative ileus duration remains still debated. To analyse the effects of early versus delayed oral feeding (liquids and food) on the recovery of intestinal motility after gastrointestinal surgery. Pubmed, Embase, Cinahl, Cochrane Central Register of Controlled Trials (CENTRAL), and the ClincalTrials.gov register will be searched to identify the RCTs of interest. Randomized clinical trials (RCTs) comparing the effect of early postoperative versus late oral feeding on major postoperative outcomes after gastrointestinal surgery will be included. Two review authors will independently screen titles and abstracts to determine the initially selected studies' inclusion. Any disagreements will be resolved through discussion and consulting a third review author. The research team members will then proceed with the methodological evaluation of the studies and their eligibility for inclusion in the systematic review.

Thinking and suggestions on pathway management of perioperative enhanced recovery after surgery in gastrointestinal tumors in China

Enhanced recovery after surgery (ERAS) is a multimodal perioperative care program to decrease the risk of delayed hospitalization, medical complications, readmission and to improve patient short- and long-term outcomes with minimized level of surgical stress responses through multidisciplinary cooperation. Despite its huge success, the program has challenges for further optimization with a primary focus on modification according to the specific pathophysiology and perioperative management characteristics of patients with gastrointestinal tumors to improve the compliance and implementation rate of items. Patient education, prehabilitation, multimodal analgesia, precision surgery, early mobilization, early oral feeding and oral nutrition supplement (ONS) should be regarded as core terms suitable for all the patients. During the application of ERAS pathway management, it is necessary to fully understand the perioperative changes of organ function and pathophysiology, and to strictly implement the ERAS program and items based on evidence-based medicine. Moreover, the close collaboration of multidisciplinary teams is needed to improve the compliance and increase the adherence rate of ERAS protocol for patients, which emphasizes the dynamic, gap-free and whole course management that covers pre-hospital, pre-operative, intra-operative, post-operative and post-hospital periods. Concurrently, we encourage our patients and their families to participate in the whole healthcare activities. Even more concerning, it is indispensable to adjust ERAS program for special time and special patients. At present, several consensus and guidelines on the ERAS management of gastrointestinal tumor surgery have come out for clinical practice in China, which, however, still lacks a high-level evidence from more high-quality clinical trials conducted by Chinese researchers. It is urgent to carry out a series of large-scale randomized controlled studies in accordance with international standards to obtain high-level evidence-based medical evidence for clinical practice, which is problem-oriented and integrated with features of metabolism and perioperative management of gastrointestinal tumor surgery.

Nutrition in acute pancreatitis: when, what and how.

This review intends to discuss recently available evidence in three topics related to nutrition in patients with acute pancreatitis, namely timing of refeeding, type of nutritional therapy and its route of administration. Recent lines of research confirm that early oral feeding leads to shorter length of stay, fewer complications and lower costs in patients with acute pancreatitis. Moreover, early (<48 h) enteral nutrition led to decreased hospital mortality in patients with mild and severe acute pancreatitis; thus, in case of intolerance to oral feeding or severe disease, nutritional therapy should be offered within 24-72 h. Furthermore, enteral nutrition should be preferred against parenteral nutrition, as it is related to shorter length of stay and less complications, while initial data bring to light the potential role of the soluble dietary fibre polydextrose as an agent that could lead to faster achievement of energy goal with concomitant lower rates of feeding intolerance. Finally, enteral nutrition can be administered through gastric or jejunal feeding, depending on digestive tolerance, whereas latest data also address the safety of percutaneous gastrostomy with a jejunal extension for enteral nutrition administration. However, more data about its real benefit are warranted. Accumulating evidence confirms the importance of early oral refeeding or early administration of enteral nutrition as vital parts of the armamentarium for the management of patients with acute pancreatitis.

Early oral feeding after esophagectomy accelerated gut function recovery by regulating brain-gut peptide secretion

