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International Urology and Nephrology

, Volume 51, Issue 1, pp 1–7 | Cite as

Total parenteral nutrition versus early enteral nutrition after cystectomy: a meta-analysis of postoperative outcomes

  • Shuxiong Zeng
  • Yongping Xue
  • Junjie Zhao
  • Anwei Liu
  • Zhensheng Zhang
  • Yinghao SunEmail author
  • Chuanliang XuEmail author
Urology - Review
  • 102 Downloads

Abstract

Background

This study aimed to systematically summarize and analyze the current evidence regarding the effect of total parenteral nutrition (TPN) versus early enteral nutrition (EEN) on postoperative outcomes of cystectomy.

Methods

A comprehensive search of online databases was conducted to identify comparative studies on the postoperative outcomes of patients receiving TPN and EEN after cystectomy. Our subsequent meta-analysis followed the PRISMA Protocol and the Cochrane Handbook.

Results

Five studies with 556 participants were included for meta-analysis. EEN was shown to have a significant effect on reducing the overall complications (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.37–0.75, P < 0.01) and infectious complications (OR 0.32, 95% CI 0.21–0.49, P < 0.01) compared with TPN. Additionally, EEN saved €614–€3120 in costs compared to TPN. There were no significant differences between TPN and EEN groups regarding mortality rate (OR 0.47, 95% CI 0.06–3.51, P = 0.46), the incidence of postoperative ileus (OR 0.90, 95% CI 0.55–1.47, P = 0.68), length of hospital stay (mean difference (MD) 2.12, 95% CI − 0.15 to 4.40, P = 0.07), or time to resume a full diet (MD 1.31, 95% CI − 1.15 to 3.77, P = 0.30).

Conclusion

EEN was found to have a significant effect on reducing infectious complications and costs compared with TPN treatment after cystectomy. Remarkably, EEN had no significant impact on mortality incidence, postoperative ileus, length of hospital stay, or the time to resumption of full diet.

Keywords

Cystectomy Parenteral nutrition Enteral nutrition Meta-analysis 

Notes

Acknowledgements

This research was financed by grants from Shanghai Sailing Program (Grant No. 18YF1422700), Starting Foundation for Young Scientists of Second Military Medical University (Grant No. 2017QN11), National Natural Science Foundation of China (Grant No. 81802515), Natural Science Foundation of Shandong Province (Grant No. ZR2016HL36), and the Medical Science and Technology Development Project of Shandong Province (Grant No. 2016WS0703).

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflicts of interest.

Ethical approval

This study was a meta-analysis based on the existing published data, and therefore did not require the approval of an institutional review board.

Supplementary material

11255_2018_2031_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 KB)

