Early Versus Traditional Postoperative Oral Feeding In Patients Undergoing Elective Colorectal Surgery:A Meta-analysis Of Safety And Efficacy

Objective:To compare the outcomes of early oral feeding(EOF)and the traditional oral feeding(TOF)on postoperative patients with colorectal cancer using Meta-analysis.Methods:The databases of PubMed,SCI?Ovid?The Cochrane Library ?CNKI ?CBM ?VIP and Wanfang Data were searched to controlled clinical trial about EOF versus TOF in patients undergoing elective colorectal surgery.The retrieval time span was from inception to June 1,2016.The studies were screened according to the inclusion and exclusion criteria,the date were extracted and the quality was evaluated by 2 reviewers independently.And than the Meta-analysis was conducted using RevMan 5.2 software.Results:The results of this Meta-analysis included 14 randomized controlled trials,a total of 1807 cases of patients.The time to first passage of flatus [MD=-16.11 h,95%CI(-18.27~-13.94 h),P<0.00001],postoperative hospital stay [MD=-1.92 d,95%CI(-2.83~-1.01 d),P<0.0001],hospitalization cost[MD=-0.58 wanyuan,95%CI(-0.71~-0.46 wanyuan),P<0.00001]were less in the EOF group than TOF group.EOF patients had lower total complication rate[OR=0.68,95%CI(0.48~0.95),P=0.03],in which the pulmonary infection [OR=0.27,95%CI(0.13~0.53),P=0.0002],pharyngolaryngitis [OR=0.06,95%CI(0.04~0.11),P<0.00001] were lower than in the TOF group,while the tube reinsertion [OR=2.34,95%CI(1.08~5.07),P=0.03]was higher than TOF group.The occurrence rate of anastomotic leakage,nausea,vomiting,abdominal distension,diarrhea,and wound infection between the two groups were not statistically different.Although there is no significant difference between the two groups in IgM,the EOF's level of IgA [MD= 0.3,95%CI(0.12~0.48),P=0.001],IgG[MD= 2.13,95%CI(0.82~3.44),P=0.001],CD4 +[MD= 3.80,95%CI(2.55~5.04),P<0.00001],CD4 + / CD8 +[MD= 0.22,95%CI(0.04~0.41),P=0.02]were higher than TOF group.In inflammatory indicators,postoperative CRP decreased rapidly [MD=-30.10,95%CI(-48.07~-12.13),P=0.001],and IL-6 was no significant difference.At the same time,more than 5 days after EOF patients had higher serum albumin levels [MD= 3.27,95%CI(2.48~4.07),P<0.00001].Conclusions:EOF can promote patient exhaust defecation,reduce postoperative hospital stay,reduce treatment costs.Also,maybe it can reduce the incidence of complications and reduce postoperative inflammation and maintain patient immune function.It is worthy of promotion.