BackgroundThe impact of early oral feeding after esophagectomy on brain-gut peptide secretion and gut function recovery has not been well investigated. This study aimed to fill this research gap. MethodsThis study was based on a randomized clinical trial (ClinicalTrials.gov: NCT01998230). The patients in the early oral feeding group started oral food intake on postoperative day 1. In the late oral feeding group, nasogastric/nasoenteral feeding was applied from postoperative day 1 to 7, after which the patients began oral food intake. Serum brain-gut peptides were selected as the primary end points and tested before surgery and on postoperative days 1, 3, and 5. The time to first flatus and first defecation after surgery were evaluated. ResultsA total of 110 participants undergoing minimally invasive McKeown esophagectomy were prospectively included, with 63 patients in the early oral feeding group and 47 patients in the late oral feeding group. The distribution of clinicopathological characteristics was balanced between the 2 groups. Perioperative dynamic surveillance demonstrated higher serum concentrations of excitatory brain-gut peptides (gastrin P = .021, motilin P = .027, and substance-P P = .023) and lower serum concentrations of inhibitory brain-gut peptides (cholecystokinin P = .004 and somatostatin P = .019) in the early oral feeding group. Perioperative serum levels of brain-gut peptides correlated with postoperative early flatus and defecation. The multivariate analysis showed early oral feeding (versus late oral feeding) to be an independent predictive factor for early flatus and defecation (hazard ratio 2.40, P < .001; hazard ratio 2.73, P < .001, respectively). ConclusionThe early oral feeding program may accelerate the recovery of gut function by regulating brain-gut peptide secretion. Brain-gut peptides are possible treatment targets to improve early oral feeding benefits and promote personalized early oral feeding programs.

Early oral feeding following duodenal resection and anastomosis: stressor or succour – a dog model

The effects of early oral feeding (EOF) on vital parameters and some stress markers after intestinal surgery was the focus of this study. Sixteen (16) Nigerian indigenous dogs were randomly assigned to 4 groups (n=4) which underwent duodenal resection and end-to-end anastomosis. Post operatively, group I animals were maintained on total parenteral nutrition (TPN) for 3 days while groups II-IV animals had parenteral nutrition with oral feeding instituted at 8, 12 and 24 hours respectively. The animals were monitored for side effects of TPN and EOF and post-operative complications. Vital parameters and some stress markers like the glucose and cortisol levels were monitored. The Mean heart and pulse rates of group I (TPN) animals were significantly (P &lt;0.05) higher than those of the EOF groups. The EOF groups had higher body weight post-operatively. On post-surgery day (PSD) 1, the mean glucose level of group I animals was significantly lower than those of group IV, while the mean cortisol values in all the groups showed a similar increase post-operatively which declined gradually after PSD 1. Therefore, EOF given 8, 12 or 24 hours after intestinal surgery is feasible, safe and more convenient, and improves nutritional status of dogs.

Optimized perioperative management (fast-track, ERAS) to enhance postoperative recovery in elective colorectal surgery.

Aim: This manuscript provides information on the history, principles, and clinical results of Fast-track or ERAS concepts to optimize perioperative management (OPM).Methods: With the focus on elective colorectal surgery description of the OPM concept and its elements for with special attention to the prevention of infectious complications and clinical results compared to traditional care will be given using recent systematic literature reviews. Additionally, clinical results for other major abdominal procedures are given.Results: An optimized perioperative management protocol for elective colorectal resections will currently consist of 25 perioperative elements. These elements include the time from before hospital admission (patient education, screening, and treatment of possible risk factors like anemia, malnutrition, cessation of nicotine or alcohol abuse, optimization of concurrent systemic disease, physical prehabilitation, carbohydrate loading, adequate bowel preparation) to the preoperative period (shortened fasting, non-sedative premedication, prophylaxis of PONV and thromboembolic complications), intraoperative measures (systemic antibiotic prophylaxis, standardized anesthesia, normothermia and normovolemia, minimally invasive surgery, avoidance of drains and tubes) as well as postoperative actions (early oral feeding, enforced mobilization, early removal of a urinary catheter, stimulation of intestinal propulsion, control of hyperglycemia). Most of these elements are based on high-level evidence and will also have effects on the incidence of postoperative infectious complications.Conclusion: Optimized perioperative management should be mandatory for elective surgery today as it enhances postoperative patient recovery, reduces morbidity and infectious complications.

The current and future role of nurses within enhanced recovery after surgery pathways.

