Nutritional approach in malnourished surgical patients: a prospective randomized study.
OBJECTIVE
Perioperative administration of a supplemented enteral formula may decrease postoperative morbidity.


METHODS
Randomized clinical trial.


METHODS
Department of surgery at a university hospital.


METHODS
One hundred ninety-six registered malnourished patients (weight loss > or = 10%) who were candidates for major elective surgery for malignancy of the gastrointestinal tract.


METHODS
After randomization (n = 150), one group received postoperative enteral feeding with a standard diet within 12 hours of surgery (control group; n = 50). Another group orally received 1 L/d for 7 consecutive days of a liquid diet enriched with arginine, omega-3 fatty acids, and RNA (preoperative group; n = 50). After surgery, patients were given the same standard enteral formula as the control group. A third group orally received 1 L/d for 7 consecutive days of the enriched liquid diet. After surgery, patients were given enteral feeding with the same enriched formula (perioperative group; n = 50).


METHODS
Postoperative complications and length of hospital stay.


RESULTS
The 3 groups were comparable for baseline demographics, biochemical markers, comorbidity factors, and surgical variables. The intent-to-treat analysis showed that the total number of patients with complications was 24 in the control group, 14 in the preoperative group, and 9 in the perioperative group (P =.02, control group vs perioperative group). Postoperative length of stay was significantly shorter in the preoperative (13.2 days) and perioperative (12.0 days) groups than in the control group (15.3 days) (P =.01 and P =.001, respectively, vs the control group).


CONCLUSIONS
Perioperative immunonutrition seems to be the best approach to support malnourished patients with cancer.
Braga
Marco
M
Department of Surgery, San Raffale University, Milan, Italy.
Gianotti
Luca
L
Nespoli
Luca
L
Radaelli
Giovanni
G
Di Carlo
Valerio
V
D000284:Administration, Oral; D001120:Arginine / Q000008:administration & dosage; D016009:Chi-Square Distribution; D004750:Enteral Nutrition / Q000379:methods*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D005526:Food, Formulated; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009748:Nutrition Disorders / Q000178:diet therapy*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D012313:RNA / Q000008:administration & dosage; D012307:Risk Factors; D016896:Treatment Outcome
D015525:Fatty Acids, Omega-3; D012313:RNA; D001120:Arginine