Evaluate the Effect of Home Enteral Nutrition Compared with Oral Diet after the Hospital Discharge of Subjects with Esophagectomy of Esophageal Cancer: A Systemic Review and Meta-analysis

Boying Zhao¹, Yuan Luo¹ and Renfu Lu^1,

¹Department of Cardiothoracic Surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing 400010, China

Cite this paper:
Boying Zhao, Yuan Luo and Renfu Lu. Evaluate the Effect of Home Enteral Nutrition Compared with Oral Diet after the Hospital Discharge of Subjects with Esophagectomy of Esophageal Cancer: A Systemic Review and Meta-analysis. Journal of Food and Nutrition Research. 2021; 9(11):571-578. doi: 10.12691/jfnr-9-11-3

Abstract

Background: We performed a meta-analysis to evaluate the effect of home enteral nutrition compared with oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer. Methods: A systematic literature search up to July 2021 was performed and 12 studies included 970 subjects with esophagectomy of esophageal cancer at the start of the study; 481 of them were using home enteral nutrition after the hospital discharge and 579 were given oral diet. They were reporting relationships between the effects of home enteral nutrition compared with oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer. We calculated the odds ratio (OR) and the mean difference (MD) with 95% confidence intervals (CIs) to assess the effects of home enteral nutrition compared with oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer using the dichotomous and contentious method with a random or fixed-effect model. Results: Home enteral nutrition had significantly higher body weight (MD, 31.4; 95% CI, 2.55-3.72, p < 0.001), body mass index (MD, 1.20; 95% CI, 0.66-1.74, p < 0.001), and serum albumin (MD, 3.14; 95% CI, 2.07-4.20, p < 0.001), hemoglobin (MD, 8.57; 95% CI, 6.52–10.63, p < 0.001), total protein (MD, 4.86; 95% CI, 2.93-6.80, p < 0.001), and pre-albumin (MD, 30.39; 95% CI, 1.27-59.50, p = 0.04) compared to oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer. Additionally, home enteral nutrition compared with oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer had no significant difference in feeding-related complications (OR, 1.04; 95% CI, 0.44-2.43, p = 0.93). Conclusions: Home enteral nutrition had significantly higher body weight, body mass index, and serum albumin, hemoglobin, total protein, and pre-albumin compared to oral diet after the hospital discharge of subjects with esophagectomy of esophageal cancer with no significant difference in feeding-related complications. Furthers studies are needed to confirm these findings.

Keywords:
esophageal cancer esophagectomy home enteral nutrition oral diet feeding-related complications hematological parameters anthropometric measurements