Enhanced recovery after surgery (ERAS) pathways have been proven to expedite recovery after many procedures and reduce lengths of stay in hospital and surgical complications. However, improvements are still needed, especially in postoperative ERAS components delivered by nurses such as early mobilisation and oral feeding. This article summarises the current and possible future role of nurses within ERAS, and recommends areas for future research. Nurses are the professionals who spend the most time with patients throughout the perioperative pathway and are known to play a vital role in delivering many components of an ERAS pathway. They frequently co-ordinate care across disciplines and ensure continuity of care. However, there is a paucity of ERAS research specific to nurses compared to other professional groups. Continual training on ERAS will be required to ensure nurses are highly educated and for the best possible ERAS implementation. In certain types of surgery, nurses may fulfil extended roles in the postoperative period, such as taking over responsibility and leadership for co-ordinating pain management, mobilisation and discharge. However, this requires a well-defined care programme, a clear definition of nursing responsibilities from surgeons, agreed discharge criteria and highly qualified nurses, along with the collection and analysis of data to test safety and efficacy. Increasing nurse involvement in ERAS research is vital to drive improvements in care and to develop nursing roles. Nurses should have a major role in the preoperative clinic, the early postoperative phase and the follow-up post-discharge period, where the benefits of ERAS need to be further documented.

Detection of Marek’s Disease Virus Serotypes 1, 2 and 3 in Poultry Flocks using PCR Technique in South-Western-Nigeria

The effects of early oral feeding (EOF) on vital parameters and some stress markers after intestinal surgery was the focus of this study. Sixteen (16) Nigerian indigenous dogs were randomly assigned to 4 groups (n=4) which underwent duodenal resection and end-to-end anastomosis. Post operatively, group I animals were maintained on total parenteral nutrition (TPN) for 3 days while groups II-IV animals had parenteral nutrition with oral feeding instituted at 8, 12 and 24 hours respectively. The animals were monitored for side effects of TPN and EOF and post-operative complications. Vital parameters and some stress markers like the glucose and cortisol levels were monitored. The Mean heart and pulse rates of group I (TPN) animals were significantly (P &lt;0.05) higher than those of the EOF groups. The EOF groups had higher body weight post-operatively. On post-surgery day (PSD) 1, the mean glucose level of group I animals was significantly lower than those of group IV, while the mean cortisol values in all the groups showed a similar increase post-operatively which declined gradually after PSD 1. Therefore, EOF given 8, 12 or 24 hours after intestinal surgery is feasible, safe and more convenient, and improves nutritional status of dogs.

Safety and benefits of early oral nutrition as part of the fast-track program among patients who have undergone gastrectomy for stomach cancer

Over the past decade, stomach cancer continues to be one of the most common diseases in the world. Currently, the methods of conservative and surgical treatment of this disease are fairly standardized. However, the issue of postoperative management of patients, including the timing of the start of oral nutrition after surgery still remains debatable. In addition, modern methods of treatment are based on the use of protocols for enhanced recovery after surgery, the safety of which remains controversial and requires discussion.Study object was to explore the safety and benefits of early oral nutrition among patients who have undergone gastrectomy for stomach cancer.Material and methods. The authors present their own experience of nutritional support for patients who underwent gastrectomy. The study included 82 patients with locally advanced stomach cancer who received surgical treatment at the n.i. Pirogov clinic of high medical technologies in the period from 2016 to 2019.Results. The safety and positive effect of the use of early oral feeding was proved. It was associated with shorter first exhaust time (2.8 ± 1.0 days vs 3.9 ± 1.2 days, p=0.001), shorter postoperative length of stay in the hospital (5.4 ± 1.5 days vs 9.5 ± 2.3 days; p=0.001), as well as a more dynamic recovery of laboratory parameters.Conclusion. Early per oral nutrition after gastrectomy can reduce the length of hospital stay without increasing the incidence of concomitant complications, which indicates its safety, expediency and potential benefit for patients with gastric cancer.

Early oral feeding after gastrointestinal anastomosis

To allow healing of the anastomotic site, nil-by-mouth is widely practiced for several days after resection and anastomosis of gastrointestinal. This study determines the feasibility and safety of early oral feeding following gastrointestinal resections and anastomoses. This prospective study included consecutive patients who underwent gastrointestinal resection from June 2016 to June 2021. These patients divided into two groups, according to their postoperative feeding protocol. The early oral feeding group received oral diet on the first postoperative day, while the late oral feeding group were started on oral feeding after the passage of flatus. No significant differences were found in tolerance to oral feeding (p = 0.230) and the postoperative complications (p = 0.253) between the two groups. Compared with the late oral feeding group, time to first flatus, bowel movement and length of postoperative hospital stay were significantly shorter in the early oral feeding group (for all p = 0.002). Early oral feeding after gastrointestinal anastomosis is feasible and safe.

Patient experience of the acute post-surgical period following total laryngectomy during the COVID-19 era.

