Early oral feeding after laparoscopic total gastrectomy in gastric cancer patients: a meta-analysis of randomized controlled trials and cohort studies.

Abstract

Background: Gastric cancer remains a leading cause of cancer-related morbidity and mortality worldwide, with surgery being central to treatment. However, postoperative malnutrition is common and significantly impairs recovery. Early oral feeding (EOF) has been proposed as a strategy to promote gastrointestinal recovery and reduce complications, but its clinical effectiveness following gastrectomy remains uncertain.

Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Studies comparing EOF with delayed oral feeding (TOF) in gastric cancer patients were included. Outcomes assessed were hospital stay, time to first anal exhaust, postoperative complications, feeding tolerance, and serum albumin and prealbumin levels. Data were pooled using random-effects models, and evidence certainty was evaluated using the GRADE approach.

Results: Fifteen studies (1,847 patients) were included. EOF significantly reduced hospital stay (-1.82 days) and time to first anal exhaust (-0.85 days), and improved albumin and prealbumin levels. No significant differences were found in postoperative complications or feeding intolerance. Subgroup analyses demonstrated consistent findings across surgical techniques, extent of gastrectomy, ERAS protocol implementation, and study design. Overall, the certainty of evidence was rated as very low due to concerns regarding risk of bias, heterogeneity, and imprecision.

Conclusion: EOF is a safe and effective approach after gastrectomy, promoting faster recovery without increasing complications. Further trials are needed to confirm its benefits and guide standardized protocols.