早期由口進食對食道癌行切除手術患者術後合併症、住院天數、三十天再入院之成效：系統性文獻回顧及統合分析

Effects of Early oral Feeding on Postoperative Complications, Length of Hospital stay, and 30-day Readmission Among Esophageal Cancer Patients Receiving Esophagectomy: Systematic Literature Review and Meta-Analysis

目的
食道癌患者行食道切除術後易發生合併症，而腸道內營養可促進身體修復及降低合併症發生，然而術後早期由口進食是否會增加食道癌行切除手術患者合併症或減少住院天數，仍需進一步驗證。本篇探討早期由口進食對食道癌行切除手術患者術後合併症、住院天數、三十天再入院之成效。
方法
以中、英文關鍵字，P：食道癌行切除手術患者（Esophageal Cancer Patients Receiving Esophagectomy）；I：早期由口進食（Early Oral Feeding）；C：常規治療管灌進食（Conventional Treatment；Tube Feeding）；O：術後合併症（Postoperative Complications）、住院天數（Length of Hospital Stay）及30天再入院（30-DayReadmission），搜尋2010年至2022年相關文獻於PubMed、Medline、Cochrane Library、CEPS和台灣碩博士論文共五個電子資料庫。選取與主題相關之研究，以RiskofBias2.0tool、2018CASPCohortStudy和Modified Jadad Scale做為文獻品質評析工具，並使用ComprehensiveMeta-AnalysisVersion3分析軟體進行統合分析。
結果
共獲得78篇文章，經嚴格篩選後納入6篇相關研究，共886位食道癌行食道切除手術患者，統合分析顯示，術後早期由口進食，可顯著降低術後合併症發生率（OR=0.538，95％CI：0.396-0.732；p<0.0001），但在肺部合併症、吻合處滲漏、術後住院天數及三十天再入院則未顯著影響（p>0.05）。
結論
早期由口進食需由醫師仔細評估傷口預後，與專業營養師討論患者妥善的進食與營養支持計畫，以確保術後早期由口進食的成效，減少術後合併症發生率，避免再次入院。

Purposes
Patients with esophageal cancer are prone to complications following esophagectomy, and enteral nutrition can promote physical recovery and reduce the incidence of complications. However, further investigation is needed to determine whether oral feeding in the early postoperative period will increase the incidence of complications or shorten hospital stay among patients with esophageal cancer receiving esophagectomy. This study examined the effects of early oral feeding on postoperative complications, length of hospital stay, and 30-day readmission among esophageal cancer patients receiving esophagectomy.
Methods
Using the following keywords in Chinese and English, P: patients with esophageal cancer receiving esophagectomy; I: early oral feeding; C: conventional treatment, tube feeding; O: postoperative complications, length of hospital stay, and 30-day readmission, literature searches were performed on five electronic databases (PubMed, Medline, Cochrane Library, CEPS, and the National Digital Library of Theses and Dissertations in Taiwan) to identify relevant studies published between 2010 and 2022. Studies related to the topic were selected and subjected to quality assessment using the Risk of Bias 2.0 tool, 2018 CASP Cohort Study, and Modified Jadad Scale, followed by meta-analysis using the Comprehensive Meta-Analysis Version 3 software.
Results
A total of 78 studies were obtained, with 6 studies being included after strict screening, for a total of 886 patients with esophageal cancer receiving esophagectomy. Meta-analysis revealed that early postoperative oral feeding significantly reduced the incidence of postoperative complications (OR=0.538, 95% CI: 0.396-0.732, p<0.0001) but did not have a significant impact on pulmonary complications, anastomotic leakage, postoperative length of hospital stay, or 30-day readmission (p>0.05).
Conclusions
To ensure the effectiveness of early oral feeding, reduce the incidence of postoperative complications, and prevent readmission, the physician must carefully assess the patient’s wound prognosis and to formulate an appropriate feeding and nutritional support plan with a professional nutritionist.