BackgroundTotal laryngectomy (TL) results in permanent functional changes requiring rapid development of complex new skills. A significant portion of this learning happens in the acute post‐surgical stage. There is increasing interest in enhanced recovery after surgery (ERAS) protocols in TL; however, implementation has been difficult. COVID‐19 has placed significant pressures on acute services, requiring rapid service changes for TL patients.AimsTo understand the acute patient experience of having a TL both before and during COVID‐19.Methods & ProceduresSemi‐structured interviews using a pre‐designed topic guide were conducted with 10 people who had undergone a TL within the last 2 years. Participants were recruited by their speech and language therapists using purposive sampling. Braun and Clarke's iterative approach to data collection and thematic analysis was used to generate key themes from the data.Outcomes & ResultsThematic analysis identified four main themes: (1) pre‐operative information‐giving: ‘it was just words’; (2) decision‐making influences: ‘I just wanted them to get it all out and get it over with’; (3) coping with adjustment to the new normal: ‘this is part of me now’; and (4) the importance of relationship‐building: ‘when you've had something like this, you need some care and understanding’.Conclusions & ImplicationsThe need for an individualized approach to TL intervention which incorporates medical and psycho‐social approaches from pre‐treatment to acute discharge is vital. ERAS models should be reviewed to shift beyond the medical model alone. Rapid service changes due to COVID‐19 did not contribute any major changes to the acute patient‐reported experience.What this paper addsWhat is already known on the subject We know that ERAS protocols have the potential to improve patient outcomes following TL. However, the research does not consider anything other than the early oral feeding debate and it has therefore been difficult to implement ERAS protocols in current service models. COVID19 required head and neck cancer services to make quick changes to surgical pathways, with the potential that some ERAS protocols had been adopted inadvertently. In order to understand the impact of this, we need to understand the patient experience following TL both before and during COVID19. What this paper adds to existing knowledge This paper used qualitative interviews to understand the acute patient experience following TL both during and before COVID19. Findings from these interviews highlighted that people were on the most part, well prepared for the functional changes they would experience after surgery. However, people felt there were gaps in service delivery at the pre‐treatment and early discharge home period. Overall, the gaps identified were from a more psycho‐social need suggesting that future ERAS models of care should consider both medical and psycho‐social principles to enhance patient experience and outcome. What are the potential or actual clinical implications of this work? Pre‐treatment services provided to people who have a TL could be reviewed to help maximize long‐term adjustment to life. Areas which could be reviewed include the method and mode of information delivery. Further work needs to be done in partnership with community services to improve the immediate discharge home experience.

Resectable Gastric Adenocarcinoma Cancer and the Role of Early Feeding on Clinical Outcome

&#x0D; Background: Gastric adenocarsinoma is one of the most common gastrointestinal tract cancer, it could be found either in elderly or young patients. Surgical resection is still the main therapeutic option and the gold standard for the resectable cases. Enhanced recovery protocols has been announced to improved the clinical outcome in of gastrointestinal cancer surgery. Especially in upper GI cancer, which still challenging in starting the oral feeding after surgical resection. We will reported the clincal outcome of early feeding on resectable gastric adenocarsinoma patients.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Methods: This was a retrospective study, taken from January 2018 - December 2020. All resectable gastric adenocarsinoma patients were included. Tumor locations, type of resection and reconstruction were evaluated. All patients had early oral feeding from the first post operative day, continued with liquid and semi solid food. The short term outcome were recorded including the anastomose leakage and surgical site infection. &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Results: We reported eight gastric cancer patients during this study, 1 patient was young gastric cancer patiens and the rest were &gt; 50 years old patients. Gastric anthrum was the most common tumor site with partial gatrectomy and Billroth II have been done. 3 patients were corpus site and 1 case of fundus cancer, total gastrectomy and roux en y esófago-jejunostomy reconstruction was done. &#x0D; &#x0D; &#x0D; We found no anastomosis leakage. No SSI and no readmission associated with post operative morbidity. &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Conclusion: Early feeding on resectable gastric adenocarsinoma patients was feasibel, has good clinical outcomes and could tolerated well, no matter what type of gastric resection we did.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Impact of Early Oral Feeding on Nasogastric Tube Reinsertion After Elective Colorectal Surgery: A Systematic Review and Meta-Analysis.

