Perioperative total parenteral nutrition in malnourished, gastrointestinalcancer patients: A randomized, clinical trial

Background: Clinical trials investigating the potential benefits of periope rative total parenteral nutrition (TPN) for reducing the risk of surgery in malnourished cancer patients have yielded controversial results. Methods: Ninety elective surgical patients with gastric or colorectal tumors and wei ght loss of 10% or more of usual body weight were randomly assigned to 10 d ays of preoperative and 9 days of postoperative nutrition vs a simple contr ol group. The daily per kilogram body weight TPN regimen included 34.6 +/- 6.3 kcal nonprotein and 0.25 +/- 0.04 g nitrogen per kilogram in a volume o f 42.6 +/- 7.3 mt of fluid. The glucose-to-fat calorie ratio was 70:30. Con trol patients did not receive preoperative nutrition but received 940 kcal nonprotein plus 85 g amino acids postoperatively. Results: Complications oc curred in 37% of the patients receiving TPN us 57% of the control patients (p = .03). Noninfectious complications mainly accounted for this difference , which was 12% us 34%, respectively (p = .02). Mortality occurred in only 5 of the control group patients (p = .05). The total length of hospitalizat ion for TPN patients was longer than for control (p = .00), whereas the len gth of postoperative stay in the two groups did not differ significantly. C onclusions: This study shows that 10 days of preoperative TPN that is conti nued postoperatively is able to reduce the complication rate by approximate ly one third and to prevent mortality in severely malnourished patients wit h gastrointestinal cancer.