Enteral Versus Parenteral Nutrition For Patients Undergoing Resection Of Stomach, Pancreatic And Esophageal Malignancies: A Meta-analysis Of Randomized Controlled Trials

Objective: This study aims to find out whether early enteral nutrition is superior to total parenteral nutrition in the early course after resection of stomach, pancreatic and esophageal malignancy using meta-analysis. BackgroundThe choice of early postoperative enteral nutrition versus parenteral nutrition after resection of stomach, pancreatic and esophageal malignancies has been a debatable subject with no definitive consensus as which would bring better outcomes. Methods: Randomized controlled trials comparing early enteral nutrition versus total parenteral nutrition in the early course after resection of stomach, pancreatic and esophageal malignancy were included. Endpoints were any complication, infective complication, non-infective complication, major complication, mortality, sepsis score, inflammatory response, intestinalfunction, costs, and length of hospital stay. Results: Eight randomized controlled trials including 594 patients (51% early enteral, 49% total parenteral) were included. The heterogeneity was negligible across and within studies. The rate of patients with any complication was significantly reduced with enteral versus parenteral (34.3% versus 44.4%, odds ratio [OR] =0.66, 95% confidence interval [CI], 0.44-0.98). But there were no significant differences in the rate of patients with infective, non-infective and major complication. Sepsis score and inflammatory response which were relating to infection favored enteral nutrition. Mortality was similar between nutritional support patterns. Recovery of intestinal function was faster in enteral group. Enteral nutrition reduced costs and also shortened length of hospital stay.Conclusions: This meta-analysis suggests that enteral nutrition could reduce rate of patients with any complication, make intestinal function recover faster and shorten length of hospital stay, but there was no significant difference in the rate of patients with infective complication. Finally, high-quality randomized controlled studies are required for further conclusions.