Perioperative intravenous glutamine supplemetation in major abdominal surgery for cancer: a randomized multicenter trial.
OBJECTIVE
To investigate whether perioperative intravenous glutamine supplementation may affect surgical morbidity.


BACKGROUND
Small-sized randomized trials showed a trend toward a reduction of postoperative infections in surgical patients receiving glutamine.


METHODS
: A randomized, multicentre trial was carried out in 428 subjects who were candidates for elective major gastrointestinal surgery. Inclusion criteria were: documented gastrointestinal cancer, weight loss <10% in previous 6 months, and age >18 years. Patients received either intravenous infusion of L-alanine-L-glutamine dipeptide (0.40 g/kg/d; equal to 0.25 g of free glutamine) (Ala-Glu group, n = 212), or no supplementation (control group, n = 216). Glutamine infusion began the day before operation and continued postoperatively for at least 5 days. No postoperative artificial nutrition was allowed unless patients could not adequately eat by day 7. Postoperative morbidity was assessed by independent observers according to a priori definition.


RESULTS
Patients were homogenous for baseline and surgical characteristics. Mean percent of weight loss was 1.4 (2.7) in controls and 1.4 (2.4) in Ala-Glu group. Overall postoperative complication rate was 34.9% (74/212) in Ala-Glu and 32.9% (71/216) in control group (P = 0.65). Infectious morbidity was 19.3% (41/212) in Ala-Glu group and 17.1% (37/216) in controls (P = 0.55). The rate of major complications was 7.5% (16/212) in Ala-Glu group and 7.9% (17/216) in controls (P = 0.90). Mean length of hospitalization was 10.2 days (4.8) in Ala-Glu group versus 9.9 days (3.9) in controls (P = 0.90). The rate of patients requiring postoperative artificial nutrition was 13.2% (28/212) in Ala-Glu group and 12.0% (26/216) in controls (P = 0.71).


CONCLUSIONS
Perioperative glutamine does not affect outcome in well-nourished GI cancer patients.
Department of Surgery, Milano-Bicocca University, S. Gerardo Hospital, Monza, Italy. luca.gianotti@unimib.it
Luca
L
Gianotti
Marco
M
Braga
Roberto
R
Biffi
Federico
F
Bozzetti
Luigi
L
Mariani
D000368:Aged; D004151:Dipeptides / Q000008:administration & dosage; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D005973:Glutamine / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*
D004151:Dipeptides; D005973:Glutamine; C045560:alanylglutamic acid