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

  • Urology - Review
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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.

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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).

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Author notes

  1. Shuxiong Zeng, Yongping Xue, and Junjie Zhao have contributed equally to this paper.

Authors and Affiliations

  1. Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, People’s Republic of China

    Shuxiong Zeng, Yongping Xue, Anwei Liu, Zhensheng Zhang, Yinghao Sun & Chuanliang Xu

  2. Department of Urology, Yantai Yuhuangding Hospital, Yantai, Shandong, People’s Republic of China

    Junjie Zhao

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  1. Shuxiong Zeng
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  2. Yongping Xue
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  4. Anwei Liu
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  5. Zhensheng Zhang
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Correspondence to Yinghao Sun or Chuanliang Xu.

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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.

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Zeng, S., Xue, Y., Zhao, J. et al. Total parenteral nutrition versus early enteral nutrition after cystectomy: a meta-analysis of postoperative outcomes. Int Urol Nephrol 51, 1–7 (2019). https://doi.org/10.1007/s11255-018-2031-6

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