Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: a randomized study.
OBJECTIVE
The aim of this study was to investigate whether specialized supportive enteral and parenteral feeding have superior effects compared to oral nutrition on recovery during long-term postoperative treatment of cancer patients with preoperative weight loss and reduced maximum exercise capacity.


METHODS
One hundred twenty-six patients referred for resection of the esophagus (n = 48), stomach (n = 28), or pancreas (n = 50) were considered to be included before operation. Included patients (n = 80) received supportive enteral or parenteral nutrition postoperatively at home corresponding to 1000 kcal/d until the patients did not wish to continue with artificial nutrition for any reason. Patients randomized to oral nutrition only served as control subjects. Caloric intake, body composition (dual-energy x-ray absorptiometry), and respiratory gas exchanges at rest and during exercise were measured including health-related quality of life.


RESULTS
Survival and hospital stay did not differ among the groups, whereas overall complications were higher on artificial nutrition (P < .05). Changes in resting energy expenditure and biochemical tests did not differ during follow-up among the groups. Body weight and whole body fat declined similarly over time in all groups (P < .005), whereas lean body mass was unchanged during follow-up compared to preoperative values. Maximum exercise capacity and maximum oxygen consumption were normalized within 6 months postoperatively in all groups. There was no difference in recovery of food intake among the groups. Parenteral feeding was associated with the highest rate of nutrition-related complications, whereas enteral feeding reduced quality of life most extensively.


CONCLUSIONS
After major surgery, specialized supportive enteral and parenteral nutrition are not superior to oral nutrition only when guided by a dietitian.
Hyltander
Anders
A
Department of Surgery, Institute of Clinical Neuroscience, Sahlgrenska University of Hospital, Göteborg University, Sweden.
Bosaeus
Ingvar
I
Svedlund
Jan
J
Liedman
Bengt
B
Hugosson
Irene
I
Wallengren
Ola
O
Olsson
Ulla
U
Johnsson
Erik
E
Kostic
Srdjan
S
Henningsson
Annika
A
Körner
Ulla
U
Lundell
Lars
L
Lundholm
Kent
K
D001823:Body Composition; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004734:Energy Metabolism; D004947:Esophagus / Q000601:surgery*; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D018529:Nutritional Support / Q000009:adverse effects / Q000379:methods*; D010101:Oxygen Consumption; D010179:Pancreas / Q000601:surgery*; D011182:Postoperative Care; D011659:Pulmonary Gas Exchange; D011788:Quality of Life; D020127:Recovery of Function; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome
D004044:Dietary Proteins