Letter regarding “The effect of early oral feeding afteresophagectomy on the incidence of anastomotic leakage: An updated review”

Abstract

We read the paper by Zhang et al. [1] with interest. The authors conducted an updated review focusing on the effect of early oral feeding (EOF) on the incidence of anastomotic leakage (AL) after esophagectomy. They concluded that EOF after esophagectomy probably does not increase the incidence of postoperative AL, and it is a promising strategy in line with the essence of fast-track surgery. This finding has implications for the generalization of trial results to the broader patient population and for future trial design. It means EOF can be applied to accelerate the recovery of gastrointestinal function for patients after esophagectomy. After carefully reading, we wish to put forth the following suggestions. Eleven references (five RCTs, six observational [case–control or cohort] studies) were included for review. The five RCTs included Lassen et al. [2], Mahmoodzadeh et al. [3], Weijs et al. [4], Sun et al. [5], and Berkelmans et al. [6]. However, we found that the study by Weijs et al. [4] wasn’t an RCT. It was a prospective study in three centers, immediate oral intake arm was conducted between 1 August 2013 and 28 May 2014, and the comparison group was a retrospective cohort (n = 50) with a per-protocol delayed start of oral intake until POD 4 to 7. This will affect the credibility of the result. The author should formulate strict inclusion and exclusion criteria. And the author should clarify the type of study to get a convincing conclusion. Declaration of interest