title: Effect of route of delivery and formulation of postoperative nutritional support in patients undergoing major operations for malignant neoplasms.
abstract: OBJECTIVE
  To study the effect of the route of delivery and formulation of postoperative nutritional support on host defense, protein metabolism, infectious complications, and outcome.
  
  
  METHODS
  Prospective, randomized, clinical trial.
  
  
  METHODS
  Department of Surgery at a university hospital.
  
  
  METHODS
  Two hundred sixty candidates for pancreaticoduodenectomy or gastrectomy for cancer.
  
  
  METHODS
  Patients were randomly allocated into 3 groups during surgery. Starting 6 hours after operation, the first group received a standard enteral formula (standard group; n = 87); the second, the same enteral formula enriched with arginine, omega-3 fatty acids, and RNA (immunonutrition group; n = 87); and the third, total parenteral nutrition (parenteral group; n = 86). The 3 regimens were isocaloric and isonitrogenous. The nutritional goal was 105 kJ/kg per day.
  
  
  METHODS
  Immune response by phagocytosis ability of polymorphonuclear cells, interleukin (IL)-2 receptor levels, and delayed hypersensitivity response; protein synthesis by IL-6 and prealbumin; tolerance of enteral feeding; incidence of postoperative complications; and length of hospital stay.
  
  
  RESULTS
  The immunonutrition group had a significantly better recovery of the immune parameters on postoperative day 8 compared with the other groups. Linear regression analysis showed an inverse correlation between IL-6 and preambulin levels (r = 0.766) only in the immunonutrition group. Only 11 patients (6.3%) in both enteral groups did not reach the nutritional goal. Postoperative infection rate was 14.9% (13/87) in the immunonutrition group, 22.9% (20/87) in the standard group, and 27.9% (24/86) in the parenteral group (P = .06). Mean +/- SD length of hospital stay was 16.1 +/- 6.2, 19.2 +/- 7.9, and 21.6 +/- 8.9 days in the immunonutrition, standard, and parenteral groups, respectively (P = .01 vs standard group; P = .004 vs parenteral group).
  
  
  CONCLUSIONS
  Early postoperative enteral feeding is a valid alternative to parenteral feeding in patients undergoing major surgery. Immunonutrition enhances the host response, induces a switch from acute-phase to constitutive proteins, and improves outcome.
authors.affiliation: Department of Surgery, Scientific Institute San Raffaele, University of Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Gianotti
authors.forename: M
authors.initials: M
authors.lastname: Braga
authors.forename: A
authors.initials: A
authors.lastname: Vignali
authors.forename: G
authors.initials: G
authors.lastname: Balzano
authors.forename: A
authors.initials: A
authors.lastname: Zerbi
authors.forename: P
authors.initials: P
authors.lastname: Bisagni
authors.forename: V
authors.initials: V
authors.lastname: Di Carlo
mesh_terms: D000368:Aged; D004750:Enteral Nutrition; D005260:Female; D005743:Gastrectomy; D005770:Gastrointestinal Neoplasms / Q000276:immunology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D012044:Regression Analysis