title: Early nasogastric tube removal combined with metoclopramide after postchemotherapy retroperitoneal lymph node dissection for metastatic testicular nonseminomatous germ cell tumor.
abstract: OBJECTIVE
  To evaluate the efficacy of combining early nasogastric tube (NGT) removal and metoclopramide after postchemotherapy retroperitoneal lymph node dissection (RPLND) in decreasing complications, time to diet tolerance, and discharge.
  
  
  METHODS
  We performed a retrospective study of 31 patients who underwent postchemotherapy RPLND at the University of Texas M. D. Anderson Cancer Center between 1994 and 1996, who were treated with a clinical care pathway that included NGT removal on postoperative day 1 and immediate use of promotility agents such as metoclopramide. A comparison was made with 42 historic controls treated from 1988 to 1994 who were managed with an NGT until the return of flatus and minimal promotility agents.
  
  
  RESULTS
  Both groups had comparable age, chemotherapy, and surgical procedures. The study group had fewer complications, with an earlier tolerance of solid food (median 5 +/- 2.5 days compared with 7 +/- 5.1 days in controls, P = 0.000) and discharge (median 6 +/- 2.6 days compared with 9 +/- 6.9 days in controls, P = 0.000). NGT replacement was required in 3.2% of study patients versus 9% of controls. Multiple regression analyses demonstrated that the number of NGT days was an independent predictor of early return of bowel function and length of hospitalization (P = 0.000), and metoclopramide was not.
  
  
  CONCLUSIONS
  Early NGT removal combined with metoclopramide after postchemotherapy RPLND allowed earlier diet tolerance and shortened hospital stays without increased complications. The role that promotility agents play as a necessary component of safe, early NGT removal is unclear.
authors.affiliation: Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Davis
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Doviak
authors.forename: S Machele
authors.initials: SM
authors.lastname: Donat
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D020878:Device Removal / Q000379:methods*; D004032:Diet; D006801:Humans; D007415:Intestinal Obstruction / Q000517:prevention & control*; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D007902:Length of Stay; D008197:Lymph Node Excision; D008787:Metoclopramide / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D012044:Regression Analysis; D012187:Retroperitoneal Space; D012189:Retrospective Studies
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D008787:Metoclopramide