Postoperative Early Enteral Nutrition vs Total Parenteral Nutrition in Patients Undergoing Total Gastrectomy
Abstracts
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Background: In Japan, total parenteral nutrition (TPN) is usually indicated in the total gastrectomized patients for perioperative nutritional support. However recent studies have shown advantages of enteral feeding in patients undergoing major operation for cancer. Aim: To investigate if early postoperative enteral nutrition (EN) has beneficial effect on postoperative clinical course and costs compared with TPN in total gastrectomized patients. Method: Eleven EN (63.6+/-5.2 yrs, mean+/-SD) and 17 TPN patients (63.8+/-12.1 yrs) who underwent total gastrectomy for gastric cancer were retrospectively investigated. An enteral feeding tube was inserted through the nose intraoperatively in EN patients. The tip of the feeding tube was placed 10 cm below the Roux-en Y jejunojejunostomy. An Omega-3 fatty acid enriched diet was administrated from 1 to 7 postoperative day (200 kcal/d-postoperative day 1 up to 800 kcal/d-POD 4~7). Oral food intake was allowed on POD7 in both groups. Blood sample was taken preoperatively, on POD1 and POD14. Plasma level of total protein, albumin were measured, and white blood cells, total lymphocytes were counted. Postoperative complications, length of hospital stay and costs were compared. Results: Changes in plasma level of total protein and albumin were not different in both groups. Changes in white blood cells, total lymphocytes were not different in both groups. Postoperative complications were observed only in the TPN group. We have experienced 6 complications (3 catheter fever, 2 pneumonia and 1 cholecystitis), but none in the EN group. Costs of nutrition during 7 days after operation were in the EN group and in the TPN group. Postoperative hospital stay was 18.1+/-2.0 days in the EN group and 27.4+/-11.1 days in the TPN group. Conclusion: Early postoperative enteral nutrition significantly reduced postoperative infections, costs and length of hospital stay in patients undergoing total gastrectomy. |
