Program of intestinal rehabilitation and early postoperative enteral nutrition: a prospective cohort study / Programa de reabilitação intestinal e introdução de nutrição enteral pós-operatória precoce: estudo de cohort prospectivo

ABSTRACT Background: Some factors can act on nutritional status of patients operated for a gastrointestinal cancer. A timely and appropriate nutritional intervention could have a positive effect on postoperative outcomes. Aim: To determine the effect of a program of intestinal rehabilitation and early postoperative enteral nutrition on complications and clinical outcomes of patients underwent gastrointestinal surgery for cancer. Methods: This is a prospective study of 465 patients underwent gastrointestinal surgery for cancer consecutively admitted in an oncological intensive care unit. The program of intestinal rehabilitation and early postoperative enteral nutrition consisted in: 1) general rules, and 2) gastrointestinal rules. Results: The mean age of analysed patients was 63.7±9.1 years. The most frequent operation sites were colon-rectum (44.9%), gynaecological with intestinal suture (15.7%) and oesophagus-gastric (11.0%). Emergency intervention was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complication (19.2% vs. 10.2%; p=0.030), respiratory complications (p=0.040), delirium (p=0.032), infectious complications (p=0.047) and gastrointestinal complications (p<0.001), mainly anastomotic leakage (p=0.033). The oncological intensive care unit mortality (p=0.018), length of oncological intensive care unit (p<0.001) and hospital (p<0.001) stay were reduced as well. Conclusions: Implementing a program of intestinal rehabilitation and early postoperative enteral nutrition is associated with reduction in postoperative complications and improvement of clinical outcomes in patients undergoing gastrointestinal surgery for cancer.

RESUMO Racional: Alguns fatores podem atuar sobre o estado nutricional de pacientes operados por câncer gastrointestinal. Intervenção nutricional oportuna e adequada poderia ter efeito positivo nos resultados pós-operatórios. Objetivo: Determinar o efeito de um programa de reabilitação intestinal e nutrição enteral pós-operatória precoce em complicações e resultados clínicos de pacientes submetidos à cirurgia gastrointestinal para câncer. Métodos: É estudo prospectivo de 465 pacientes submetidos à cirurgia gastrointestinal para câncer consecutivamente admitido em uma unidade de terapia intensiva oncológica. O programa de reabilitação intestinal e nutrição enteral pós-operatória precoce consistiu em: 1) regras gerais e 2) regras gastrointestinais. Resultados: A idade média dos pacientes analisados ​​foi de 63,7±9,1 anos. Os locais de operação mais frequentes foram colorretais (44,9%), ginecológicos com sutura intestinal (15,7%) e esofagogástrico (11,0%). Intervenção de emergência foi realizada em 12,7% dos pacientes. O programa de reabilitação intestinal e nutrição enteral pós-operatória precoce reduziu complicações maiores (19,2% vs. 10,2%; p=0,030), complicações respiratórias (p=0,040), delírio (p=0,032), complicações infecciosas (p=0,047) e gastrointestinais complicações (p<0,001), principalmente vazamento anastomótico (p=0,033). A mortalidade da unidade oncológica de terapia intensiva (p=0,018), duração da unidade oncológica de terapia intensiva (p<0,001) e hospital (p<0,001) permaneceu também reduzida. Conclusões: A implantação de um programa de reabilitação intestinal e nutrição enteral pós-operatória precoce está associada à redução das complicações pós-operatórias e à melhora dos resultados clínicos em pacientes submetidos a operações gastrointestinais para câncer.

