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Perioperative Total Parenteral Nutrition in Malnourished, Gastrointestinal Cancer Patients: A Randomized, Clinical Trial

Department of Surgery of the Gastrointestinal Tract, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

Cecilia Gavazzi, MD

Nutrition Support Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

Rosalba Miceli, PhD

Division of Biometry and Medical Statistics, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

Nicoletta Rossi, BSc

Division of Biometry and Medical Statistics, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

Luigi Mariani, PhD

Division of Biometry and Medical Statistics, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

Luca Cozzaglio, MD

Department of Surgery of the Gastrointestinal Tract, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

Giuliano Bonfanti, MD

Department of Surgery of the Gastrointestinal Tract, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

Sabrina Piacenza, MD

Nutrition Support Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

Background: Clinical trials investigating the potential benefits of perioperative total parenteral nutrition (TPN) for reducing the risk of surgery in malnourished cancer patients have yielded controversial results. Methods: Ninety elective surgical patients with gastric or colorectal tumors and weight loss of 10% or more of usual body weight were randomly assigned to 10 days of preoperative and 9 days of postoperative nutrition us a simple control group. The daily per kilogram body weight TPN regimen included 34.6 ± 6.3 kcal nonprotein and 0.25 ± 0.04 g nitrogen per kilogram in a volume of 42.6 ± 7.3 mL of fluid. The glucose-to-fat calorie ratio was 70:30. Control patients did not receive preoperative nutrition but received 940 kcal nonprotein plus 85 g amino acids postoperatively. Results: Complications occurred in 37% of the patients receiving TPN us 57% of the control patients (p = .03). Noninfectious complications mainly accounted for this difference, which was 12% us 34%, respectively (p = .02). Mortality occurred in only 5 of the control group patients (p = .05). The total length of hospitalization for TPN patients was longer than for control (p = .00), whereas the length of postoperative stay in the two groups did not differ significantly. Conclusions: This study shows that 10 days of preoperative TPN that is continued postoperatively is able to reduce the complication rate by approximately one third and to prevent mortality in severely malnourished patients with gastrointestinal cancer. (Journal of Parenteral and Enteral Nutrition 24:7-14, 2000)

Journal of Parenteral and Enteral Nutrition, Vol. 24, No. 1, 7-14 (2000)
DOI: 10.1177/014860710002400107


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