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Sung, H., et al., Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 2021. 71(3): p. 209-249.
[2]	Rustgi, A.K. and H.B. El-Serag, Esophageal carcinoma. New England Journal of Medicine, 2014. 371(26): p. 2499-2509.
[3]	Cohen, D.J. and L. Leichman, Controversies in the treatment of local and locally advanced gastric and esophageal cancers. Journal of Clinical Oncology, 2015. 33(16): p. 1754-1759.
[4]	Martin, L. and P. Lagergren, Risk factors for weight loss among patients surviving 5 years after esophageal cancer surgery. Annals of surgical oncology, 2015. 22(2): p. 610-616.
[5]	Bozzetti, F., et al., The nutritional risk in oncology: a study of 1,453 cancer outpatients. Supportive care in cancer, 2012. 20(8): p. 1919-1928.
[6]	Marin, F.A., et al., Grade of esophageal cancer and nutritional status impact on postsurgery outcomes. Arquivos de gastroenterologia, 2010. 47: p. 348-353.
[7]	Baker, M., et al., A systematic review of the nutritional consequences of esophagectomy. Clinical nutrition, 2016. 35(5): p. 987-994.
[8]	Heneghan, H.M., et al., Prospective study of malabsorption and malnutrition after esophageal and gastric cancer surgery. Annals of surgery, 2015. 262(5): p. 803-808.
[9]	Ligthart-Melis, G., et al., Dietician-delivered intensive nutritional support is associated with a decrease in severe postoperative complications after surgery in patients with esophageal cancer. Diseases of the Esophagus, 2013. 26(6): p. 587-593.
[10]	Li, H.-N., et al., A Meta-analysis of Jejunostomy Versus Nasoenteral Tube for Enteral Nutrition Following Esophagectomy. Journal of Surgical Research, 2021. 264: p. 553-561.
[11]	Hynes, O., et al., The impact of pre-and post-operative weight loss and body mass index on prognosis in patients with oesophageal cancer. European Journal of Surgical Oncology (EJSO), 2017. 43(8): p. 1559-1565.
[12]	Peng, J., et al., Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis. Diseases of the Esophagus, 2016. 29(4): p. 333-341.
[13]	Cederholm, T., et al., ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical nutrition, 2017. 36(1): p. 49-64.
[14]	Lorimer, P.D., et al., Enteral feeding access has an impact on outcomes for patients with esophageal cancer undergoing esophagectomy: an analysis of SEER-Medicare. Annals of surgical oncology, 2019. 26(5): p. 1311-1319.
[15]	Choi, A.H., et al., Complications of feeding jejunostomy tubes in patients with gastroesophageal cancer. Journal of Gastrointestinal Surgery, 2017. 21(2): p. 259-265.
[16]	Stroup, D.F., et al., Meta-analysis of observational studies in epidemiology: a proposal for reporting. Jama, 2000. 283(15): p. 2008-2012.
[17]	Higgins, J.P., et al., Measuring inconsistency in meta-analyses. Bmj, 2003. 327(7414): p. 557-560.
[18]	Liberati, A., et al., The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of clinical epidemiology, 2009. 62(10): p. e1-e34.
[19]	Gupta, A., et al., Obesity is Independently Associated With Increased Risk of Hepatocellular Cancer–related Mortality. American journal of clinical oncology, 2018. 41(9): p. 874-881.
[20]	Collaboration, C., RoB 2: A revised Cochrane risk-of-bias tool for randomized trials. Available at (Accessed December 6, 2019): bias/resources/rob-2-revised-cochrane-risk-bias-tool-randomized-trials, 2020.
[21]	Cao, Z., W. Pan, and L. Er-kang, Clinical significance of fine-needle catheter jejunostomy on enteral nutrition support for esophageal carcinoma patients after operation. Chin J Clin, 2013. 7: p. 6355-7.
[22]	Bowrey, D.J., et al., A randomised controlled trial of six weeks of home enteral nutrition versus standard care after oesophagectomy or total gastrectomy for cancer: report on a pilot and feasibility study. Trials, 2015. 16(1): p. 1-12.
[23]	Gavazzi, C., et al., Impact of home enteral nutrition in malnourished patients with upper gastrointestinal cancer: a multicentre randomised clinical trial. European Journal of Cancer, 2016. 64: p. 107-112.
[24]	Zhang, W., J. Huang, and D. Lin, Efficacy of home enteral nutrition after oesophagectomy. Med Forum, 2016. 20: p. 4774–6.
[25]	Wu, Z., et al., Home enteral nutrition after minimally invasive esophagectomy can improve patients\'quality of life and reduce the risk of malnutrition. Asia Pacific Journal of Clinical Nutrition, 2017.
[26]	Wu, Z., et al., Home enteral nutrition after minimally invasive esophagectomy can improve quality of life and reduce the risk of malnutrition. Asia Pacific journal of clinical nutrition, 2018. 27(1): p. 129-136.
[27]	Tong, Y., X. Lang, and L. Xie, Effects of home enteral nutrition for postoperative patients of esophageal cancer. . Chin J Mod Nurs, 2018;. 24: p. 1292–6.
[28]	Ji, S., The effect of whole-course nutritional therapy on postoperative short-term outcomes in patients with esophageal cancer. Bengbu Medical College, 2019.
[29]	Wang, Q., C. Wang, and P. Wang, Effects of home enteral nutritional support therapy on nutritional status of patients after resection of esophageal cancer. J Clin Res, 2019. 36: p. 1651–2.
[30]	Liu, K., et al., Safety, feasibility, and effect of an enhanced nutritional support pathway including extended preoperative and home enteral nutrition in patients undergoing enhanced recovery after esophagectomy: a pilot randomized clinical trial. Diseases of the Esophagus, 2020. 33(2): p. doz030.
[31]	Pattamatta, M., et al., Effect of direct oral feeding following minimally invasive esophagectomy on costs and quality of life. Journal of Medical Economics, 2021. 24(1): p. 54-60.
[32]	Chen, X., G. Zhao, and L. Zhu, Home enteral nutrition for postoperative elderly patients with esophageal cancer. Annals of Palliative Medicine, 2021. 10(1): p. 278-284.
[33]	Liu, L., et al., Home enteral nutrition after esophagectomy for esophageal cancer: A systematic review and meta-analysis. Medicine, 2020. 99(36).
[34]	Matsuoka, M. and S. Iijima, Consideration of nutritional support for decreased caloric intake in patients with severe weight loss after esophageal cancer surgery. Gan to kagaku ryoho. Cancer & chemotherapy, 2019. 46(Suppl 1): p. 132-134.
[35]	Gomes, F., et al., ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clinical nutrition, 2018. 37(1): p. 336-353.
[36]	Smalley, S.R., et al., Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. Journal of clinical oncology, 2012. 30(19): p. 2327.
[37]	Boshier, P., et al., Assessment of body composition and sarcopenia in patients with esophageal cancer: a systematic review and meta-analysis. Diseases of the Esophagus, 2018. 31(8): p. doy047.
[38]	Gannon, J., et al., Reduced fitness and physical functioning are long-term sequelae after curative treatment for esophageal cancer: a matched control study. Dis Esophagus, 2017. 30(8): p. 1-7.
[39]	Elliott, J.A., et al., Sarcopenia: prevalence, and impact on operative and oncologic outcomes in the multimodal management of locally advanced esophageal cancer. Annals of surgery, 2017. 266(5): p. 822-830.
[40]	Ediebah, D.E., et al., Quality of life as a prognostic indicator of survival: a pooled analysis of individual patient data from Canadian cancer trials group clinical trials. Cancer, 2018. 124(16): p. 3409-3416.