EARLY POSTOPERATIVE ENTERAL FEEDING IMPROVES WHOLE-BODY PROTEIN KINETICS IN UPPER GASTROINTESTINAL CANCER-PATIENTS

BACKGROUND: Patients with upper gastrointestinal (GI) tract malignanci es are at increased risk for malnutrition, as well as postoperative mo rbidity and mortality. As data clearly documenting the benefit of earl y postoperative enteral feeding in upper GI cancer patients as compare d with no feeding are sparse, we examined the protein kinetic effects of early enteral feeding and compared it with standard postoperative c are tie, intravenous fluid), METHODS: Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospectively randomize d to either enteral feeding (FEED, n = 12) starting on postoperative d ay (POD) 1 via a jejunostomy tube or intravenous fluid (IVF, n = 17). On POD 5, all patients underwent resting energy expenditure determinat ion and a protein metabolic study using the isotope C-14-leucine to de termine whole body (WE, mu mol leu/kg/min) protein kinetics. RESULTS: Respiratory quotient and insulin (mu U/ mt) levels were significantly increased in patients receiving enteral feeding (0.85 +/- 0.02, 19.8 /- 4.5 versus 0.78 +/- 0.02, 9.3 +/- 0.8, FEED versus IVF, P < 0.05), Free fatty acids (meq/dL) were significantly lower in FEED group (0.36 +/- 0.04) as compared with IVF group (0.85 +/- 0.07, P < 0.0001). Whi le there were no significant differences in WE protein oxidation (0.10 +/- 0.01 versus 0.10 +/- 0.02) or synthesis(0.81 +/- 0.09 versus 0.68 +/- 0.08, IVF versus FEED), WE protein catabolism was significantly l ess (0.91 +/- 0.10 versus 0.37 +/- 0.09, P = 0.002), and WE protein ne t balance was converted to positive in FEED group (-0.10 +/- 0.01 vers us 0.30 +/- 0.03, IVF versus FEED, P < 0.001). CONCLUSIONS: Early ente ral feeding decreases fat oxidation and whole body protein catabolism while improving net nitrogen balance. By significantly improving prote in metabolism, enteral feeding may decrease postoperative morbidity an d mortality in upper GI cancer patients. (C) 1997 by Excerpta Medica,I nc.