Benefits of early postoperative enteral feeding in cancer patients.
OBJECTIVE
To evaluate the effect of the early postoperative administration of an enriched enteral diet in cancer patients.


METHODS
Randomised controlled study.


METHODS
Surgical intensive care unit of a university hospital.


METHODS
77 consecutive patients undergoing curative surgery for gastric or pancreatic cancer.


METHODS
Patients were randomised into 3 groups to receive: a standard enteral formula (n=24); the same formula enriched with arginine, RNA, and omega-3 fatty acids (n = 26), isonitrogen isocaloric total parenteral nutrition (n = 27). Enteral nutrition was started within 12 h following surgery. Infusion rate was progressively increased reaching the full regimen on postoperative day (POD) 4. On admission and on POD 1 and 8, the following measurements were performed: serum level of total iron-binding capacity, albumin, prealbumin, retinol-binding protein (RBP), and cholinesterase. Delayed hypersensitivity response (DHR), IgG, IgM, IgA, lymphocyte subsets. and monocyte phagocytosis ability were also evaluated. Bioelectrical impedance analysis was performed preoperatively and on POD 2, 7, and 11. The rate and severity of postoperative infections and the length of hospital stay were evaluated.


RESULTS
In all patients, a significant drop of nutritional and immunologic parameters was observed on POD 1. A significant increase of prealbumin (p<0.02), RBP (p<0.005), monocyte phagocytosis ability (p<0.001), and DHR (p<0.005) was found on POD 8 only in the group fed with the enriched diet. A significant reduction of severity of postoperative infections and length of postoperative stay was found in the group with the enriched diet compared to the other groups.


CONCLUSIONS
These data are suggestive of an improvement of the nutritional and immunologic status and clinical outcome in cancer patients who receive an enriched enteral diet in the early postoperative course.
Braga
M
M
Department of Surgery, Scientific Institute San Raffaele, University of Milan, Italy.
Vignali
A
A
Gianotti
L
L
Cestari
A
A
Profili
M
M
Di Carlo
V
V
D000368:Aged; D001120:Arginine / Q000008:administration & dosage; D001798:Blood Proteins / Q000378:metabolism; D001806:Blood Urea Nitrogen; D003422:Critical Care; D002149:Energy Intake / Q000502:physiology; D004750:Enteral Nutrition / Q000379:methods*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000097:blood / Q000628:therapy*; D012313:RNA / Q000008:administration & dosage; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000097:blood / Q000601:surgery*; D013530:Surgical Wound Infection / Q000097:blood / Q000628:therapy
D001798:Blood Proteins; D015525:Fatty Acids, Omega-3; D012313:RNA; D001120:Arginine