Treatment with growth hormone, somatostatin and insulin in combination with hypocaloric parenteral nutrition in gastrointestinal cancer patients after surgery

Abstract

Objective The metabolic response to gastrointestinal cancer in patients undergoing surgery is associated with hypermetabolism and insulin resistance. The potential use of synergetic anabolic hormones in conjunction with hypocaloric parenteral nutrition ( HPN) has become a significant area of investigation. The current study was performed to determine the clinical efficiency and safety of combined hormone therapy in addition to HPN in gastrointestinal cancer patients. Methods One hundred patients with the nutrition risk screening ( NRS) score of 3 or 4 undergoing surgery for gastrointestinal cancer were randomized into two groups. The patients in the control group received standard total parenteral nutrition (TPN) and systemic insulin. The patients in the study group received HPN and systemic insulin in addition to the pretreatment of recombinant human growth hormone ( r-hGH) and octreotide. Clinical efficiency and safety were evaluated by the measurement of hormones and protein metabolites, immune function, clinical outcome,and adverse events. Follow-ups were performed to determine the influence on prognosis. Results Treatment with r-hGH, octreotide, and insulin in combination with HPN significantly increased protein synthesis , immune function and metabolic tolerance, decreased infectious complications, and shortened postoperative hospital stays, but did not increase the risk of tumor development and recurrence in the study group compared to the control group. Conclusion The proper short-term perioperative administration of growth hormone,somatostatin,and insulin in combination with HPN can overcome the postoperative stress response through the increase of protein synthesis to improve immune function in gastrointestinal cancer patients after surgery. Key words: Hypocaloric parenteral nutrition; Recombined human growth hormone; Somatostatin ,cancer