Change in Dietary Intake and Nutritional Status Using Mealworms as Hospital Meal in Postoperative Patients

The purpose of this study was to verify the validity of Mealworms as a hospital meal with increased nutrition density. We provided a meal for postoperative patients and conducted analysis of dietary intake and nutritional status of patients and assessment of acceptability of the meal. This study was carried out as a randomized control trial. Patients were supplied either a hospital meal using Mealworms (Experimental group) or a regular hospital meal (Control group). We investigated the administration amounts of parenteral nutrition (PN) and food intake of patients after surgery and measured anthropometry, body composition, and blood tests before surgery and at hospital discharge. We included 34 postoperative patients who were admitted to Gangnam Severance Hospital from March to September. In the groups of patients not supplied with PN, the experimental group (964.68±284.6 kcal, 38.82±12.9 g) had significantly higher dietary calorie and protein intake than the control group (666.62±153.7 kcal, 24.47±4.9 g)(P<0.05). Additionally in the group of patients not supplied with PN, the experimental group (1.37%) showed a significantly higher increase in fat free mass index than the control group (−3.46%)(P<0.05). In all subjects, calorie density and protein density were significantly higher in the experimental group (P<0.001), and acceptability of calorie (P=0.036) and protein (P=0.001) was also significantly higher in the experimental group. Therefore, the results of this study support the validity of the introduction of hospital meals using Mealworms.

Early postoperative enteral nutrition compared with parenteral nutrition in patients with colorectal cancer / 局解手术学杂志

Objective To analyze the effect of different postoperative nutrition:enteral nutrition( EN) and parenteral nutrition( PN) in patients with colorectal cancer. Methods 84 patients with colorectal cancer were collected in this study from Jan. 2012 to Jan. 2014, and they were divided into the EN group (43 cases) and the PN group (41 cases). They were given EN or PN after operation. The nutritional parameters such as ALB, TF and PA were detected before surgery and 7 days after operation, Observe the adverse reaction, time of gastroin-testinal function recovery, infection and costs after operation. Results There was no statistical difference (P>0. 05) in the nutritional pa-rameters and rate of adverse reaction between the two groups. The rate of infection in EN group was lower than that in PN group(P<0. 01), and the time of gastrointestinal function recovery was shorter in EN group compared with that in PN group (P<0. 01). Conclusion EN is better in recovery of gastrointestinal function, and there is less complication compared to PN. EN have clinical application value for patients with gastrointestinal cancer.

Application of nutrition gastrostomy in the retrosternal route for esophageal reconstruction after operation / 中国肿瘤临床

Objective:Esophageal cancer has high morbidity in China, and surgery is the main treatment for this disease. Postop-erative nutrition is also important for the patients. In this article, we discuss the possibility of retrosternal route gastrostomy feeding (RGF). Methods: The data of 127 esophageal cancer patients between 2011 and 2013 were retrospectively analyzed. RGF was per-formed in all the patients, and post-operation complications were studied. Results: Bowel obstruction, catheter displacement, and wound infection did not occur. Conclusion:RGF is a safe and effective nutrition method for patients who underwent retrosternal recon-struction.

Comparative study of different postoperative nutrition in patients with gastrointestinal cancer / 肠外与肠内营养

Objective: To investigate the laboratory,clinical and economic results of early postoperative enteral nutrition(EEN) in patients with gastrointestinal cancer.Methods: 120 patients with gastrointestinal cancer were randomly divided into three groups: EEN,early postoperative parenteral nutrition(PN), and traditional nutrition(CON)groups.The 1/3 and 2/3 target volumes were administered on the first and second postoperative days(1POD,2POD),and the full volume was given from 3POD to 8POD in EEN and PN groups.The routine formula was offerd from 1POD to 8POD in CON group.The nutritional and immune parameters were detected one day before surgery and 9POD, and the clinical and economic results were collected in three groups.Results: The levels of ALB,TF,PA,CD3,CD4,CD4/CD8 were significantly higher in EEN and PN groups than those in CON group(both P＜0.01),and the CD3,CD4,CD4/CD8 were better in EEN group than those in PN group(P＜0.05).The side effects of EEN group were similar to those of PN group(P>0.05). The recovery of bowel function was quicker in EEN group than that in PN and CON groups(both P＜0.05).The complication rate, cost of nutrition support,and cost of complication treatment were lower in EEN group than those in PN group(P＜0.05, P＜0.01, P＜0.01).Although the cost of nutrition support was lowest but the complication rate and cost of complication treatment were all highest in CON group.Conclusion: EEN is better in immune function, recovery of bowel function,complication rate, and cost-effectiveness than those in PN, and from our multiple angular viewpoints EEN is the first choice for patients with gastrointestinal cancer.