The Impact of Early Oral Feeding on Post-Operative Morbidity After Esophagectomy: A Systematic Review and Meta-Analysis.

Abstract

Anastomotic leak and post-operative pneumonia are major contributors to postoperative morbidity following esophagectomy and have traditionally led to delays in oral feed initiation. Newer evidence, however, suggests early initiation of feeds may be safe. The aim of this systematic review and meta-analysis is to assess the safety of initiation of oral feeds on postoperative day one versus delayed initiation. A systematic search was conducted on six databases and studies were included if they compared safety outcomes of adult esophagectomy patients initiating feeds on postoperative day one versus delayed imitation. A random-effects meta-analysis with restricted maximum likelihood was performed and study quality was assessed with the Newcastle-Ottawa Scale. Ten studies with a total of 1714 patients were included. Our primary outcome of anastomotic leak showed no significant between the early and delayed oral feeding group (8 studies, OR 0.92, 95% CI 0.59-1.41, p = 0.69). For the secondary outcomes, there was no difference in length of stay (4 studies, mean difference -2.27 days, 95% CI -5.13 to 0.60, p = 0.12) and there was decreased odds of postoperative pneumonia (9 studies, OR 0.74, 95% CI 0.58-0.95, p = 0.02). Initiating oral intake on postoperative day one after esophagectomy does not increase length of stay or risk of anastomotic leak and postoperative pneumonia. These findings support consideration of early oral feeding as a safe component of perioperative care when applied appropriately.