A randomised study of parenteral nutritional suport in the post-palliative operations of advanced pancreatic carcinoma patients receiving chemotherapy / 中国临床营养杂志

ABSTRACT

Objective The incidence of pancreatic cancer is increasing worldwide, and also in china. The characteristics of the cancer are short course, rapid progress and high mortality, with median survival time of about 6 months. Unfortunately, the early symptoms of patients are not peculiarity. There are not simple, direct and effective methods of early diagnosis. When the patients have jaundice and abdominal pain, probably they are the advanced disease (stage Ⅲ-Ⅳ) ,with unresectable tumours,and have to perform biliary bypass operation for alleviative treatment. Furthermore, the most of all patients exhibit advanced disease, which is often associated with a reduced performance status, malnourished condition, immune function deficiency, all of which severely limit patients tolerance for toxic chemotherapy regimens. These may result in physiological problems that can alter the metabolism and distribution of cytotoxic drugs and therefor lead to an increase in treatment-related toxicity. Purpose To explore the effect of TPN in the post-palliative operations, Roux-en-Ycholedceho-jejunostomy, of advaneed pancreatic carcinoma patients receiving chemotherapy. Methods From Jan. 1996 to Jan. 1999, 40 cases had receiving combination chemotherapy after palliative operations for relief of jaundice by biliary hypass, and surgical biopsy for histologically cemented. The patients were randomly divided inter 2 groups (1) treatment group (chemotherapy + TPN), 12 men and 8 women had a median age of 57.8 years old. (2) Control group (chemotherapy + routine treatment), 13 men and 7 women had a median age of 58.2 years old. All the patients received combined chemotherapy, the regimen was 5-Fu+ CF + MMC + DDP/EPI (5-fluorouracil + Calcium folniate + Mitomycin C + Cisplatin or Epirubicin ) or IFN-γ (interferon-γ). Dosages of drugs were modified for bone marrow toxicity, stomatits and declining performance status. After 28 days, the regimen performed once again. The regimen of TPN was total caloric value (NPC) 20 Kcal/kg·d, nitrogen 0.2kg/kg·d, N/Q = 1g 125Kcal, Glucose/Fat=64. The nutritional & immunological parameters, quality of life, effects of treatment wrer monitored. Results Treatemnt group is superior to control group. After TPN, serum pre. albumin, transferrin concentration, retinol-binding protein, total lymphocyte count, natural killer cells activity, IL-2R+ cells (CD25) percentage of peripheral blood, grades of quality of life and survival time increased significantly (P<0.05, P<0.01 respectively). However, no significant difference was observed in IFN-γ application group (P>0.05). Conelusions The nutritional support can improve nutritional and immune situation and quality of life, and prolong the survival time of the patients, but no relapse-free survival.