BENEFITS OF EARLY POSTOPERATIVE ENTERAL FEEDING IN CANCER-PATIENTS

Objective: To evaluate the effect of the early postoperative administr ation of an enriched enteral diet in cancer patients. Design: Randomis ed controlled study. Setting: Surgical intensive care unit of a univer sity hospital. Patients: 77 consecutive patients undergoing curative s urgery for gastric or pancreatic cancer. Interventions: Patients were randomised into 3 groups to receive: a standard enteral formula (n = 2 4); the same formula enriched with arginine, RNA, and omega-3 fatty ac ids (n = 26); isonitrogen isocaloric total parenteral nutrition (n = 2 7). Enteral nutrition was started within 12 h following surgery. Infus ion rate was progressively increased reaching the full regimen on post operative day (POD) 4. On admission and on POD 1 and 8, the following measurements were performed: serum level of total iron-binding capacit y, albumin, prealbumin, retinol-binding protein (REP), and cholinester ase. Delayed hypersensitivity response (DHR), IgG, IgM, IgA, lymphocyt e subsets, and monocyte phagocytosis ability were also evaluated. Bioe lectrical impedance analysis was performed preoperatively and on POD 2 , 7, and 11. The rate and severity of postoperative infections and the length of hospital stay were evaluated. Results: In all patients, a s ignificant drop of nutritional and immunologic parameters was observed on POD 1. A significant increase of prealbumin (p<0.02), REP (p<0.005 ), monocyte phagocytosis ability (p<0.001), and DHR (p<0.005) was foun d on POD 8 only in the group fed with the enriched diet. A significant reduction of severity of postoperative infections and length of posto perative stay was found in the group with the enriched diet compared t o the other groups.Conclusions: These data are suggestive of an improv ement of the nutritional and immunologic status and clinical outcome i n cancer patients who receive an enriched enteral diet in the early po stoperative course.