Abstract
Background: Peripheral parenteral nutrition allows repletion of acute nutrient deficiencies and could prevent further nutrition deficits before and after colorectal surgery. A randomized open study was performed to evaluate the effect of perioperative peripheral parenteral nutrition (PPN) support on postoperative morbidity after colorectal cancer surgery within an enhanced recovery program. Methods: Patients were randomized into two groups: peripheral parenteral nutrition (PPN) (with Peri-Olimel N4-E) versus conventional fluid therapy (FT). Ninety-day postoperative complications, laboratory parameters, length of hospital stay, and compliance with the ERAS protocol were assessed. Results: A total of 158 patients were analysed. The overall 90-day complication rate was 38.6% (61 patients), and 24 patients had major complications (Clavien–Dindo III–V) (15.2%). In the multivariate analysis, the intervention (PPN vs. FC) showed a protective effect against postoperative complications (p = 0.0031, OR = 0.2 (CI: 0.08–0.87)). Following ordinal regression, PPN and early oral tolerance showed a protective effect, being less likely to develop complications or to move from minor to major complications. In patients with low compliance to ERAS during the first postoperative day, PPN showed a protective effect, preventing 28% of morbidity. Conclusions: Perioperative peripheral parenteral nutrition (PPN) support with Peri-Olimel N4-E in colorectal cancer surgery associated with early oral intake could reduce postoperative complications.
Highlights
Colorectal cancer (CRC) is still among the most frequently diagnosed cancers, accounting for 1.14 million new cases in 2020, and surgery continues to be the main pillar of treatment [1]
A single-centre, open, pragmatic, randomized controlled trial was performed comparing the influence of peripheral parenteral nutrition (PPN) versus conventional fluid therapy (FT) on postoperative complications in colorectal surgery patients
To the best of our knowledge, this is the first trial that shows that PPN supplementation and early compliance with enhanced recovery after surgery (ERAS) programs can reduce postoperative morbidity
Summary
Colorectal cancer (CRC) is still among the most frequently diagnosed cancers, accounting for 1.14 million new cases in 2020, and surgery continues to be the main pillar of treatment [1]. Perioperative nutritional care is one of the pillars of evidence-based ERAS programs, as patients undergoing oncological surgery present an increased risk of malnutrition. Surgical stress and the consequent increase in energy expenditure, weight loss, eating difficulties, and poor appetite decrease nutritional status. It is an underestimated value, 10–20% of patients with CRC are malnourished before surgery. Postoperative nutritional support is crucial in maintaining nutritional status during the catabolic postoperative period, and ERAS protocols support early postoperative feeding within hours after surgery. It has been demonstrated that early oral feeding can improve tissue healing and shorten the postoperative hospital stay, improving clinical outcomes, readmissions, and costs of care [7,8,9,10,11]
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