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.