Is nasogastric or nasojejunal decompression necessary following gastrectomy for gastric cancer? A systematic review and meta-analysis of randomised controlled trials.

Whether nasogastric or nasojejunal decompression (ND) prevents anastomotic leakage, hastens the return of bowel function, and shortens hospital stay after gastrectomy for gastric cancer has long been controversial. We evaluated the necessity of routine ND after radical gastrectomy for gastric cancer with a systematic review and meta-analysis. We searched literature published prior to January 2014 in PubMed, Embase, Cochrane Library, Web of Science, and BIOSIS Previews for relevant randomized controlled trials (RCTs). Only prospective RCTs comparing individuals with and without ND after gastrectomy for gastric cancer were included. Outcome measures included time to first flatus, time to starting oral diet, anastomotic leakage, pulmonary complications, wound dehiscence, length of hospital stay, morbidity, and mortality. Cochrane Collaboration RevMan 5.2 software was used for the meta-analysis. Eight RCT studies fulfilled our inclusion criteria. Of the 1,141 patients in those RCTs, 570 received nasogastric or nasojejunal decompression and 571 did not. Anastomotic leakage, pulmonary complications, wound dehiscence, morbidity, and mortality were comparable between the groups. Stratified by the type of gastrectomy or gastrojejunostomy, no significant differences in above mentioned outcomes were observed in subgroup analyses. The no ND group displayed a significantly shorter time to oral diet (weighted mean difference [WMD] = 0.45, 95% confidence interval [CI] = 0.29 to 0.61, p < 0.001) and a marginally shorter end of hospital stay (WMD = 0.48, 95% CI = -0.01 to 0.98, p = 0.05). The ND group significantly shortened time to first flatus (WMD = -0.7, 95% CI = -1.13 to -0.27, p = 0.001), especially with Roux-en-Y reconstruction (WMD = -1.0, 95 % CI = -1.52 to -0.48, p = 0.0002) and prolonged time to starting oral diet (WMD = 0.52, 95% CI = 0.13 to 0.90, p = 0.009) in the patients with subtotal gastrectomy. Routine ND appears to be unnecessary after gastrectomy for gastric cancer, irrespective of the extent of resection, and the type of digestive reconstruction.