Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition.
OBJECTIVE
To evaluate the potential clinical, metabolic, and economic advantages of enteral nutrition over total parenteral nutrition.


METHODS
Prospective, randomized clinical trial.


METHODS
Department of surgery in a university hospital.


METHODS
Two hundred and fifty-seven patients with cancer of the stomach (n = 121), pancreas (n = 110), or esophagus (n = 26) were randomized to receive postoperative total parenteral nutrition (TPN group, n = 131) or early enteral nutrition (EEN group, n = 126). The nutritional goal was 25 kcal/kg/day. The two nutritional formulas were isocaloric and isonitrogenous, and they were continued until oral intake was at least 800 kcal/day.


METHODS
Morbidity, mortality, length of hospital stay, and treatment costs were evaluated in all patients. In 40 consecutive patients, selected nutritional, immunologic and inflammatory variables were studied. Moreover, intestinal oxygen tension was evaluated by micropolarographic implantable probes.


RESULTS
The nutritional goal was reached in 100/126 (79.3%) patients in the EEN group and in 128/131 (97.7%) patients in the TPN group (p <.001). In the EEN group, hyperglycemia (serum glucose, >200 mg/dL) was observed in 4.7% of the patients vs. 9.1% in the TPN group (p = NS). Alteration of serum electrolyte levels was 3.9% in the EEN group vs. 13.7% in the TPN group (p <.01). No significant difference was found in nutritional, immunologic, and inflammatory variables between the two groups. The overall complication rate was similar (40.4% for TPN vs. 35.7%, for EEN; p =.52). No difference was detected for either infectious or noninfectious complications, length of hospital stay, and mortality. From postoperative day 5, intestinal oxygen tension recovered faster in the EEN group than in the TPN group (43 +/- 5 mm Hg vs. 31 +/- 4 mm Hg at day 7; p <.001). EEN was four-fold less expensive than TPN ($25 vs. $90.60/day, respectively).


CONCLUSIONS
EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinically require postoperative artificial nutrition.
Department of Surgery, Scientific Institute, S. Raffaele Hospital, Milan, Italy. braga.marco@hsr.it
M
M
Braga
L
L
Gianotti
O
O
Gentilini
V
V
Parisi
C
C
Salis
V
V
Di Carlo
D000368:Aged; D002149:Energy Intake; D004750:Enteral Nutrition / Q000191:economics* / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D004938:Esophageal Neoplasms / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D005260:Female; D005526:Food, Formulated / Q000032:analysis; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D007239:Infections / Q000209:etiology; D007249:Inflammation; D007413:Intestinal Mucosa / Q000378:metabolism*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015596:Nutrition Assessment; D010100:Oxygen / Q000378:metabolism*; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D010289:Parenteral Nutrition, Total / Q000191:economics* / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome
D010100:Oxygen