Comparative Study of Total Parenteral Nutrition and Early Enteral Nutrition in Patients with Gastric Cancer after Total Gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YUAN Congwei , LI Junsheng , JI Zhenling , ZHANG Yanan , CHEN Weidong , JU Xingtang

Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing 210009, ChinaCorresponding Author: LI Jun-sheng, E-mail: lijunshenghd@126.com;

Corresponding author：

Keywords：

Gastric cancer; Total gastrectomy; Enteral nutrition; Total parenteral nutrition

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　　Objective 　To investigate the influence on the postoperative recovery for giving either total parenteral nutrition （TPN） or early enteral nutrition (EEN) to patients with gastric cancer after total gastrectomy.
　　Methods 　Eighty-six patients with gastric cancer undergone total gastrectomy were divided into TPN group (n=31) and EEN group (n=55). Patients in TPN group received TPN support via vena cava (internal jugular vein or subclavian vein), while patients in EEN group received early feeding through the naso-intestinal tube, which was placed during operation, and volume of enteral nutrition (fresubin) was increased daily, full enteral nutrition was expected on day 3-5. Nutrition status after operation, postoperative plasma albumin (Alb), the time of passing gas or stool, the time of oral intake, hospital stay and any postoperative complications were recorded and analyzed.
　　Results 　There were no significant differences between two groups (P gt;0.05) in postoperative plasma Alb level, the time of passing gas or stool, postoperative complications rate or hospital stay. However, in the TPN group, the time of oral intake was shorter than that in EEN group (P=0.004).
　　Conclusions 　Both TPN and EEN are the suitable nutritional methods for patients with gastric cancer after total gastrectomy, and with no detectable difference. For patients with high risk, such as severe malnutrition, naso-intestinal tube should be placed for EEN.

Citation： YUAN Congwei,LI Junsheng,JI Zhenling,ZHANG Yanan,CHEN Weidong,JU Xingtang. Comparative Study of Total Parenteral Nutrition and Early Enteral Nutrition in Patients with Gastric Cancer after Total Gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(4): 357-362. doi: Copy

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19.	Braga M, Gianotti L, Gentilini O, et al. Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition [J]. Crit Care Med, 2001; 29(2): 242-248.
20.	Hu QG, Zheng QC. The influence of enteral nutrition in postoperative patients with poor liver function [J]. World J Gastroenterol, 2003; 9(4): 843-846.
21.	Soliani P, Dell’Abate P, Del Rio P, et al. Early enteral nutrition in patients treated with major surgery of the abdomen and the pelvis [J]. Chir Ital, 2001; 53(5): 619-632.
22.	Pearlstone DB, Lee JI, Alexander RH, et al. Effect of enteral and parenteral nutrition on amino acid levels in cancer patients [J]. JPEN J Parenter Enteral Nutr, 1995; 19(3): 204-208.
23.	傅少华，朱剑飞，孙庆宇. 66例老年胃癌患者全胃切除术后的营养支持 [J]. 苏州大学学报(医学版), 2007; 27(1): 147-148, 150.

1. 赵晓雷, 彭俊生. 不同营养支持方法在胃癌病人术后的应用 [J]. 肠外与肠内营养, 2007; 14(1): 32-34, 38.
2. 　吴国豪. 肿瘤患者营养不良的原因与危害 [J]. 中国实用外科杂志, 2002; 22(11): 644-646.
3. 　汪敏徽，侯维孝. 肠内营养在胃癌术后的临床营养 [J]. 中华胃肠外科杂志, 2004; 7(4): 330-332.
4. 　Shastri YM, Shirodkar M, Mallath MK, et al. Endoscopic feeding tube placement in patients with cancer: a prospective clinical audit of 2 055 procedures in 1 866 patients [J]. Aliment Pharmacol Ther, 2008; 27(8): 649-658.
5. 　Doglietto GB, Papa V, Tortorelli AP, et al. Nasojejunal tube placement after total gastrectomy: a multicenter prospective randomized trial [J]. Arch Surg, 2004; 139(12): 1309-1313.
6. 　Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature [J]. J Gastrointest Surg, 2008; 12(4): 739-755.
7. 　林伟, 陈金坤, 徐海健, 等. 全胃切除术后早期肠内营养对免疫状态的影响 [J]. 齐齐哈尔医学院学报, 2007; 28(10): 1178-1179.
8. 　Farreras N, Artigas V, Cardona D, et al. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer [J]. Clin Nutr, 2005; 24(1): 55-65.
9. 　Reissman P, Teoh TA, Cohen SM, et al. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial [J]. Ann Surg, 1995; 222(1): 73-77.
10. 　〖JP3〗李江, 刘斌, 侯宇, 等. 腹部外科术后早期肠内营养的临床研究与应用 [J]. 中国普外基础与临床杂志, 2006; 13(3): 355-357.
11. 　Woodcock NP, Zeigler D, Palmer MD, et al. Enteral versus parenteral nutrition: a pragmatic study [J]. Nutrition, 2001; 17(1): 53-55.
12. 　Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery [J]. Am J Surg, 1980; 139(1): 160-167.
13. 　Detsky AS, Baker JP, O’Rourke K, et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery [J]. JPEN J Parenter Enteral Nutr, 1987; 11(5): 440-446.
14. 　Meguid MM, Debonis D, Meguid V, et al. Complications of abdominal operations for malignant disease [J]. Am J Surg, 1988; 156(5): 341-345.
15. 　Middleton MH, Nazarenko G, Nivison-Smith I, et al. Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals [J]. Intern Med J， 2001; 31(8): 455-461.
16. 　Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition [J]. Am J Clin Nutr, 1997; 66(3): 683-706.
17. 　van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients [J]. N Engl J Med, 2001; 345(19): 1359-1367.
18. 　Guedon C, Schmitz J, Lerebours E, et al. Decreased brush border hydrolase activities without gross morphologic changes in human intestinal mucosa after prolonged total parenteral nutrition of adults [J]. Gastroenterology, 1986; 90(2): 373-378.〖HJ2〗[19]　Sedman PC, MacFie J, Palmer MD, et al. Preoperative total parenteral nutrition is not associated with mucosal atrophy or bacterial translocation in humans [J]. Br J Surg, 1995; 82(12): 1663-1667.
19. 　Braga M, Gianotti L, Gentilini O, et al. Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition [J]. Crit Care Med, 2001; 29(2): 242-248.
20. 　Hu QG, Zheng QC. The influence of enteral nutrition in postoperative patients with poor liver function [J]. World J Gastroenterol, 2003; 9(4): 843-846.
21. 　Soliani P, Dell’Abate P, Del Rio P, et al. Early enteral nutrition in patients treated with major surgery of the abdomen and the pelvis [J]. Chir Ital, 2001; 53(5): 619-632.
22. 　Pearlstone DB, Lee JI, Alexander RH, et al. Effect of enteral and parenteral nutrition on amino acid levels in cancer patients [J]. JPEN J Parenter Enteral Nutr, 1995; 19(3): 204-208.
23. 　傅少华，朱剑飞，孙庆宇. 66例老年胃癌患者全胃切除术后的营养支持 [J]. 苏州大学学报(医学版), 2007; 27(1): 147-148, 150.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative Study of Total Parenteral Nutrition and Early Enteral Nutrition in Patients with Gastric Cancer after Total Gastrectomy

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