Early postoperative enteral nutrition improves gut oxygenation and reducescosts compared with total parenteral nutrition

Objective: To evaluate the potential clinical, metabolic, and economic adva ntages of enteral nutrition over total parenteral nutrition. Design Prospective, randomized clinical trial. Setting: Department of surgery in a university hospital. Patients: Two hundred and fifty-seven patients with cancer of the stomach ( n = 121), pancreas (n = 110), or esophagus (n = 26) were randomized to rece ive postoperative total parenteral nutrition (TPN group, n = 131) or early enteral nutrition (EEN group, n = 126), The nutritional goal was 25 kcal/kg /day. The two nutritional formulas were isocaloric and isonitrogenous, and they were continued until oral intake was at least 800 kcal/day, Measurements: Morbidity, mortality, length of hospital stay, and treatment costs were evaluated in all patients. In 40 consecutive patients, selected nutritional, immunologic and inflammatory variables were studied. Moreover, intestinal oxygen tension was evaluated by micropolarographic implantable probes. Main Results: The nutritional goal was reached in 100/126 (79.3%) patients in the EEN group and in 128/131 (97.7%) patients in the TPN group (p < .001 ), In the EEN group, hyperglycemia (serum glucose, >200 mg/dL) was observed in 4.7% of the patients vs, 9.1% in the TPN group (p = NS), Alteration of serum electrolyte levels was 3.9% in the EEN group vs, 13.7% in the TPN gro up (p < .01), No significant difference was found in nutritional, immunolog ic, and inflammatory variables between the two groups. The overall complica tion rate was similar (40.4% for TPN vs, 35.7%, for EEN; p = .52), No diffe rence was detected for either infectious or noninfectious complications, le ngth of hospital stay, and mortality. From postoperative day 5, intestinal oxygen tension recovered faster in the EEN group than in the TPN group (43 +/- 5 mm Hg vs, 31 +/- 4 mm Hg at day 7; p <,001), EEN was four-fold less e xpensive than TPN ($25 vs, $90.60/day, respectively). Conclusion: EEN represents a rational alternative to TPN in patients who un dergo upper gastrointestinal tract surgery for cancer and who clinically re quire postoperative artificial nutrition.