Reply to the letter regarding 'The effect of early oral feeding after esophagectomy on the incidence of anastomotic leakage: an updated review'.

Dear Editor in Chief, We really appreciate the letter from the readers and their interest in this review [1]. The readers found a serious mistake that the study by Weijs et al. cited in the text wasn’t a randomized controlled trial (RCT) because of the retrospective nature of the control group [2]. Therefore, the study design of this article should be considered as a retrospective case-control study, with an evidence level of 4 according to the Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence [3]. Early oral feeding (EOF) within 3 days following esophagectomy demonstrates its safety and promising efficacy in a few RCTs. However, the current available data are obviously insufficient. A metaanalysis based on the limited sample is not appropriate, which might result in misleading information for inexperienced surgeons, considering the potential risk of anastomotic leakage. Further large-scale, well-designed trials are warranted before a formal consensus or guideline supporting EOF in esophagectomy could be drawn.