Early initiation of oral feeding following upper gastrointestinal tumor surgery: a randomized controlled trial.

OBJECTIVES: Despite increasing trends toward the early initiation of oral feeding after gastrointestinal (GI) surgeries, current evidence has not been convincing. The present randomized clinical trial aimed to compare the clinical outcomes of early oral feeding (EOF) with late oral feeding (LOF) following surgery for upper GI tumors. METHODS: One hundred and nine consecutive patients with esophageal or gastric tumors undergoing surgical resection in two hospitals in Tehran, Iran, were enrolled in this prospective randomized controlled trial, and were randomly assigned to a group starting EOF on the first postoperative day and another group that remained nil by mouth until the return of bowel sounds (LOF group). The clinical and surgical outcomes were compared between the two groups. RESULTS: The clinical outcomes were significantly better in the patients in the EOF group (p < 0.05). Repeated nil per os (14.8 vs. 30.9 %) and re-hospitalization (1.8 vs. 7.3 %) were more common in LOF group (p < 0.0001). Additionally, gas passage, nasogastric tube (NGT) discharge, a decrease in intravenous serum to less than 1000 ml per day, the time to start a soft diet and hospital discharge following surgery occurred significantly earlier in the EOF group than in the LOF group (p < 0.0001). CONCLUSION: Early oral feeding after the surgical resection of esophageal and gastric tumors is safe, and is associated with favorable early in-hospital outcomes and a sooner return to physiological GI function and hospital discharge.

Early Oral Feeding After Surgery for Upper Gastrointestinal Malignancies: A Prospective Cohort Study.

OBJECTIVES: Poor nutritional status following abdominal surgeries for esophageal and gastric cancers remains a major challenge in postoperative care. Our study aimed to investigate the efficacy of starting early oral feeding (EOF) in patients undergoing surgical resection of upper gastrointestinal malignancies. METHODS: A total of 180 consecutive patients with a diagnosis of esophageal or gastric malignancies undergoing elective surgical resection between January 2008 and February 2011 were enrolled in this prospective cohort study. Seventy-two patients were assigned to the EOF group, and 108 patients received late oral feeding (LOF). Postoperative endpoints were compared between the two groups. RESULTS: Nasogastric tubes were removed from patients on average 3.3±1.6 days after the surgery in the EOF group and 5.2±2.5 days in the LOF group (p < 0.001). The soft diet regimen was started and tolerated significantly sooner in the EOF group (5.8±1.2 days) than the LOF group (9.5±5.5 days). Hospital stay was significantly shorter in the EOF group compared to the LOF group (6.7±3.1 days vs. 9.1±5.8 days, p < 0.001). Surgical complications and rehospitalization occurred less in EOF group compared with the LOF group. However, the differences were not significant (p > 0.050). CONCLUSIONS: EOF is safe following esophageal and gastric cancer surgery and results in faster recovery and hospital discharge.