[The role of perioperative enteral and parenteral nutrition treatment in pancreatic cancer: a multicenter, prospective randomized controlled trial].
OBJECTIVE
To compare the two different nutritional supports, enteral nutrition and parenteral nutrition in the aspects of nutritional conditions, immune status, the incidence of perioperative complications and quality of life impacts in pancreatic cancer.


METHODS
For the pancreatic cancer patients which pancreaticoduodenectomy were performed from January 2007 to December 2008 in five high-volume medical centres, prospective, randomized controlled study was carried out. The enrolled patients were randomly divided into enteral nutritional group (EN group) and parenteral nutritional group (PN group). Related indicators, such as nutritional conditions, immune status, incidence of complications, general status and quality of life were assessed.


RESULTS
The 200 patients were enrolled, while 178 cases which 90 patients in EN group and 88 patients in PN group were qualified to evaluate. The 22 cases were dropped out. For the mean hospital stay ((23 ± 13) days and (27 ± 24) days respcectively), Karnofsky score and the life quality scoring, there are no statistical differences between the two groups. In post-operation day 7 and day 10, the prealbumin was (69 ± 16) mg/L and (80 ± 22) mg/L in EN group and it was (67 ± 19) mg/L and (70 ± 11) mg/L in PN group, which are all significantly decreased than preoperational levels ((186 ± 38) mg/L for enteral group and (179 ± 37) mg/L for parenteral group, t = -2.24, -2.13, -2.23, -2.20, all P < 0.05), but there was no statistically significant between the 2 groups (P > 0.05). Other general indicators such as the albumin, hemoglobin, total bilirubin, blood urea nitrogen, serum creatinine, serum potassium and serum sodium, revealed no statistical differences in the 2 groups (P > 0.05); The total lymphocytes, CD(+)3CD(+)4 and CD(+)3CD(+)8 lymphocytes in PN group was (0.687 ± 0.065)×10(9)/L, (0.363 ± 0.029)×10(9)/L, and (0.183 ± 0.018)×10(9)/L respectively in post-operation day 10, which they are significantly decreased than in preoperational levels of PN group and the respective counterpart of EN group in post-operation day10 (t = -2.04-2.83, P < 0.05). The 35 patients were suffered from different complications in the 2 groups, but there was no statistical differences among them (P > 0.05).


CONCLUSIONS
Enteral nutritional support could not decrease the incidence of perioperative complications in pancreatic cancer patient, but it can improve the immunonutrition status in comparison with parenteral nutrition.
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Jun-chao
JC
Guo
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Jian
J
Li
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Ya
Y
Hu
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Tai-ping
TP
Zhang
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Quan
Q
Liao
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Meng-hua
MH
Dai
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China. Email: Zhao8028@263.net.
Yu-pei
YP
Zhao
D000293:Adolescent; D000328:Adult; D000368:Aged; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery / Q000628:therapy*; D010288:Parenteral Nutrition; D059035:Perioperative Period; D011446:Prospective Studies; D055815:Young Adult