A prospective study of early enteral nutrition and combined enteral nutrition and parenteral nutrition in patients with hepatocellular carcinoma after precise hepatectomy

Abstract

Objective To compare the clinical value of early enteral nutrition (EEN) and combined enteral nutrition (EN) and parenteral nutrition (PN) in patients with hepatocellular carcinoma (HCC) after precise hepatectomy. Methods The prospective study was conducted. The clinical data of 60 HCC patients who underwent precise hepatectomy in the Affiliated Drum Tower Hospital of Nanjing University Medical School between January 2013 and December 2014 were collected. All patients were allocated into the EN group and combined EN+ PN group by random number table method. Patients in the EN group and combined EN+ PN group respectively received EEN and early combined EN+ PN at 24 hours postoperatively for 7 days, total nutrient intakes between groups were consistent, with an average daily intake of nitrogen-feeding of 0.2 g/(kg·d) and an average daily intake of nonprotein calories of 25 kcal/(kg·d). Observation indicators: (1) comparison of nutritional indexes between groups; (2) comparison of liver function between groups; (3) comparison of postoperative conditions between groups. Measurement data with normal distribution were represented as ±s. Comparisons at the same time between groups were respectively analyzed using the group-design t test. Comparisons of count data were analyzed using the chi-square test. Ordinal data were analyzed by the nonparametric test. Comparison of repeated measurement data were done using the repeated measures ANOVA. Results Sixty patients were screened for eligibility, and 30 in each group. (1) Comparison of nutritional indexes between groups: levels of albumin (Alb), globulin, prealbumin and hemoglobin (Hb) and lymph nodes count in the EN group were respectively (41±4)g/L, (28±4)g/L, (188±37)mg/L, (139±17)g/L, (1.6±0.6)×109/L before operation and (32±4)g/L, (23±5)g/L, (114±41)mg/L, (121±19)g/L, (1.1±0.7)×109/L at 1 day postoperatively and (34±5)g/L, (26±4)g/L, (169±41)mg/L, (113±16)g/L, (1.9±1.1)×109/L at 8 days postoperatively, with statistically significant differences in above indexes (F=2.23, 4.45, 8.96, 5.21, 2.18, P 0.05). Levels of Alb, globulin, prealbumin and Hb and lymph nodes count in the combined EN+ PN group were respectively (42±4)g/L, (28±6)g/L, (188±29)g/L, (142±16)g/L, (1.6±0.6)×109/L before operation and (31±5)g/L, (20±5)g/L, (96±31)g/L, (124±16)g/L, (0.9±0.4)×109/L at 1 day postoperatively and (34±4)g/L, (24±4)g/L, (143±18)g/L, (115±18)g/L, (1.4±0.7)×109/L at 8 days postoperatively, with statistically significant differences in above indexes (F=3.21, 7.35, 4.36, 7.78, 3.19, P 0.05) and in changing trends of Alb, globulin, prealbumin, Hb and lymph nodes count (F=8.54, 3.83, 7.21, 6.33, 3.91, P>0.05). Levels of prealbumin at 8 days postoperatively were statistically different between groups (t=3.00, P 0.05) and in levels of TBil and DBil (t=0.08, 0.23, P>0.05). Levels of ALT, AST, ALP, GGT, TBil, DBil and CRP in the combined EN+ PN group were respectively (41±38) U/L, (43±25)U/L, (100±89)U/L, (106±46)U/L, (17.9±9.8)μmol/L, (6.2±3.6)μmol/L, (3.7±2.3)mg/L before operation and (462±409)U/L, (494±162)U/L, (73±53)U/L, (75±57)U/L, (28.1±18.8)μmol/L, (9.1±6.1)μmol/L, (40.7±26.2)mg/L at 1 day postoperatively and (90±47)U/L, (42±16)U/L, (95±40)U/L, (110±66)U/L, (22.5±14.5)μmol/L, (8.2±8.1)μmol/L, (26.9±24.6)mg/L at 8 days postoperatively, with statistically significant differences in above indexes among pre-operation, 1 and 8 days postoperatively (F=5.96, 3.73, 6.94, 3.88, 7.97, 4.14, 5.25, P 0.05) and in levels of TBil, DBil and CRP (t=0.09, 0.37, 0.58, P>0.05). There was no statistically significant difference in changing trends of ALT, AST, ALP, GGT, TBil, DBil and CRP of 2 groups (F=7.18, 2.23, 3.94, 5.88, 4.72, 2.17, 6.53, P>0.05) and in above indexes among pre-operation, 1 and at 8 days postoperatively (t=0.27, 0.42, 0.91, 0.12, 0.96, 0.24, 0.59, 0.32, 0.49, 1.27, 0.88, 0.07, 1.07, 1.45, 0.23, 1.11, 0.88, 0.32, 0.35, 0.93, 0.21, P>0.05). (3) Comparison of postoperative conditions between groups: times of initial defecation were respectively (3.2±1.0)days and (4.2±1.2)days in the EN group and combined EN+ PN group, showing a statistically significant difference (t=3.21, P<0.05). Conclusion EEN and combined EN+ PN are safe and feasible in HCC patients after precise hepatectomy, and also can improve liver function recovery, but EEN has advantages of promoting protein synthesis and gastrointestinal function recovery. Key words: Hepatic neoplasms; Precise hepatectomy; Nutritional support therapy; Enteral nutrition; Parenteral nutrition