Table 2.

Characteristics of included studies.

Study ID	Study Design	Cancer Types with % Ovarian Cancer	Sample Size	Time of Intervention	Type of Nutritional Intervention	Comparison	Outcomes Measures	Results
Pearl et al. 1998 [15]	RCT	Ovarian (32.3%), cervical, uterine and benign cancers	n = 195	Post-operation on the first postoperative day	EOF: Clear liquid diet	TOF: Nothing by mouth until bowel sounds, the passage of stool or flatus	Incidence of vomiting and nausea Intestinal function recovery LOS Postoperative complications	-No significant differences between the two groups in: incidence of vomiting postoperative complications -Significantly more patients in the EOF group developed nausea (p = 0.006) -Significantly reduction in the EOF group of: time of development of bowel sounds (p = 0.007) time to initiation of clear liquid and regular diets (p < 0.001) LOS (p = 0.001)
Cutillo et al. 1999 [16]	RCT with parallel arm design	Ovarian (48.3%) and other gynecologic cancers	n = 122	Post-operation on the first postoperative day	EOF: Clear-fluid diet, passing to a semiliquid fiberless diet within the next 24 h	Nasogastric decompression followed by feeding at the first passage of flatus	Incidence of nausea and vomiting Intestinal function recovery: time to first passage of flatus and stool, time elapsed before adequate tolerance of a regular diet LOS Postoperative complications	-No significant differences between the two groups in incidence of nausea and vomiting. -Significant reduction in the EOF group of: time of resolution of postoperative ileus(p < 0.01) time elapsed to a regular diet (p < 0.01) time of first passage of stool (p < 0.01) LOS (p < 0.05)
Pearl et al. 2002 [17]	RCT	Ovarian (33%), cervical, uterine and benign cancers	n = 245	Post-operation on the first postoperative day	EOF: Regular diet	EOF: Clear liquid diet	Incidence of nausea and vomiting Abdominal distention, passage of flatus before discharge LOS Postoperative complications	-No significant differences between the two groups in: incidence of nausea and vomiting abdominal distention time of first passage of flatus before discharge LOS postoperative complications
Feng et al. 2008 [18]	RCT	Ovarian (18.3%) and other gynecologic cancers	n = 60	Post-operation on the first 6 postoperative hours	Semiliquid diet followed by regular diet	Clear-liquid diet tosemiliquid diet toregular diet	Incidence of nausea and vomiting Time to development of bowel sound and passage of flatus Pre and post operative weight Urine acetone Fasting blood sugar	-Significant reduction (p < 0.05) in clear feeds group of: incidence of nausea time of regular diet resumption -No significant differences between the two groups in: incidence of vomiting time to development of bowel sound time of first passage of flatus pre and post operative weight urine acetone and fasting blood sugar
Celik et al. 2009 [19]	RCT with parallel arm design	Ovarian (32%) and other gynecologic cancers	n = 50	Pre-operation on the last 2 preoperative days post-operation on the first 7 postoperative days	IEN	Standardenteral nutrition	Nutritional measures (albumin, prealbumin) LOS Postoperative complications Mortality rate.	-No significant differences between the two groups in: nutritional measures mortality rate (p > 0.05) -Significant reduction in patients receiving IEN vs patients receiving standard enteral nutrition in: LOS (p < 0.05) postoperative complications (p < 0.05) for wound infections and dehiscence
Minig et al. 2009a [20]	RCT	Ovarian cancer (87.5%)	n = 40	Post-operation during the first 24 postoperative hours	EOF: Clear liquid diet	TOF: Nothing by mouth until the resumption of normal bowel function	LOS VAS score (abdominal pain) QoL (EORTC OV-28 and EORTC C-30) EBL Incidence of nausea and vomiting Postoperative complications Intestinal function recovery Analgesic and antiemetic drugs requirements	-Significant reduction of LOS (p = 0.022) in EOF group vs TOF group. -No significant differences between both groups in: VAS score QoL EBL incidence of nausea and vomiting postoperative complications intestinal activity recovery analgesic and antiemetic drugs needs
Minig et al. 2009b [21]	RCT	Ovarian (58%), endometrial, cervix and other cancers	n = 143	Post-operation during the first 24 postoperative hours	EOF: Clear liquid diet	TOF: Nothing by mouth until the resumption of normal bowel function	LOS VAS score (Abdominal pain) QoL Incidence of nausea and vomiting Postoperative complications Intestinal function recovery Analgesic and antiemetic drugs requirements	-Significant reduction of LOS in the EOF group (p = 0.006). -Significant higher overall postoperative (p = 0.003) and infective complications (p = 0.017) in the TOF group compared to the EOF group. -Significant higher mean level of postoperative satisfaction (p < 0.001) in the EOF group. -No differences between both groups in: QoL incidence of nausea and vomiting abdominal pain analgesic and antiemetic drugs requirements
