Best Evidence Summary for Early Oral Feeding after Colorectal Cancer Surgery
DOI:
https://doi.org/10.70088/cg6h1j18Keywords:
colorectal cancer, early postoperative period, early oral feeding, evidence-based nursingAbstract
To systematically retrieve and summarize the best evidence on early oral feeding after colorectal cancer surgery. Following the evidence-based "6S" evidence model, we searched for clinical decisions, guidelines, evidence summaries, expert consensuses, systematic reviews, and randomized controlled trials (RCTs) published from January 2018 to May 2024. Two researchers trained in evidence-based nursing independently evaluated the quality of the literature and extracted evidence that met the quality criteria. A total of 22 articles were included, comprising 4 clinical decisions, 8 guidelines, 5 expert consensuses, 3 systematic reviews, and 2 RCTs. Twenty-nine pieces of evidence were summarized across seven dimensions: safety, contraindications, nutritional risk screening and malnutrition assessment, principles of nutritional therapy, energy and protein management, feeding protocols, and tolerance assessment and assurance. The best evidence on early oral feeding after colorectal cancer surgery summarized in this study is scientific and systematic. It provides a theoretical basis for optimizing nutritional support strategies and improving nutritional management in clinical practice, and serves as a reference for evidence-based practice.References
National Health Commission Medical Administration Department and Chinese Society of Clinical Oncology, "National Health Commission Chinese guidelines for diagnosis and treatment of colorectal cancer (2023 edition)," Chinese Journal of Gastrointestinal Surgery, vol. 26, no. 6, pp. 505–528, 2023.
S. M. Wang, R. S. Zheng, B. F. Han, et al., "Age-specific characteristics of cancer incidence and mortality in China, 2022," China Cancer, vol. 33, no. 3, pp. 165–174, 2024.
J. Li, B. C. Zhao, and Z. J. Wang, "Perioperative nutritional support for colorectal cancer under the concept of enhanced recovery after surgery," Journal of Clinical Surgery, vol. 29, no. 7, pp. 693–695, 2021.
M. A. Daghmouri, M. A. Chaouch, M. Oueslati, et al., "Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review," Annals of Medicine and Surgery, vol. 72, p. 103124, 2021.
"Postoperative prognosis and nursing intervention measures for colorectal cancer," American Journal of Translational Research, vol. 13, no. 12, pp. 14096–14101, 2021.
C. Meissner, S. Tiegges, M. Broehl, et al., "International study on the prevalence of malnutrition in centralized care for colorectal cancer patients," Innovative Surgical Sciences, vol. 8, no. 2, pp. 83–92, 2023.
P. E. Wischmeyer, F. Carli, D. C. Evans, et al., "American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway," Anesthesia and Analgesia, vol. 126, no. 6, pp. 1883–1895, 2018.
G. Herbert, R. Perry, H. K. Andersen, et al., "Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications," Cochrane Database of Systematic Reviews, vol. 10, no. 10, p. CD004080, 2018.
E. Rinninella, R. Persiani, D. D'Ugo, et al., "NutriCatt protocol in the Enhanced Recovery After Surgery (ERAS) program for colorectal surgery: The nutritional support improves clinical and cost-effectiveness outcomes," Nutrition, vol. 50, pp. 74–81, 2018.
Chinese Society of Gastrointestinal Surgery, Chinese Society of Colorectal Surgery, and Upper Gastrointestinal Surgeons Committee of Chinese College of Surgeons, "Chinese expert consensus on perioperative whole-course nutrition management for gastrointestinal surgery (2021 Edition)," Chinese Journal of Practical Surgery, vol. 41, no. 10, pp. 1111–1125, 2021.
A. H. Wang, Y. N. Zhang, X. X. Zhi, et al., "Construction and effect evaluation of precise oral nutrition guidance program for colorectal cancer patients under enhanced recovery after surgery," Chinese Journal of Practical Nursing, vol. 39, no. 17, pp. 1281–1287, 2023.
Y. Chen, R. Yan, S. Yang, et al., "Best evidence summary for perioperative oral nutritional supplementation in adult colorectal cancer patients based on ORTCC," Journal of Nursing Science, vol. 37, no. 23, pp. 87–91, 2022.
J. L. Irani, T. L. Hedrick, T. E. Miller, et al., "Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons," Surgical Endoscopy, vol. 37, no. 1, pp. 5–30, 2023.
Chinese Society of Colorectal Surgery, Chinese Society of Nutrition Support, and Colorectal Surgeons Committee of Chinese College of Surgeons, "Chinese expert consensus on perioperative nutritional therapy for colorectal cancer (2019 edition)," Chinese Journal of Practical Surgery, vol. 39, no. 6, pp. 533–537, 2019.
Y. Hu and Y. F. Hao, Evidence-Based Nursing. Beijing, China: People's Medical Publishing House, 2018.
H. X. Zuo, Y. M. Niu, and Y. L. Cheng, "Retrieval of evidence-based nursing resources," Chinese Evidence-Based Nursing, vol. 1, no. 4, pp. 145–151, 2015.
