Early feeding compared with nasogastric decompression after major oncologic gynecologic surgery: A randomized study

Objective: To evaluate the feasibility, safety, and tolerance of early feed ing in patients undergoing surgery for gynecologic malignancies. Methods: Patients were stratified according to operative time and type of t umor and were randomized into two arms: A) early oral feeding and B) nasoga stric decompression followed by feeding at the first passage of natus. Vari ables assessed included nausea, vomiting, time to first passage of natus an d stool, time elapsed before adequate tolerance of a regular diet, postoper ative stay, and complications. Results: Sixty-one patients were randomized into each arm. The types of tum or, the surgical procedures performed, and the operative times were similar in both groups. Early oral feeding in patients in arm A was associated wit h a significantly faster resolution of postoperative ileus (P < .01), with a more rapid return to a regular diet (P < .01), with an earlier first pass age of stool (P < .01), and with a shorter postoperative stay (P < .05) tha n patients in arm B. Rates of nausea and vomiting were similar in both arms . Hindered deglutition and nasal soreness caused by the nasogastric tube we re observed in 88% of patients in arm B. Insertion of a nasogastric tube wa s necessary in six patients in arm A (10%), and three of these had postoper ative complications. Thus, early feeding was feasible in 95% of patients an d did not seem to be related to preoperative chemotherapy, tumor type, or l ymphadenectomy. Conclusion: Early feeding is feasible and well tolerated and is associated with reduced postoperative discomfort and a more rapid recovery in patients undergoing major surgery for gynecologic malignancies. (C) 1999 by The Ame rican College of Obstetricians and Gynecologists.