Ertas et al. 2013 [22]	RCT	Ovarian (36.9%), endometrial and cervix cancers	n = 149	Post-operation on the first postoperative morning until the first passage of flatus	Chewing-gum 3 times/day	Control	Postoperative intestinal function recovery LOS	-Significant reduction (p < 0.001) in patients who chewed gum compared to controls of: time to flatus and defecation time to bowel movement time to tolerate diet LOS
Baker et al. 2015 [23]	RCT	Ovarian cancer (100%)	n = 109	Post-operationon the first postoperative day	Early enteral feeding: standard fiber (20P:30F:50C) 125 kJ/kg body weight.Until adequate oral intake could be maintained: 65–75% of the daily nutritional requirements.	Standard oral diet	QoL: FACT-G, FACT-O, EQ5D index, Euroqol-VAS, ICU or HDU admission %Nausea/vomiting Blood transfusion % Nutritional status (PG-SGA score) Pain score Weight Protein and energy intake LOS	-No significant differences between both groups in: QoL LOS pain score Euroqol-VAS ICU or HDU admission % Nausea/vomiting blood transfusion % protein and energy intake weight -Improvements of nutritional status (PG-SGA score) in the early enteral feeding patients vs. controls: significant different (p < 0.05) at 7 days postoperatively only (intention-to-treat analysis).
Güngördüket al. 2017 [24]	RCT	Ovarian (39.5%), endometrial, cervical and fallopian cancers	n = 114	Post-operationon the first morning after surgery	3 cups of caffeinated coffee daily (100 mL at 10:00 AM, 3:00 PM and /:00 PM)	Routine care without coffee consumption	Intestinal activity recovery (time to the first passage of flatus after surgery, time to first defecation, time to first bowel movement, time to toleration of a solid diet) LOS	-Significant reduction (p < 0.001) in patients who consumed coffee compared with controls in: time to flatus and defecation time to bowel movement time to tolerate diet. -Reduction of LOS in patients who consumed coffee compared to controls.
Bauersfeld et al. 2018 [25]	RCT with cross-over design	Ovarian (11.7%) and breast cancers	n = 34	During CT	Group ASTF* of 60 h (36 h before to 24 h after CT) during the first three of scheduled 6 CTsthenstandard Mediterranean diet during the last three of scheduled 6 CTs.	Group BStandard Mediterranean diet during the first three of scheduled 6 CTsthenSTF* of 60 h (36 h before to 24 h after CT) during the first three of scheduled 6 CTs	QoL: FACT-G Fatigue: FACIT-F	-In the group A, significant improvements during fasted periods compared to standard diet in: QoL fatigue -In the group B, no significant reduction during fasted period compared to standard diet in QoL Fatigue
Cohen et al. 2018 [26]	RCT	Ovarian (62.2%) and endometrial cancers	n = 45	During (n = 11) or post-CT	KD diet (70:25:5 energy from fat, protein, and carbohydrate)	ACS diet: high fiber, lower fat	Body composition: android fat mass, visceral fat, lean mass Fasting serum insulin	-Significant reduction in the KD group compared to the ACS group of: total and android fat mass (p < 0.05) percentage of change in visceral fat (p < 0.05) fasting serum insulin (p < 0.01) -No significant differences between both groups in adjusted total lean mass.
Cohen et al. 2018 [27]	RCT with parallel arm design	Ovarian (62.2%) and endometrial cancers	n = 45	During CT (n = 11) or post-CT	KD diet (70:25:5 energy from fat, protein, and carbohydrate)	ACS diet: moderate- to high-carbohydrate, high fiber, low fat	Mental function by Medical Outcomes Study Short Form-12 Health Survey (SF-12 Appetite (VAS) Food cravings by FCI	-No significant differences between both groups in mental function hunger and appetite -Less frequent food cravings in KD group than ACS group at 12 weeks (p < 0.05).
Paxton et al. 2012 [28]	RCT with parallel arm design	Ovarian cancer (100%)	n = 52	Post-CT≥6 months	LFHF group	FVJC group	Serum carotenoid and tocopherol levels Dietary intake Weight QoL	-Significant improvements in both groups (p < 0.01) in: serum carotenoid and alpha-tocopherol levels -Significant improvement in the LFHF group (p < 0.05) in: dietary intake (fiber intake, daily servings of juice fruits and vegetables) -No difference in both groups in: QoL Weight

Abbreviations: ACS, american cancer society; BMI, body mass index; C, carbohydrate; EBL, estimated blood loss; ECOG, eastern cooperative oncology group; EOF, early oral feeding; EORTC, European Organization for the Research and Treatment of Cancer; F, fat; FACIT-F, Functional Assessment of Chronic Illness Therapy-Fatigue; FACT-G, Functional Assessment of Cancer Therapy—General; FACT-O, Functional Assessment of Cancer Therapy—Ovarian; FCI, food craving inventory; FVJC, fruit and vegetable juice concentrates; HDU, high dependency unit; ICU, intensive care unit; IEN, immunenhancing enteral nutrition; KD, ketogenic diet; LFHF, low fat high fibre; LOS, length of hospital stay; n, number; P, protein; PGA-SGA score, Patient-Generated Subjective Global Assessment; Post-CT, post-chemotherapy treatment; QoL, quality of life; RCT, randomized controlled trial; STF, short-term fasting; TOF, traditional oral feeding; CT, chemotherapy treatment; VAS, visual analogue scale. * Fasting period: unrestricted amounts of water, herbal tea, 2x100cl vegetable juice and small standardized quantities of light vegetable broth with a maximum total daily energy intake of 350 kcal.