F. Zhou, Y. F. Hao, X. Cong, et al., "Supplementary explanation and reflections on AGREE II and domain scores," Journal of Nursing, vol. 25, no. 18, pp. 56–58, 2018.
Y. F. Zhou, Y. Gu, Y. Hu, et al., "JBI critical appraisal tools for different types of studies——prevalence and analytical cross-sectional studies," Journal of Nurses Training, vol. 33, no. 3, pp. 219–221, 2018.
D. Pieper, N. Koensgen, J. Breuing, et al., "How is AMSTAR applied by authors — a call for better reporting," BMC Medical Research Methodology, vol. 18, no. 1, p. 56, 2018.
C. Q. Wang and Y. Hu, "JBI evidence pre-grading and recommendation level system (2014 edition)," Journal of Nurses Training, vol. 30, no. 11, pp. 964–967, 2015.
R. Ricciardi, G. MacKay, and G. P. Joshi, "Enhanced Recovery After Surgery (ERAS) protocols for colorectal surgery in adults," UpToDate, Mar. 18, 2025. [Online]. Available: https://www.uptodate.com/contents/enhanced-recovery-after-colorectal-surgery?source=mostViewed_widget
K. S. Romanowski and R. Askari, "Overview of Perioperative Nutrition Support," UpToDate, Feb. 18, 2025. [Online]. Available: https://www.uptodate.com/contents/overview-of-perioperative-nutrition-support?source=mostViewed_widget#references
D. Seres, "Nutrition support in critically ill adult patients: initial evaluation and prescription," UpToDate, Mar. 2, 2025. [Online]. Available: https://www.uptodate.com/contents/nutrition-support-in-critically-ill-adult-patients-initial-evaluation-and-prescription
N. Siparsky, "Overview of postoperative fluid therapy in adults," UpToDate, Mar. 2, 2025. [Online]. Available: https://www.uptodate.com/contents/overview-of-postoperative-fluid-therapy-in-adults
Chinese Society of Surgery and Chinese Society of Anesthesiology, "Chinese clinical practice guidelines for enhanced recovery after surgery (2021) (Part 1)," Medical Journal of Peking Union Medical College Hospital, vol. 12, no. 5, pp. 624–631, 2021.
Chinese Society of Surgery and Chinese Society of Anesthesiology, "Chinese clinical practice guidelines for enhanced recovery after surgery (2021) (Part 5)," Medical Journal of Peking Union Medical College Hospital, vol. 12, no. 5, pp. 658–665, 2021.
Chinese Society for Parenteral and Enteral Nutrition, "Clinical application guidelines for parenteral and enteral nutrition in Chinese adult patients (2023 edition)," National Medical Journal of China, vol. 103, no. 13, pp. 946–974, 2023.
China Anti-Cancer Association Nutrition Committee, "Oral nutritional supplement guideline update," Electronic Journal of Metabolism and Nutrition of Cancer, vol. 10, no. 1, pp. 64–68, 2023.
M. Muscaritoli, J. Arends, P. Bachmann, et al., "ESPEN practical guideline: Clinical Nutrition in cancer," Clinical Nutrition, vol. 40, no. 5, pp. 2898–2913, 2021.
A. Weimann, M. Braga, F. Carli, et al., "ESPEN practical guideline: Clinical nutrition in surgery," Clinical Nutrition, vol. 40, no. 7, pp. 4745–4761, 2021.
U. O. Gustafsson, M. J. Scott, M. Hubner, et al., "Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018," World Journal of Surgery, vol. 43, no. 3, pp. 659–695, 2019.
Guangdong ERAS Society, "Lingnan expert consensus on the comprehensive management of oral nutritional supplements for enhanced recovery in colorectal surgery patients (2018 edition)," Digestive Oncology (Electronic Edition), vol. 10, no. 4, pp. 167–172, 2018.
Chinese Colorectal Cancer Professional Committee, "Expert consensus on perioperative management of elderly colorectal cancer patients in China (2020 edition)," Chinese Journal of Colorectal Diseases (Electronic Edition), vol. 9, no. 4, pp. 325–334, 2020.
China Anti-Cancer Association Nutrition Committee and Chinese Society for Parenteral and Enteral Nutrition, "Expert consensus on nutritional therapy for colorectal cancer patients," Electronic Journal of Metabolism and Nutrition of Cancer, vol. 9, no. 6, pp. 735–740, 2022.
E. MacVicar, F. Cullen, S. L. Kastora, et al., "A systematic review of the impact of post-operative oral fluid intake on ileus following elective colorectal surgery," International Journal of Surgery, vol. 103, p. 106651, 2022.
L. Reece, S. Hogan, M. Allman-Farinelli, et al., "Oral nutrition interventions in patients undergoing gastrointestinal surgery for cancer: A systematic literature review," Supportive Care in Cancer, vol. 28, no. 12, pp. 5673–5691, 2020.
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Copyright (c) 2026 Yuzhen Jiang, Jiexuan Xu, Yan Xu, Lifen Peng, Fan Yang, Sangu Zhang, Yuying Chen (Author)
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