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Perioperative artificial nutrition in malnourished gastrointestinal cancer patients
Abstract
AIM: To investigate the potential role of perioperative nutrition in reducing complications and mortality in malnourished gastrointestinal cancer patients.
METHODS: Four hundred and sixty-eight elective moderately or severely malnourished surgical patients with gastric or colorectal cancers defined by the subjective global assessment (SGA) were randomly assigned to 7 d preoperative and 7 d postoperative parenteral or enteral nutrition vs a simple control group. The nutrition regimen included 24.6±5.2 kcal /kg per d non-protein and 0.23±0.04 g nitrogen /kg per d. Control patients did not receive preoperative nutrition but received 600±100 kcal non-protein plus or not plus 62 ± 16 g crystalline amino acids postoperatively.
RESULTS: Complications occurred in 18.3% of the patients receiving nutrition and in 33.5% of the control patients (P = 0.012). Fourteen patients died in the control group and 5 in those receiving nutrition. There were significant differences in the mortality between the two groups (2.1% vs 6.0%, P = 0.003). The total length of hospitalization and postoperative stay of control patients were significantly longer (29 vs 22 d, P = 0.014) than those of the studied patients (23 vs 12 d，P = 0.000).
CONCLUSION: Perioperative nutrition support is beneficial for moderately or severely malnourished gastrointestinal cancer patients and can reduce surgical complications and mortality.
INTRODUCTION
Malnutrition is common in gastrointestinal cancer patients and the causes are often complex and multi-factorial. Although it is widely accepted that malnutrition adversely affects the postoperative outcome of patients, there is little evidence that perioperative nutrition support can reduce surgical risk in malnourished cancer patients. Early retrospective studies suggested that perioperative nutrition support may effectively reduce postoperative complications[1,2]. Subsequent prospective, randomized clinical trials (RCTs) demonstrated that the benefits of perioperative nutrition support are limited to severely malnourished patients undergoing major surgery[3,4]. Most RCTs of perioperative nutritional support in patients with gastrointestinal cancer have shown that the degree of malnutrition varies considerably, ranging from no weight loss to weight loss exceeding 10 % and the results obtained by these studies are different in malnourished and non-malnourished patients[1-4]. Unfortunately, studies in really malnourished gastrointestinal cancer patients are not available. Meanwhile, parenteral and enteral nutrition is till controversial in perioperative malnourished gastrointestinal cancer patients[5].
The aim of this study was to evaluate the efficacy of optimal perioperative nutrition support in reducing complications and mortality in malnourished gastrointe-stinal cancer patients.
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