References

  1. 1.
    Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, Raj G, Bochner BH, Dalbagni G, Herr HW, Donat SM (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55(1):164–174CrossRefGoogle Scholar
  2. 2.
    De Nunzio C, Cindolo L, Leonardo C, Antonelli A, Ceruti C, Franco G, Falsaperla M, Gallucci M, Alvarez-Maestro M, Minervini A, Pagliarulo V, Parma P, Perdona S, Porreca A, Rocco B, Schips L, Serni S, Serrago M, Simeone C, Simone G, Spadavecchia R, Celia A, Bove P, Zaramella S, Crivellaro S, Nucciotti R, Salvaggio A, Frea B, Pizzuti V, Salsano L, Tubaro A (2013) Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort. Eur J Surg Oncol 39(7):792–798CrossRefGoogle Scholar
  3. 3.
    Vidal A, Arnold N, Vartolomei MD, Kiss B, Burkhard F, Thalmann GN, Roth B (2016) Oncological and functional outcomes of postoperative total parenteral nutrition after radical cystectomy in bladder cancer patients: a single-center randomized trial. Int J Urol 23(12):992–999CrossRefGoogle Scholar
  4. 4.
    Roth B, Birkhauser FD, Zehnder P, Thalmann GN, Huwyler M, Burkhard FC, Studer UE (2013) Parenteral nutrition does not improve postoperative recovery from radical cystectomy: results of a prospective randomised trial. Eur Urol 63(3):475–482CrossRefGoogle Scholar
  5. 5.
    Zaloga GP (2006) Parenteral nutrition in adult inpatients with functioning gastrointestinal tracts: assessment of outcomes. Lancet 367(9516):1101–1111CrossRefGoogle Scholar
  6. 6.
    Zhao XF, Wu N, Zhao GQ, Liu JF, Dai YF (2016) Enteral nutrition versus parenteral nutrition after major abdominal surgery in patients with gastrointestinal cancer: a systematic review and meta-analysis. J Investig Med 64(5):1061–1074CrossRefGoogle Scholar
  7. 7.
    Peter JV, Moran JL, Phillips-Hughes J (2005) A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med 33(1):213–220 (discussion 260–211)CrossRefGoogle Scholar
  8. 8.
    Mazaki T, Ebisawa K (2008) Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg 12(4):739–755CrossRefGoogle Scholar
  9. 9.
    Voskuilen CS, van de Putte EEF, der Hulst JB, van Werkhoven E, de Blok WM, van Rhijn BWG, Horenblas S, Meijer RP (2018) Short-term outcome after cystectomy: comparison of early oral feeding in an enhanced recovery protocol and feeding using Bengmark nasojejunal tube. World J Urol 36(2):221–229CrossRefGoogle Scholar
  10. 10.
    Zeng SX, Zhang ZS, Zhao JJ, Sun YH, Xu CL (2018) Total parenteral nutrition versus early oral nutrition after cystectomy: a meta-analysis of the effect on perioperative outcomes. PROSPERO CRD42018093901. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018093901. Accessed 15 Oct 2018
  11. 11.
    Higgins J, Green S (2011) Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration http://www.cochrane-handbook.org. Accessed 15 Oct 2018
  12. 12.
    Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, Dawes M, Howick J (2009) Oxford Centre for Evidence-based Medicine—levels of evidence (March 2009). Centre for Evidence-Based Medicine Web site. http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed 15 Oct 2018
  13. 13.
    Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135CrossRefGoogle Scholar
  14. 14.
    Wells G, Shea B, O’Connel D, Peterson J, Welch V, Losos M, Tugwell P (2016) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohrica/programs/clinical_epidemiology/oxfordasp. Accessed 15 Oct 2018
  15. 15.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12CrossRefGoogle Scholar
  16. 16.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560CrossRefGoogle Scholar
  17. 17.
    Maccagnano C, Rocchini L, Suardi N, Pellucchi F, Ibrahim B, Crescenti A, Salonia A, Zanni G, Villa L, Gandaglia G, Capogrosso P, Passoni N, Fossati N, Corti S, Rigatti P, Montorsi F, Colombo R (2011) A new multimodal anesthesiological and nutritional approach in radical cystectomy with urinary diversion based on ileal segment: a single-centre, prospective, randomized study. J Urol 185(4):e564CrossRefGoogle Scholar
  18. 18.
    Declercq P, De Win G, Van der Aa F, Beels E, Van der Linden L, Van Poppel H, Willems L, Spriet I (2015) Reduced length of stay in radical cystectomy patients with oral versus parenteral post-operative nutrition protocol. Int J Clin Pharm 37(2):379–386CrossRefGoogle Scholar
  19. 19.
    de Vries RR, Kauer P, van Tinteren H, van der Poel HG, Bex A, Meinhardt W, van Haarst EP, Horenblas S (2012) Short-term outcome after cystectomy: comparison of two different perioperative protocols. Urol Int 88(4):383–389CrossRefGoogle Scholar
  20. 20.
    Pham KN, Schwartz LW, Garg T, Langenstroer P, Guralnick ML, See WA, O’Connor RC (2014) Immediate total parenteral nutrition after radical cystectomy and urinary diversion. WMJ 113(1):20–23Google Scholar
  21. 21.
    Wan X, Bi J, Gao X, Tian F, Wang X, Li N, Li J (2015) Partial enteral nutrition preserves elements of gut barrier function, including innate immunity, intestinal alkaline phosphatase (IAP) level, and intestinal microbiota in mice. Nutrients 7(8):6294–6312CrossRefGoogle Scholar
  22. 22.
    Schorghuber M, Fruhwald S (2018) Effects of enteral nutrition on gastrointestinal function in patients who are critically ill. Lancet Gastroenterol Hepatol 3(4):281–287CrossRefGoogle Scholar
  23. 23.
    Lin LY, Lin HC, Lee PC, Ma WY, Lin HD (2007) Hyperglycemia correlates with outcomes in patients receiving total parenteral nutrition. Am J Med Sci 333(5):261–265CrossRefGoogle Scholar
  24. 24.
    Pang KH, Groves R, Venugopal S, Noon AP, Catto JWF (2017) Prospective implementation of enhanced recovery after surgery protocols to radical cystectomy. Eur Urol.  https://doi.org/10.1016/j.eururo.2017.07.031 Google Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Shuxiong Zeng
    • 1
  • Yongping Xue
    • 1
  • Junjie Zhao
    • 2
  • Anwei Liu
    • 1
  • Zhensheng Zhang
    • 1
  • Yinghao Sun
    • 1
    Email author
  • Chuanliang Xu
    • 1
    Email author
  1. 1.Department of Urology, Changhai HospitalSecond Military Medical UniversityShanghaiPeople’s Republic of China
  2. 2.Department of UrologyYantai Yuhuangding HospitalYantaiPeople’s Republic of China

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