A Prospective, Randomized Trial of Early Enteral Feeding After Resection of Upper Gastrointestinal Malignancy

Abstract

ObjectiveThe purpose of the study was to determine whether early postoperative enteral feeding with an immune-enhancing formula (IEF) decreases morbidity, mortality, and length of hospital stay in patients with upper gastrointestinal (GI) cancer. Summary Background DataEarly enteral feeding with an IEF has been associated with improved outcome in trauma and critical care patients. Evaluable data documenting reduced complications after major upper GI surgery for malignancy with early enteral feeding are limited. MethodsBetween March 1994 and August 1996, 195 patients with a preoperative diagnosis of esophageal (n = 23), gastric (n = 75), peripancreatic (n = 86), or bile duct (n = 1 1) cancer underwent resection and were randomized to IEF via jejunostomy tube or control (CNTL). Tube feedings were supplemented with arginine, RNA, and omega-3 fatty acids, begun on postoperative 1, and advanced to a goal of 25 kcalkg per day. The CNTL involved intravenous crystalloid solutions. Statistical analysis was by t test, chi square, or logistic regression. ResultsPatient demographics, nutritional status, and operative factors were similar between the groups. Caloric intake was 61 % and 22% of goal for the IEF and CNTL groups, respectively. The IEF group received significantly more protein, carbohydrate, lipids and immune-enhancing nutrients than did the CNTL group. There were no significant differences in the number of minor, major, or infectious wound complications between the groups. There was one bowel necrosis associated with IEF requiring reoperation. Hospital mortality was 2.5% and median length of hospital stay was 11 days, which was not different between the groups. 567

The safety and feasibility of early postoperative oral nutrition on the first postoperative day after gastrectomy for gastric carcinoma

“…For this reason, in the previous studies on early enteral nutrition after esophagogastric surgery, enteral nutrition was often administered via an intestinal tube (naso-jejunal tube or catheter jejunostomy) to protect anastomosis [19][20][21][22]. However, several experimental and clinical studies have demonstrated that early enteral feeding increases wound healing and anastomotic strength in intestines and somatic tissues [23,24].…”

Modulation of postoperative immune and inflammatory response by immune-enhancing enteral diet in gastrointestinal cancer patients

“…Biologically, there have been several reasons reported including better substrate utilization, prevention of mucosal atrophy, preservation of normal gut flora, gut integrity, and immune competence. Early enteral vs parenteral feeding in traumatized and surgical patients is gaining wide consensus after the promising results showing good tolerance and notable reduction of septic morbidity [1,[6][7][8][9] . Our data confirm that early postoprative enteral feeding may be carried out safely in patients who have undergone major operations for cancer.…”

Early Enteral Nutrition Versus Parenteral Nutrition After Resection of Esophageal Cancer: a Retrospective Analysis

“…Furthermore, most clinical studies did not compare enteral nutrition and total parenteral nutrition in a randomized fashion [14,22,24]. Of the studies performed in a prospective randomized fashion [9,25,26], the patients studied were not limited to esophageal cancer patients, such that the bona fide effects of EEN in esophageal surgery were not clear. Furthermore, the term Bearly^was defined as EN started within 24-48 h after admission or surgery [27]; however, EN started within 24 h had shown no advantage for the postoperative course in esophageal cancer [28].…”