Feeding tube placement during cytoreductive surgery and heated intraperitoneal chemotherapy does not improve postoperative nutrition and is associated with longer length of stay and higher readmission rates.
BACKGROUND
Patients with colorectal cancer and peritoneal carcinomatosis (CRC/PC) may benefit from cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC). Nutritional support is frequently required for patients after CRS/HIPEC. It remains unclear if placement of feeding access is of benefit in regard to improving postoperative nutrition in this patient population.


METHODS
Patients with CRC/PC who underwent complete cytoreduction were evaluated. Preoperative and postoperative nutritional data and discharge outcomes were retrospectively recorded. The presence of a feeding tube and PCI scores were recorded by review of operative notes. Readmission rates were calculated for patients at 30 d and 60 d after discharge from hospital.


RESULTS
Forty-one patients underwent CRS/HIPEC, 25 had feeding tube placement at the time of surgery. Weight loss was common after HIPEC as 38 of 41 patients demonstrated weight loss. The mean weight loss was 7.6%. total parenteral nutrition was required at discharge in four patients (7.9%); three of these patients had feeding access placed. There was no difference in the degree of weight loss between groups (7.1 ± 3.7% no tube versus 7.9 ± 5.8% patients with tube; P = 0.608). The mean decrease in albumin was 12.7% but was not significantly different in patients with feeding access and those without (10.0% versus 14.75%; P = 0.773). Sixty-day readmission rates were higher in patients with feeding tubes (36% compared with 0%, P < 0.01).


CONCLUSIONS
Significant nutritional loss is common after CRS/HIPEC for patients with CRC/PC. Feeding tube placement does not prevent this and appears to be related to higher readmission rates and longer length of stay.
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: sean.dineen@uky.edu.
Sean P
SP
Dineen
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Kristen A
KA
Robinson
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Christina L
CL
Roland
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Karen A
KA
Beaty
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Safia
S
Rafeeq
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Paul F
PF
Mansfield
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Richard E
RE
Royal
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Keith F
KF
Fournier
D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000556:secondary* / Q000628:therapy; D010478:Chemotherapy, Cancer, Regional Perfusion; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006979:Hyperthermia, Induced; D007441:Intubation, Gastrointestinal; D007902:Length of Stay / Q000706:statistics & numerical data; D016685:Mitomycin / Q000008:administration & dosage; D009752:Nutritional Status; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010359:Patient Readmission / Q000706:statistics & numerical data; D010534:Peritoneal Neoplasms / Q000556:secondary* / Q000628:therapy; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D016685:Mitomycin
Carcinomatosis; Cytoreduction; Feeding tube; HIPEC; Nutrition