title: Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial.
abstract: BACKGROUND
  Clinical trials investigating the potential benefits of perioperative total parenteral nutrition (TPN) for reducing the risk of surgery in malnourished cancer patients have yielded controversial results.
  
  
  METHODS
  Ninety elective surgical patients with gastric or colorectal tumors and weight loss of 10% or more of usual body weight were randomly assigned to 10 days of preoperative and 9 days of postoperative nutrition vs a simple control group. The daily per kilogram body weight TPN regimen included 34.6 +/- 6.3 kcal nonprotein and 0.25 +/- 0.04 g nitrogen per kilogram in a volume of 42.6 +/- 7.3 mL of fluid. The glucose-to-fat calorie ratio was 70:30. Control patients did not receive preoperative nutrition but received 940 kcal nonprotein plus 85 g amino acids postoperatively.
  
  
  RESULTS
  Complications occurred in 37% of the patients receiving TPN vs 57% of the control patients (p = .03). Noninfectious complications mainly accounted for this difference, which was 12% vs 34%, respectively (p = .02). Mortality occurred in only 5 of the control group patients (p = .05). The total length of hospitalization for TPN patients was longer than for control (p = .00), whereas the length of postoperative stay in the two groups did not differ significantly.
  
  
  CONCLUSIONS
  This study shows that 10 days of preoperative TPN that is continued postoperatively is able to reduce the complication rate by approximately one third and to prevent mortality in severely malnourished patients with gastrointestinal cancer.
authors.affiliation: Department of Surgery of the Gastrointestinal Tract, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bozzetti
authors.forename: C
authors.initials: C
authors.lastname: Gavazzi
authors.forename: R
authors.initials: R
authors.lastname: Miceli
authors.forename: N
authors.initials: N
authors.lastname: Rossi
authors.forename: L
authors.initials: L
authors.lastname: Mariani
authors.forename: L
authors.initials: L
authors.lastname: Cozzaglio
authors.forename: G
authors.initials: G
authors.lastname: Bonfanti
authors.forename: S
authors.initials: S
authors.lastname: Piacenza
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery; D002149:Energy Intake; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009748:Nutrition Disorders / Q000150:complications / Q000628:therapy*; D010289:Parenteral Nutrition, Total; D011182:Postoperative Care; D011300:Preoperative Care; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery