Clinical Study Of Geriatric Patients Without Gastrointestinal Decompression Application Accompanied By Early Oral Feeding After Radical Gastric Cancer Surgery

Objective: This study used Systematic evaluation and Meta-analysis combined with retrospective clinical cohort study to jointly investigate the clinical efficacy of geriatric patients without gastrointestinal decompression application accompanied early oral feeding after radical gastric cancer surgery.Methods:(1)Systematic evaluation and Meta-analysis section: Articles on the application of gastrointestinal decompression tube after radical gastric cancer surgery from the database establishment to October 2022 were retrieved from Pub Med,Cochrane Library,Web of Science,Embase,CBM,Wanfang Data,CNKI and VIP by Me SH terms combined with free-text terms.The included articles were subjected to literature screening,quality assessment and data extraction,and Meta-analysis was performed using Review Manager and Stata software.(2)Retrospective cohort study section: The clinical data of patients diagnosed with gastric cancer with radical surgery from October 2020 to December 2022 in the Department of General Surgery I of Gansu Provincial People’s Hospital were retrospectively analyzed,and those aged ≥60 years were included.They were divided into the postoperative no decompression + early oral feeding group(NDE+EOF)and the postoperative decompression + conventional feeding group(DE+CF).In addition,patients receiving the NDE+EOF group were matched to those receiving the DE+CF group in a 1:1 ratio by propensity score matching analysis(PSM)to balance the confounder in the observational study.The clinical characteristics,intraoperative indicators,clinical recovery indicators,and postoperative complications of their two groups of patients were analyzed separately.Results:(1)Systematic evaluation and Meta-analysis section: The 33 studies that met the criteria included a total of 4383 patients,of whom 2210 were included in the NDE group and 2173 were treated with DE.The NDE group was more likely to have a better outcome in terms of time to first oral feeding [MD=-0.90,95% CI(-1.11,-0.69),P<0.00001],time to first postoperative out of bed [MD=-0.35,95% CI(-0.66,-0.05),P=0.02],time to first flatus [MD=-0.32,95% CI(-0.49,-0.14),P =0.0003],time to first defecation [MD=-0.43,95% CI(-0.74,-0.13),P =0.006] and postoperative hospital stay[MD=-1.22,95% CI(-1.74,-0.70),P <0.00001] were significantly earlier than in the DE group.In addition,the NDE group reduced the incidence of postoperative pulmonary infection [OR=0.43,95% CI(0.32,0.57),P <0.00001],nausea and vomiting[OR=0.29,95% CI(0.16,0.51),P <0.0001],and sore throat [OR=0.07,95% CI(0.05,0.09),P <0.00001 ].At the same time,there was no increased risk of postoperative anastomosis leakage or gastroparesis(P > 0.05).In subgroup analysis,when the extent of surgical resection was distal gastrectomy(DG),the differences between the NDE and DE groups in terms of time to first oral feeding,time to first postoperative out of bed,time to first flatus,and postoperative hospital stay lost statistical significance(P >0.05).(2)Retrospective cohort study section: The final number of 107 patients who met the criteria was included.There were 32 patients in the NDE+EOF group and 75 in the DE+CF group.After PSM,there were 17 patients in each of the two groups.Compared with the DE+CF group,the NDE+EOF group had significantly higher albumin at 7 d postoperatively(35.3 ± 2.7 vs 33.6 ± 3.6 g/L,P = 0.036),lymphocyte level at 1 d postoperatively [(0.7(0.4,0.9)vs 0.5(0.3,0.7)g/L,P = 0.014],time to first defecation[4.0(3.0,4.0)vs.5.0(4.0,7.0)days,P < 0.001],postoperative hospital stay [9.0(8.0,10.8)vs.11.0(9.0,12.0)days,P = 0.002],total hospital stay [14.0(13.0,16.0)vs.17.0(15.0,20.0)days,P = 0.001] and total hospitalization cost(78,050.6 ± 15,926.5 vs.88,414.0 ± 17,243.7 RMB,P = 0.004)were significantly reduced,as were postoperative sore throat [4(12.5%)vs.30(40.0%),P = 0.005] and the incidence of hypoproteinemia[14(43.8%)vs.55(73.3%),P = 0.003] were significantly lower.The results after performing PSM showed that the time to first defecation [4.0(3.0,4.0)vs 5.0(4.0,6.5)days,P = 0.005] and total hospital stay [14.0(13.0,16.0)vs 17.0(15.0,19.0)days,P =0.012] were significantly shorter in the NDE+EOF group than in the DE+CF group.However,the differences in postoperative hospital stay(P = 0.180),total hospitalization cost(P = 0.715),postoperative sore throat(P = 0.437),and incidence of hypoproteinemia(P = 0.300)were not statistically significant.Conclusions:(1)Based on the available evidence verifying the safety and efficacy of no gastrointestinal decompression after gastric cancer surgery,it is recommended that routine use of gastrointestinal decompression after gastric cancer surgery is not necessary.(2)The absence of gastrointestinal decompression accompanied by early oral feeding in geriatric patients after radical gastric cancer surgery is relatively safe and feasible in short-term clinical indicators.It improves the postoperative nutritional status of geriatric patients,promotes the recovery of postoperative gastrointestinal function,and reduces the length of hospital stay and total hospitalization cost while decreasing the incidence of postoperative sore throat and hypoproteinemia.