Is It A Must Of Inserting Nasogastric Tube After Radical Cystectomy With Urinary Diversion ? A Meta-analysis

Objective:To systematically evaluate the necessity of inserting nasogastric tube after radical cystectomy with urinary diversion.Methods:The PubMed,MEDLINE,Cochrane Library,OVID,Elsevier,CBM,CNKI,VIP and Wanfang databases were searched up to February 2017 to collect the English and Chinese literatures about randomized controlled trials(RCT),Cohort study,and Case-control analysis that compared the individuals with or without nasogastric tube after radical cystectomy with urinary diversion.The reviewers screened the literature,extracted the data and assessed the quality according to the method of Cochrane systematic review,and conducted Meta-analysis with RevMan 5.3 software.We performed the meta-analysis to evaluate the role of nasogastric tube after radical cystectomy with urinary diversion.Result:One randomized controlled trial and one perspective Cohort study and five retrospective Case-Control studies(860 patients)fulfilled the inclusion criteria.There was significant difference between the time(days)commencement of a liquid diet and the development of bowel sounds in patients without nasogastric tube than those with NGT(nasogastric tube)[P < 0.00001,SMD =-0.43,95% CI-0.60 to 0.26,P < 0.0001,standard mean difference(SMD)=-0.35,95% CI-0.52 to-0.18;respectively].Additionally,there was no significant differences in pulmonary complications,wound complication and the paralytic ileus or bowel obstruction [P = 0.25,odds ratio(OR)= 0.60 95% CI 0.25 to 1.43;P = 0.66 OR = 1.16 95% CI 0.60 to 2.25;P = 0.080,OR = 0.55,95% CI 0.29 to 1.07;respectively].Furthermore,the difference of the duration of hospital stay(days)between the NGT group and Without NGT group are obvious.(P = 0.0005,SMD =-0.30,95% CI-0.47 to-0.13).Conclusion:It cannot shorten the time of gastrointestinal function recovery or reduce the incidence of complications after radical cystectomy by using the nasogastric tube;Therefore,we do not recommend the use of nasogastric tube after radical cystectomy with urinary diversion routinely.