Total parenteral nutrition versus early enteral nutrition after cystectomy: a meta-analysis of postoperative outcomes.

ABSTRACT

BACKGROUND: This study aimed to systematically summarize and analyze the current evidence regarding the effect of total parenteral nutrition (TPN) versus early enteral nutrition (EEN) on postoperative outcomes of cystectomy. METHODS: A comprehensive search of online databases was conducted to identify comparative studies on the postoperative outcomes of patients receiving TPN and EEN after cystectomy. Our subsequent meta-analysis followed the PRISMA Protocol and the Cochrane Handbook. RESULTS: Five studies with 556 participants were included for meta-analysis. EEN was shown to have a significant effect on reducing the overall complications (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.37-0.75, P < 0.01) and infectious complications (OR 0.32, 95% CI 0.21-0.49, P < 0.01) compared with TPN. Additionally, EEN saved €614-€3120 in costs compared to TPN. There were no significant differences between TPN and EEN groups regarding mortality rate (OR 0.47, 95% CI 0.06-3.51, P = 0.46), the incidence of postoperative ileus (OR 0.90, 95% CI 0.55-1.47, P = 0.68), length of hospital stay (mean difference (MD) 2.12, 95% CI - 0.15 to 4.40, P = 0.07), or time to resume a full diet (MD 1.31, 95% CI - 1.15 to 3.77, P = 0.30). CONCLUSION: EEN was found to have a significant effect on reducing infectious complications and costs compared with TPN treatment after cystectomy. Remarkably, EEN had no significant impact on mortality incidence, postoperative ileus, length of hospital stay, or the time to resumption of full diet.