Nutritional Approach in Malnourished Surgical Patients

Abstract

Hypothesis: Perioperative administration of a sup- plemented enteral formula may decrease postoperative morbidity. Design: Randomized clinical trial. surgery, patients were given enteral feeding with the same enriched formula (perioperative group; n=50). Main Outcome Measures: Postoperative complica- tions and length of hospital stay. Setting: Department of surgery at a university hospital. Patients: One hundred ninety-six registered malnour- ished patients (weight loss?10%) who were candidates for major elective surgery for malignancy of the gastro- intestinal tract. Intervention: After randomization (n=150), one group received postoperative enteral feeding with a standard diet within 12 hours of surgery (control group; n=50). An- other group orally received 1 L/d for 7 consecutive days of a liquid diet enriched with arginine, ?-3 fatty acids, andRNA(preoperative group; n=50). After surgery, pa- tients were given the same standard enteral formula as the control group. A third group orally received 1 L/d for 7 consecutive days of the enriched liquid diet. After Results: The 3 groups were comparable for baseline de- mographics,biochemicalmarkers,comorbidityfactors,and surgical variables.Theintent-to-treat analysisshowedthat the total number of patients with complications was 24 in the control group, 14 in the preoperative group, and 9 in the perioperative group (P=.02, control group vs periop- erativegroup).Postoperativelengthofstaywassignificantly shorter in the preoperative (13.2 days) and perioperative (12.0 days) groups than in the control group (15.3 days) (P=.01 and P=.001, respectively, vs the control group). Conclusion: Perioperative immunonutrition seems to be the best approach to support malnourished patients with cancer. Arch