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Early Postoperative Oral Feeding After Colectomy: An Analysis of Factors That May Predict Failure

From the Division of Surgical Oncology, Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, New York.

Correspondence: Address correspondence and reprints requests to: Nicholas J. Petrelli, MD, Medical Director, Helen F. Graham Cancer Center, 4735 Ogletown-Stanton Road, MAPII, Suite 1201, Newark, DE 19713; Fax: 302-428-5790; E-mail: npetrelli{at}christianacare.org

Background: Previous studies have shown that early postoperative oral feeding is feasible. Traditionally patients were fed when flatus or defecation documented the return of bowel function. This study was undertaken to determine factors that may preclude early feeding.

Methods: One hundred four successive patients underwent colorectal surgery from October 1999 to January 2001. Eighty-nine patients started an oral diet either on postoperative day 1 or 2. Their clinical outcomes were recorded prospectively. Fifteen of the 104 patients were excluded for small-bowel resection (5 patients), perioperative complications (5 patients), prior radiation (3 patients), and small-bowel obstruction (2 patients). A failure in postoperative feeding consisted of nausea, vomiting, or readmission.

Results: The mean age of our cohort was 65 years (range, 28–87 years). There were 45 male and 44 female patients. The mean postoperative hospital stay was 6 days (range, 3–13 days). The median American Society of Anesthesiology score was II (range, I–IV). The types of resection performed were right colectomy (27 patients), low anterior resection (26 patients), sigmoid resection (11 patients), abdominoperineal resection (8 patients), formation or closure of colostomy (7 patients), posterior pelvic exenteration (4 patients), total colectomy (3 patients), left colectomy (2 patients), and transverse colectomy (1 patient). Sixty-five patients (73%) tolerated early oral feeding. Of the 24 patients that did not, 16 had nausea or emesis, and 8 required readmission for postoperative complications (small-bowel obstruction [4 patients], wound dehiscence [1 patient], abdominal pain [1 patient], and anastomotic leak [2 patients]). Univariate analysis revealed that the use of volume expanders contributed to intolerance of early feeding. On multivariate analysis, blood loss during the operation was the only factor contributing to failure of early postoperative oral feeding.

Conclusions: Early oral feeding is safe and feasible for postcolectomy patients with a history of colorectal neoplasms.

Key Words: Oral feeding • Colorectal • Colectomy • Postoperative