A team from Milan, Italy, investigated postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer, who were candidates for major elective surgery.
Current opinion favors the use of enteral over parenteral nutrition. However, the clinical benefits of early postoperative nutrition in patients undergoing elective surgery have never been clearly shown.
The researchers aimed to test the hypothesis that postoperative enteral nutrition is better (fewer postoperative complications) than parenteral nutrition containing similar energy and nitrogen levels (112 kJ kg-1day-1 and 1.4 g amino acid kg-1day-1).
Patients were assigned to enteral nutrition (n = 159) or parenteral nutrition (n = 158).
|Postoperative enteral nutrition:|
- Complication rate reduced
- Postoperative stay reduced
- Not as well tolerated as parenteral nutrition
The primary endpoint was the occurrence of postoperative complications. Secondary endpoints were length of postoperative hospital stay, adverse effects, and treatment crossover.
Postoperative complications occurred in 54 (34%) patients fed enterally versus 78 (49%) fed parenterally (relative risk [RR], 0·69).
Length of postoperative stay was 13·4 days and 15·0 days in the enteral nutrition and parenteral nutrition groups, respectively.
The researchers found that adverse effects occurred in 56 (35%) patients fed enterally versus 22 (14%) patients fed parenterally (RR, 2·50).
A total of 14 (9%) patients on enteral nutrition had to switch to parenteral nutrition, whereas none of those fed parenterally crossed over to enteral feeding.
Dr Federico Bozzetti, of the Italian Society for Parenteral and Enteral Nutrition, Milan, said on behalf of his colleagues, "Early enteral nutrition significantly reduces the complication rate and duration of postoperative stay compared with parenteral nutrition.
"However, parenteral nutrition is better tolerated than enteral nutrition," he concluded.