BackgroundColorectal cancer is a common malignant tumor appearing in the gastrointestinal tract. Surgical resection is recognized as the best means to improve patient survival. However, it is controversial whether early oral feeding (EOF) after elective colorectal resection demonstrates safety and efficacy in concerned clinical outcomes.MethodsWe searched PubMed, Embase, Cochrane Library, and CNKI from inception to September 2021. Two authors independently screened the retrieved records and extracted data. EOF was defined as feeding within 24 h after surgery, while traditional oral feeding (TOF) was defined as feeding that started after the gastrointestinal flatus or ileus was resolved. The primary outcome was nasogastric tube insertion, and the secondary outcomes were the length of hospital stay and total complications. Categorical data were combined using odds ratio (OR), and continuous data were combined using mean difference (MD).ResultsWe screened 10 studies from 34 records after full-text reading, with 1,199 patients included in the analysis. Nasogastric tube reinsertion (OR 1.69; 95% CI 1.08 to 2.64, p=0.02) was more frequent in the EOF group, and older ages (>60 years) were associated with higher risk of nasogastric tube reinsertion (OR 2.05; 95% CI 1.05 to 3.99, p = 0.04). Reduced length of hospital stay (MD −1.76; 95% CI −2.32 to −1.21; p < 0.01) and the rate of total complications (OR 0.49; 95% CI 0.37 to 0.65, p < 0.01) were observed in EOF compared with TOF.ConclusionsEOF was safe and effective for patients undergoing elective colorectal surgery, but the higher rate of nasogastric tube reinsertion compared with TOF should not be ignored.

Attitudes towards Enhanced Recovery after Surgery (ERAS) interventions in colorectal surgery: nationwide survey of Australia and New Zealand colorectal surgeons

BackgroundWhilst Enhanced Recovery after Surgery (ERAS) has been widely accepted in the international colorectal surgery community, there remains significant variations in ERAS programme implementations, compliance rates and best practice recommendations in international guidelines.MethodsA questionnaire was distributed to colorectal surgeons from Australia and New Zealand after ethics approval. It evaluated specialist attitudes towards the effectiveness of specific ERAS interventions in improving short term outcomes after colorectal surgery. The data were analysed using a rating scale and graded response model in item response theory (IRT) on Stata MP, version 15 (StataCorp LP, College Station, TX).ResultsOf 300 colorectal surgeons, 95 (31.7%) participated in the survey. Of eighteen ERAS interventions, this study identified eight strategies as most effective in improving ERAS programmes alongside early oral feeding and mobilisation. These included pre-operative iron infusion for anaemic patients (IRT score = 7.82 [95% CI: 6.01–9.16]), minimally invasive surgery (IRT score = 7.77 [95% CI: 5.96–9.07]), early in-dwelling catheter removal (IRT score = 7.69 [95% CI: 5.83–9.01]), pre-operative smoking cessation (IRT score = 7.68 [95% CI: 5.49–9.18]), pre-operative counselling (IRT score = 7.44 [95% CI: 5.58–8.88]), avoiding drains in colon surgery (IRT score = 7.37 [95% CI: 5.17–8.95]), avoiding nasogastric tubes (IRT score = 7.29 [95% CI: 5.32–8.8]) and early drain removal in rectal surgery (IRT score = 5.64 [95% CI: 3.49–7.66]).ConclusionsThis survey has demonstrated the current attitudes of colorectal surgeons from Australia and New Zealand regarding ERAS interventions. Eight of the interventions assessed in this study including pre-operative iron infusion for anaemic patients, minimally invasive surgery, early in-dwelling catheter removal, pre-operative smoking cessation, pre-operative counselling, avoidance of drains in colon surgery, avoiding nasogastric tubes and early drain removal in rectal surgery should be considered an important part of colorectal ERAS programmes.

Management of oral feeding following total laryngectomy around the world: YO-IFOS international study.

To analyze worldwide practices regarding the initiation of oral feeding after total laryngectomy (TL). Online survey. Among the 332 responses received, 278 from 59 countries were analyzed. Our results showed that 45.6% of respondents started water and 45.1% started liquid diet between postoperative days 7 and 10. Semi-solid feeds were initiated between days 10 and 14 for 44.9% of respondents and a free diet was allowed after day 15 for 60.8% of respondents. This timing was significantly delayed in cases of laryngo-pharyngectomy and after prior radiotherapy (p < 0.001). A greater proportion of respondents in Africa and Oceania allowed early oral feeding before day 6 as compared with the rest of the world (p < 0.001). Despite increasing number of publications, there is still a lack of evidence to support early oral feeding. The majority of respondents preferred to delay its initiation until at least 7 days after surgery.