The effect of early enteral nutrition on hyperthermic intraoperative intraperitoneal chemotherapy-induced mucosal permeability following gastrectomy.
OBJECTIVE
To investigate (1) the effect of hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) on intestinal permeability of patients with advanced gastric cancer and (2) the protective effect of postoperative enteral nutrition (EN) on patients.


METHODS
All patients were divided randomly into 3 groups: the EN group, treated with EN during postoperative period; the EN+HIIC group, treated with HIIC and postoperative EN; and the PN+HIIC group, treated with HIIC and postoperative parenteral nutrition. The lactulose/mannitol (L/M) ratio was used to evaluate the permeability of intestinal mucous.


RESULTS
Compared with the ratio of L/M on the day before operation (POD-1), the ratio of L/M on POD+3 increased significantly in all 3 groups (P < .0001) and then decreased gradually. The L/M ratio of the EN and EN+HIIC groups recovered to the baseline on POD+12. In contrast, the PN+HIIC group still had an elevated L/M ratio until POD+12. The ratios of L/M in the EN+HIIC group on POD+7 and POD+12 were significantly different from those of the PN+HIIC group (0.0855 ± 0.0462 vs 0.1298 ± 0.063, P = .007; 0.0336 ± 0.0235 vs 0.0616 ± 0.0430, P = .038, respectively).


CONCLUSIONS
Gastric cancer radical resection resulted in a significant increase in intestinal permeability. HIIC aggravated the injury of intestinal mucous permeability, which could be reversed by EN.
Jiangsu Cancer Hospital, Nanjing, Jiangsu, China.
Gang
G
Li
Rongmin
R
Gu
Xu
X
Wen
Da
D
Wei
Xuezhi
X
Ming
Huanqiu
H
Chen
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D004750:Enteral Nutrition; D005260:Female; D005743:Gastrectomy; D006358:Hot Temperature; D006801:Humans; D006979:Hyperthermia, Induced; D007408:Intestinal Absorption; D007410:Intestinal Diseases / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology*; D007421:Intestine, Small / Q000378:metabolism / Q000473:pathology; D007792:Lactulose / Q000378:metabolism; D008297:Male; D008353:Mannitol / Q000378:metabolism; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000517:prevention & control; D010539:Permeability; D011183:Postoperative Complications / Q000628:therapy*; D013270:Stomach / Q000601:surgery; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000601:surgery*
D000970:Antineoplastic Agents; D008353:Mannitol; D007792:Lactulose