Home enteral nutrition for patients with esophageal cancer undergoing esophagectomy: A systematic review and meta-analysis

Chi Zhang; Li-Wen Hu; Yong Qiang; Zhuang-Zhuang Cong; Chao Zheng; Wen-Feng Gu; Chao Luo; Kai Xie; Yi Shen

doi:10.3389/fnut.2022.895422

Home enteral nutrition for patients with esophageal cancer undergoing esophagectomy: A systematic review and meta-analysis

Front Nutr. 2022 Jul 28:9:895422. doi: 10.3389/fnut.2022.895422. eCollection 2022.

Authors

Chi Zhang¹, Li-Wen Hu¹, Yong Qiang², Zhuang-Zhuang Cong¹, Chao Zheng², Wen-Feng Gu¹, Chao Luo³, Kai Xie⁴, Yi Shen^{1

2

3

4}

Affiliations

¹ Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China.
² Department of Cardiothoracic Surgery, School of Medicine, Jinling Hospital, Southeast University, Nanjing, China.
³ Department of Cardiothoracic Surgery, School of Clinical Medicine, Jinling Hospital, Southern Medical University, Guangzhou, China.
⁴ Department of Cardiothoracic Surgery, School of Clinical Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.

Abstract

Introduction: Home enteral nutrition (HEN) is a relatively new nutritional intervention that provides patients with EN support at home through jejunostomy or nasogastric feeding tubes. We conducted this systematic review and meta-analysis to explore the safety and effect of HEN compared with normal oral diet (NOD) in postoperative patients with esophageal cancer (EC).

Methods: EMBASE, Medline, Web of Science, and the Cochrane Library were used to search articles in English-language journals. The intervention effect was expressed using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcome measures, with 95% confidence intervals (95% CIs). The chi-square test and I-square test were used to test heterogeneity among studies.

Results: Four studies were eventually included in this meta-analysis. Compared with NOD, HEN has a favorable impact on postoperative body mass index (BMI) (weighted mean difference [WMD] = 0.70, 95% CI: 0.09-1.30, P = 0.02), lean body mass (LBM) (WMD = 0.76, 95% CI: 0.04-1.48, P = 0.04), and appendicular skeletal muscle mass index (ASMI) (WMD = 0.30, 95% CI: 0.02-0.58, P = 0.03). Physical function (WMD = 9.26, 95% CI: 8.00-10.53, P < 0.001), role function (WMD = 9.96, 95% CI: 8.11-11.82, P < 0.001), and social function (WMD = 8.51, 95% CI: 3.48-13.54, P = 0.001) of the HEN group were better than those of the NOD group at 3 months, and HEN could reduce the fatigue of patients (WMD = -12.73, 95% CI: -14.8 to -10.66, P < 0.001) and the incidence of postoperative pneumonia (RR = 0.53, 95% CI: 0.34-0.81, P = 0.004). There was no significant difference in albumin between HEN and NOD groups (WMD = 0.05, 95% CI: -0.03 to 0.13, P = 0.20).

Conclusion: HEN improved nutritional status and quality of life (QOL) in postoperative patients with EC and reduced fatigue and the incidence of postoperative pneumonia. All in all, the results of our meta-analysis support the use of HEN after esophagectomy.

Keywords: HEN; esophageal cancer; esophagectomy; home enteral nutrition; nutritional status.

Publication types

Systematic Review