Reduction of postoperative complication rate with the use of early oral feeding in gynecologic oncologic patients undergoing a major surgery: a randomized controlled trial.
BACKGROUND
A randomized controlled trial was performed to assess the outcome of early oral postoperative feeding (EOF) compared with traditional oral feeding (TOF) in gynecologic oncology patients undergoing a complex laparotomy, including upper abdominal surgery.


METHODS
Patients aged 18-75 years, undergoing an elective laparotomy and with a preoperative suspicion of gynecologic malignancy, were eligible. Exclusion criteria included infectious conditions, intestinal obstruction, severe malnutrition, American Society of Anesthesiologists score C4, intestinal resection, and postoperative stay in the intensive care unit lasting 24 h. Patients allocated to EOF received liquid diet in the first postoperative day and then regular diet. Patients received traditional feeding scheme until resolution of postoperative ileus to start liquid diet. The primary end-point of the trial was length of hospital stay.


RESULTS
Between January 1, 2007, and November 17, 2007, a total of 143 patients were randomized to receive either EOF or TOF. Hospital stay for patients who received EOF (n=71) was 4.7 vs. 5.8 days for the TOF group (n=72) (P=0.006). The mean level of postoperative satisfaction was significantly higher in the EOF group (82.8 vs. 71.7 mm, P B 0.001). Patients who received the TOF scheme had significantly higher overall postoperative complications (39 vs. 17% in EOF group, P=0.003) and infective complications (14% in TOF group vs. 3% in EOF group, P=0.017). Variables such as nausea and vomiting, analgesic and antiemetic requirement as well as level of pain and quality of life were not different between groups.


CONCLUSIONS
On the basis of these findings, the policy of EOF should be used after a complex gynecologic oncologic laparotomy.
Minig
Lucas
L
Gynecology Department, European Institute of Oncology, Milan, Italy. lucasminig@yahoo.com
Biffi
Roberto
R
Zanagnolo
Vanna
V
Attanasio
Anna
A
Beltrami
Carmen
C
Bocciolone
Luca
L
Botteri
Edoardo
E
Colombo
Nicoletta
N
Iodice
Simona
S
Landoni
Fabio
F
Peiretti
Michele
M
Roviglione
Giovanni
G
Maggioni
Angelo
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D004435:Eating; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D008875:Middle Aged; D009367:Neoplasm Staging; D010149:Postoperative Pain; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult