A PROSPECTIVE, RANDOMIZED TRIAL OF EARLY ENTERAL FEEDING AFTER RESECTION OF UPPER GASTROINTESTINAL MALIGNANCY

Objective The purpose of the study was to determine whether early post operative enteral feeding with an immune-enhancing formula (IEF) decre ases morbidity, mortality, and length of hospital stay in patients wit h upper gastrointestinal (GI) cancer. Summary Background Data Early en teral 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. Methods Between March 1994 and August 199 6, 195 patients with a preoperative diagnosis of esophageal (n = 23), gastric (n = 75), peripancreatic (n = 86), or bile duct (n = 11) cance r 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 kcal/kg per day. The CNTL involved intravenous crystalloid solutions. Statistical analysis was by t test, chi square, or logistic regression. Results Patient demographics, nutritional status, and ope rative factors were similar between the groups. Caloric intake was 61% and 22% of goal for the IEF and CNTL groups, respectively. The IEF gr oup received significantly more protein, carbohydrate, lipids and immu ne-enhancing nutrients than did the CNTL group. There were no signific ant differences in the number of minor, major, or infectious wound com plications between the groups. There was one bowel necrosis associated with IEF requiring reoperation. Hospital mortality was 2.5% and media n length of hospital stay was 11 days, which was not different between the groups. Conclusion Early enteral feeding with an IEF was not bene ficial and should not be used in a routine fashion after surgery for u pper GI malignancies.