[Early enteral nutrition in cancer patients subjected to a total gastrectomy].
BACKGROUND
Total parenteral nutrition has a high cost and frequency of complications. Enteral feeding is a feasible alternative that can be started early in the postoperative period.


OBJECTIVE
To assess digestive tolerance to early enteral feeding in cancer patients undergoing total gastrectomy and to compare early enteral feeding (EEF) with total parenteral nutrition plus enteral feeding (TPN + EF), initiated after overcoming postoperative ileus.


METHODS
Subjects with a resectable gastric cancer were considered eligible for the study. During surgery a nasoenteral tube was placed and patients were prospectively randomized to EEF or TPN + EF. Digestive tolerance, effectiveness, complications and costs between both modalities of nutritional support were compared.


RESULTS
Twenty eight patients (15 male, aged 63 +/- 14 years old) were studied. Fourteen patients were randomized to EEF and 14 to TPN + EF. Diarrhea occurred in 14 and 29% of EEF and TPN + EF patients respectively, (p: NS). Patients with TPN + EF received an average of 28 Cal/kg/day and 1.1 g/kg/day proteins. Patients with EEF received an average of 29 Cal/kg/day and 0.8 g/kg/day proteins. At the eighth postoperative day, serum albumin was 3.9 +/- 0.7 and 3.2 +/- 0.5 g/dl in EEF and TPN + EF patients respectively (p < 0.05), serum prealbumin was 16.9 +/- 5 and 12.3 +/- 4.3 mg/dl in EEF and TPN + EF patients respectively (p < 0.05) and nitrogen balance was +2.4 +/- 1.5 and -1.6 +/- 0.6 g/24 h in EEF and TPN + EF patients respectively (p < 0.05). Postoperative hyperglycemia was observed with a lower frequency and nutritional support costs and length of hospital stay were significantly lower in the EEF group.


CONCLUSIONS
After total gastrectomy EEF is well tolerated, safe and effective, even during the early postoperative ileus. This therapeutic modality could be the first choice for nutritional support in these patients.
Papapietro
Karin
K
Unidad de Nutrición, Departamento de Cirugía, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santos Dumont 999, Independencia, Santiago.
Díaz
Emma
E
Csendes
Attila
A
Díaz
Juan C
JC
Burdiles
Patricio
P
Maluenda
Fernando
F
Braghetto
Italo
I
Llanos
José L
JL
D'Acuña
Sonia
S
Rappoport
Jaime
J
D000368:Aged; D004750:Enteral Nutrition / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000191:economics; D011182:Postoperative Care; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D013997:Time Factors; D015431:Weight Loss