• Annals of surgery · Mar 2018

    Randomized Controlled Trial

    Early Oral Feeding Following McKeown Minimally Invasive Esophagectomy: An Open-label, Randomized, Controlled, Noninferiority Trial.

    • Hai-Bo Sun, Yin Li, Xian-Ben Liu, Rui-Xiang Zhang, Zong-Fei Wang, Toni Lerut, Chia-Chuan Liu, Alfonso Fiorelli, Yin-Kai Chao, Daniela Molena, Robert J Cerfolio, Soji Ozawa, Andrew C Chang, and written on behalf of the AME Thoracic Surgery Collaborative Group.
    • Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, P. R. China.
    • Ann. Surg. 2018 Mar 1; 267 (3): 435-442.

    ObjectiveOur objective was to evaluate the impact of early oral feeding (EOF) on postoperative cardiac, respiratory, and gastrointestinal (CRG) complications after McKeown minimally invasive esophagectomy for esophageal cancer.Summary Background DataNil-by-mouth with enteral tube feeding is routinely practiced after esophagectomy.MethodsPatients were randomly allocated to receive oral feeding on the first postoperative day (EOF group) or late oral feeding (LOF group) 7 days after surgery. The primary endpoint was the occurrence of postoperative CRG complications, and the secondary outcomes included bowel function recovery and short-term quality of life (QOL).ResultsBetween February 2014 and October 2015, 280 patients were enrolled in this study. There were 140 patients in the EOF group and 140 patients in the LOF group. EOF was noninferior to LOF for CRG complications (30.0% in the EOF group vs. 32.9% in the LOF group; 95% confidence interval of the difference: -13.8% to 8.0%). Compared with the LOF group, the EOF group showed significantly shorter time to first flatus (median of 2 days vs. 3 days, P = 0.001) and bowel movement (median of 3 vs. 4 days, P < 0.001). Two weeks after the operation, patients in the EOF group reported higher global QOL and function scores and lower symptom scores than patients in the LOF group.ConclusionsIn patients after McKeown minimally invasive esophagectomy is noninferior to the standard of care with regard to postoperative CRG complications. In addition, patients in the EOF group had a quicker recovery of bowel function and improved short-term QOL.

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