Postoperative enteral versus parenteral nutrition in malnourished patientswith gastrointestinal cancer: a randomised multicentre trial

Background Although current opinion favours the use of enteral over parente ral nutrition, the clinical benefits of early postoperative nutrition in pa tients undergoing elective surgery have never been clearly shown. We aimed to test the hypothesis that postoperative enteral nutrition is better (fewe r postoperative complications) than parenteral nutrition containing similar energy and nitrogen amounts (112 kJ kg(-1)day(-1) and 1.4 g aminoacid kg(- 1)day(-1)). Methods We did a randomised multicentre clinical trial in patients with gas trointestinal cancer who were malnourished and candidates for major electiv e surgery. 159 patients were assigned to enteral nutrition and 158 to paren teral nutrition. The primary endpoint was the occurrence of postoperative c omplications, and secondary endpoints were length of postoperative hospital stay, adverse effects, and treatment crossover. Analysis was by intention to treat. Findings Postoperative complications occurred in 54 (34%) patients fed ente rally versus 78 (49%) fed parenterally (relative risk 0.69, 95% CI 0.53-0.9 0, p=0.005). Length of postoperative stay was 13.4 days and 15.0 days in th e enteral nutrition and parenteral nutrition groups, respectively (p=0.009) . Adverse effects occurred in 56 (35%) patients fed enterally versus 22 (14 %) patients fed parenterally (2.50, 1.61-3.86, p<0.0001). 14 (9%) patients on enteral nutrition had to switch to parenteral nutrition, whereas none of those fed parenterally crossed over to enteral feeding. Interpretation We conclude that early enteral nutrition significantly reduc es the complication rate and duration of postoperative stay compared with p arenteral nutrition, although parenteral nutrition is better tolerated than enteral nutrition.