EARLY POSTOPERATIVE ENTERAL NUTRITION IMPROVES PERIPHERAL PROTEIN KINETICS IN UPPER GASTROINTESTINAL CANCER-PATIENTS UNDERGOING COMPLETE RESECTION - A RANDOMIZED TRIAL

Background: Patients with upper gastrointestinal (GI) tract malignanci es are at risk for malnutrition and postoperative morbidity and mortal ity. We examined the protein kinetic effects of early enteral feeding in this population and compared it with results in patients receiving IV fluid. Methods: Twenty-nine patients undergoing resection of an upp er GI tract malignancy were prospectively randomized to either enteral feeding starting on postoperative day (POD) 1 via a jejunostomy tube (FEED, n = 12) or IV fluid (IVF, n = 17). On POD5, all patients underw ent a protein metabolic study using [H-3]phenylalanine to determine fo rearm skeletal muscle (nmol phenylalanine/100 g/min) protein net balan ce. Free fatty acids (FFA, mEq/dL) and insulin levels (mU/mL) were mea sured. Results: Protein net balance was significantly less negative in the FEED group compared with the IVF group (-1.4 +/- 0.8 vs -5.0 +/- 1.4, p < .05). Respiratory quotient was significantly increased in pat ients receiving enteral feeding (0.85 +/- 0.02 vs 0.78 +/- 0.02 FEED v s IVF, p < .05). FFA levels were significantly decreased in the FEED g roup (0.36 +/- 0.04 us 0.85 +/- 0.07, P < .05). Insulin levels were si gnificantly elevated in the FEED group (19.8 +/- 45 vs 9.3 +/- 0.8, P < .05). Insulin levels correlated with amino acid fluxes. Conclusions: Postoperative enteral nutrition in upper GI cancer patients results i n an improvement in protein kinetic net balance and amino acid Bur acr oss peripheral tissue. In addition, insulin levels are elevated, and t his elevation correlates with amino fluxes across the forearm. By impr oving peripheral protein kinetics, early postoperative enteral nutriti on may potentially contribute to a decrease in postoperative morbidity and mortality in upper gastrointestinal cancer patients.