Effect of Route of Delivery and Formulation of Postoperative Nutritional Support in Patients Undergoing Major Operations for Malignant Neoplasms

Gianotti, Luca; Braga, Marco; Vignali, Andrea; Balzano, Gianpaolo; Zerbi, Alessandro; Bisagni, Pietro

doi:10.1001/archsurg.1997.01430350072012

Cited by 185 publications

(124 citation statements)

References 41 publications

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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Background Unlike the wide acceptance of early enteral nutrition after colorectal surgery, little information is available regarding the feasibility of immediate oral nutrition after gastric cancer surgery. This study evaluated the feasibility and safety of oral nutrition on the first postoperative day after gastrectomy. Methods From September 2010 to March 2011, 74 consecutive gastric cancer patients received an oral diet on the first postoperative day after gastrectomy. Surgical outcomes, including hospital stay, morbidity, and mortality, were compared with a conventional diet group (n = 96, before September 2010), in which an oral diet was started on the third or fourth postoperative day.Results No significant differences were found in the clinicopathological characteristics or operation types between the two groups. Average diet start times in the early diet (ED) and conventional diet (CD) groups were 1.8 and. 3.2, respectively (p \ 0.001). The mean hospital stay was significantly shorter in the ED group (7.4 vs. 8.9 days, p = 0.004). There was no significant difference in postoperative morbidity (p = 0.947) between the two groups. Gastrointestinal-related complications, such as anastomosis leakage or postoperative ileus, were also similar in the two groups. Overall compliance to early oral nutrition in the ED group was 78.5 %, and an old age (C70 years) was found to affect the compliance to early postoperative oral nutrition. Conclusions Postoperative oral nutrition is safe and feasible on the first postoperative day after gastrectomy. However, elderly patients require careful monitoring when applying early oral nutrition after gastrectomy.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…No problems 166 (36) 172 (37) Slight problems 93 (20) 90 (19) Moderate problems 114 (24) 99 (21) Severe problems 65 (20) 80 (17) Extreme problems 29 (6) 32 (7)…”

Section: Results: Cost-effectivenessmentioning

confidence: 99%

“…No problems 280 (61) 287 (61) Slight problems 87 (19) 71 (15) Moderate problems 60 (13) 71 (15) Severe problems 20 (4) 24 (5) Extreme problems 20 (4) 20 (4)…”

Section: Results: Cost-effectivenessmentioning

confidence: 99%

“…Adams et al 15 Borzotta et al 16 Cerra et al 17 Dunham et al 18 Gianotti et al 19 Hadfield et al 14 Kalfarentzos et al 20 Kudsk et al 21 Radrizzani et al 12 Rapp et al 22 Reynolds et al 23 Woodcock et al 24 Rayes et al 25 Overall Gianotti et al 19 Kalfarentzos et al 20 Radrizzani et al 12 Rayes et al 25 Overall …”

Section: Primarymentioning

confidence: 99%

“…No problems 299 (54) 293 (54) Slight problems 106 (19) 113 (21) Moderate problems 85 (15) 72 (13) Severe problems 31 (6) 29 (5) Extreme problems 37 (7) 37 (7) Usual activities…”

Section: Self-carementioning

confidence: 99%

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A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

Harvey

Parrott

Harrison

et al. 2016

Health Technol Assess

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BackgroundMalnutrition is a common problem in critically ill patients in UK NHS critical care units. Early nutritional support is therefore recommended to address deficiencies in nutritional state and related disorders in metabolism. However, evidence is conflicting regarding the optimum route (parenteral or enteral) of delivery.ObjectivesTo estimate the effect of early nutritional support via the parenteral route compared with the enteral route on mortality at 30 days and on incremental cost-effectiveness at 1 year. Secondary objectives were to compare the route of early nutritional support on duration of organ support; infectious and non-infectious complications; critical care unit and acute hospital length of stay; all-cause mortality at critical care unit and acute hospital discharge, at 90 days and 1 year; survival to 90 days and 1 year; nutritional and health-related quality of life, resource use and costs at 90 days and 1 year; and estimated lifetime incremental cost-effectiveness.DesignA pragmatic, open, multicentre, parallel-group randomised controlled trial with an integrated economic evaluation.SettingAdult general critical care units in 33 NHS hospitals in England.Participants2400 eligible patients.InterventionsFive days of early nutritional support delivered via the parenteral (n = 1200) and enteral (n = 1200) route.Main outcome measuresAll-cause mortality at 30 days after randomisation and incremental net benefit (INB) (at £20,000 per quality-adjusted life-year) at 1 year.ResultsBy 30 days, 393 of 1188 (33.1%) patients assigned to receive early nutritional support via the parenteral route and 409 of 1195 (34.2%) assigned to the enteral route had died [p = 0.57; absolute risk reduction 1.15%, 95% confidence interval (CI) −2.65 to 4.94; relative risk 0.97 (0.86 to 1.08)]. At 1 year, INB for the parenteral route compared with the enteral route was negative at −£1320 (95% CI −£3709 to £1069). The probability that early nutritional support via the parenteral route is more cost-effective – given the data – is < 20%. The proportion of patients in the parenteral group who experienced episodes of hypoglycaemia (p = 0.006) and of vomiting (p < 0.001) was significantly lower than in the enteral group. There were no significant differences in the 15 other secondary outcomes and no significant interactions with pre-specified subgroups.LimitationsBlinding of nutritional support was deemed to be impractical and, although the primary outcome was objective, some secondary outcomes, although defined and objectively assessed, may have been more vulnerable to observer bias.ConclusionsThere was no significant difference in all-cause mortality at 30 days for early nutritional support via the parenteral route compared with the enteral route among adults admitted to critical care units in England. On average, costs were higher for the parenteral route, which, combined with similar survival and quality of life, resulted in negative INBs at 1 year.Future workNutritional support is a complex combination of timing, dose, duration, delivery and type, all of which may affect outcomes and costs. Conflicting evidence remains regarding optimum provision to critically ill patients. There is a need to utilise rigorous consensus methods to establish future priorities for basic and clinical research in this area.Trial registrationCurrent Controlled Trials ISRCTN17386141.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 28. See the NIHR Journals Library website for further project information.

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Outcome and Cost-effectiveness of Perioperative Enteral Immunonutrition in Patients Undergoing Elective Upper Gastrointestinal Tract Surgery

Senkal

Zumtobel²,

Bauer³

et al. 1999

Arch Surg

266

166

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Effect of Route of Delivery and Formulation of Postoperative Nutritional Support in Patients Undergoing Major Operations for Malignant Neoplasms

Abstract: Early postoperative enteral feeding is a valid alternative to parenteral feeding in patients undergoing major surgery. Immunonutrition enhances the host response, induces a switch from acute-phase to constitutive proteins, and improves outcome.

Cited by 185 publications

References 41 publications

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

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

A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

Outcome and Cost-effectiveness of Perioperative Enteral Immunonutrition in Patients Undergoing Elective Upper Gastrointestinal Tract Surgery

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