Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta‐analysis

Early postoperative enteral nutrition (EN) after esophagectomy in esophageal cancer patient has been reported to be correlated with a better rehabilitation than parenteral nutrition (PN). However, a robust conclusion has not been achieved. Therefore, we performed a meta‐analysis to compare the postoperative EN and PN in patients with esophageal cancer undergoing esophagectomy. Three electronic databases were searched for eligible studies to be included in the meta‐analysis. The summary relative risk/weighted mean difference (RR/WMD) estimates and corresponding 95% confidence interval (CI) were calculated using fixed‐ and random‐effects models. Ten studies met the inclusion criteria. The analysis demonstrated that the early postoperative EN could significantly decrease the pulmonary complications (RR = 0.37, 95% CI = 0.22–0.62, P = 0.00, test for heterogeneity: I² = 0.0%, P = 0.89) and anastomotic leakage (RR = 0.46, 95% CI = 0.22–0.96, P = 0.04, test for heterogeneity: I² = 0.0%, P = 0.66) compared with PN. On the eighth postoperative day, the EN group had a higher levels of albumin (WMD = 1.84, 95% CI = 0.47–3.21, P = 0.01, test for heterogeneity: I² = 84.5%, P = 0.00) and prealbumin (WMD = 12.96, 95% CI = 3.63–22.29, P = 0.01, test for heterogeneity: I² = 0.0%, P = 0.63) compared with the PN group. However, there was no difference in digestive complications between these two approaches (RR = 1.30, 95% CI = 0.79–2.13, P = 0.30, test for heterogeneity: I² = 0.0%, P = 0.97). For patients with esophageal cancer following esophagectomy, the early postoperative EN support could decrease the morbidity of severe complications, such as pulmonary complications and anastomotic leakage, and maintain patients at a better nutritional status than parenteral nutrion support.