Early Postoperative Enteral Nutrition Research Articles

Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications.

Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications.

Feeding Jejunostomy after esophagectomy cannot be routinely recommended. Analysis of nutritional benefits and catheter-related complications

BackgroundPatients undergoing esophagectomy for cancer usually deal with malnourishment which increases postoperative morbimortality. The objective of this paper is to analyze the nutritional benefits of feeding jejunostomy (FJ) for early postoperative enteral nutrition (EN) and directly-related complications. Material and methodsRetrospective study of 100 patients undergoing esophagectomy for cancer between 2008 and 2016. ResultsFJ was placed in 47 patients. 82.98% reached EN requirements in FJ group, with a median EN re-start of 1.9 days and median days to objective requirements of 5 days.51.06% developed directly-related FJ complication, 91.66% of them mild ones (gastrointestinal or catheter-related). 2 patients (4.25%) required re-intervention.No significant differences were shown in total protein and albumin seric levels during first postoperative week and in anastomotic leak rate between both groups (p > 0.05). ConclusionsFeeding jejunostomies are associated with a great number of complications although most are not life-threatening. Since its nutritional benefit is not proven FJ cannot routinely recommended after esophagectomy. However, the optimal pathway for EN reintroduction, including direct oral intake, is still a matter of debate.

Effects of early postoperative enteral nutrition versus usual care on serum albumin, prealbumin, transferrin, time to first flatus and postoperative hospital stay for patients with colorectal cancer: A systematic review and meta-analysis

Background: Early enteral nutrition (EEN) after surgery had been reported to decrease morbidity and mortality. However, no meta-analysis performed on nutrition status and recovery after surgery to Colorectal cancer (CRC).Aim: We aimed to estimate effect of EEN for postoperative CRC.Methods: Electronic databases were searched for randomized controlled trials published prior to September 2017. Papers comparing EEN after surgery to traditional nutritional regimen in CRC patients were selected. The chosen articles should containe one or more of the following outcome measures: serum albumin, prealbumin, transferrin, time to first flatus and postoperative hospital stay.Results: 2307 cases from 26 studies were included. The analysis showed that EEN was more effective in increasing serum albumin and prealbumin, promoting the recovery of gastrointestinal function, and decreasing the time of postoperative hospital stay, especially for colon cancer.Conclusion: EEN can improve nutritional status and promote intestinal function recovery for patients undergoing CRC surgery.

PROGRAM OF INTESTINAL REHABILITATION AND EARLY POSTOPERATIVE ENTERAL NUTRITION: A PROSPECTIVE COHORT STUDY.

ABSTRACTBackground: 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.

Pancreatoduodenectomy: Brazilian practice patterns

Background: Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. The aim of this study is to understand the Brazilian practice patterns for pancreatoduodenectomy. Methods: A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy. The survey was sent to members who declared an interest in pancreatic surgery. Results: A total of 60 questionnaires were sent, and 52 have returned (86.7%). The Southeast had the most survey respondents, with 25 surgeons (48.0%). Only two surgeons (3.9%) performed more than 50% of their pancreatoduodenectomies by laparoscopy. A classic Whipple procedure was performed by 24 surgeons (46.2%) and a standard International Study Group on Pancreatic Surgery lymphadenectomy by 43 surgeons (82.7%). For reconstruction, pancreaticojejunostomy was performed by 49 surgeons (94.2%), single limb technique by 41(78.9%), duct-to-mucosa anastomosis by 38 (73.1%), internal trans-anastomotic stenting by 26 (50.0%), antecolic route of gastric reconstruction by 39 (75.0%), and Braun enteroenterostomy was performed by only six surgeons (11.5%). Prophylactic abdominal drainage was performed by all surgeons, and somatostatin analogues were utilized by six surgeons (11.5%). Early postoperative enteral nutrition was routine for 22 surgeons (42.3%), and 34 surgeons (65.4%) reported routine use of a nasogastric suction tube. Conclusion: Heterogeneity was observed in the pancreatoduodenectomy practice patterns of surgeons in Brazil, some of them in contrast with established evidence in the literature.

A Case of Non-Occlusive Mesenteric Ischemia During Postoperative Early Enteral Nutrition

A Case of Non-Occlusive Mesenteric Ischemia During Postoperative Early Enteral Nutrition

PANCREATODUODENECTOMY: BRAZILIAN PRACTICE PATTERNS.

ABSTRACT Background:Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. Aim:To understand the Brazilian practice patterns for pancreatoduodenectomy. Method:A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy. The survey was sent to members who declared an interest in pancreatic surgery. Results: A total of 60 questionnaires were sent, and 52 have returned (86.7%). The Southeast had the most survey respondents, with 25 surgeons (48.0%). Only two surgeons (3.9%) performed more than 50% of their pancreatoduodenectomies by laparoscopy. A classic Whipple procedure was performed by 24 surgeons (46.2%) and a standard International Study Group on Pancreatic Surgery lymphadenectomy by 43 surgeons (82.7%). For reconstruction, pancreaticojejunostomy was performed by 49 surgeons (94.2%), single limb technique by 41(78.9%), duct-to-mucosa anastomosis by 38 (73.1%), internal trans-anastomotic stenting by 26 (50.0%), antecolic route of gastric reconstruction by 39 (75.0%), and Braun enteroenterostomy was performed by only six surgeons (11.5%). Prophylactic abdominal drainage was performed by all surgeons, and somatostatin analogues were utilized by six surgeons (11.5%). Early postoperative enteral nutrition was routine for 22 surgeons (42.3%), and 34 surgeons (65.4%) reported routine use of a nasogastric suction tube. Conclusion: Heterogeneity was observed in the pancreatoduodenectomy practice patterns of surgeons in Brazil, some of them in contrast with established evidence in the literature.

Clinical Outcome of Early Enteral Feeding on Patients Post Esophagectomy

Objectives: Aim of our work is to study the effect of early enteral feeding through either nasoentral or feeding jejunostomy tube post esophagectomy on patients recovery and hospital stay. Background: Postoperative nutrition is a well known aspect of care in recent years and has been shown to decrease the incidence of complications and hospital stay. Enteral nutrition has been shown to be superior to parenteral nutrition as it is more physiological, safer, cheaper and early enteral nutrition has been clearly confirmed to reduce postoperative morbidity. Methods: This is randomized combined retrospective and prospective study that is conducted in surgical oncology department, South Egypt cancer institute, Assiut University; from October 2012 to October 2016. Patients in this study were divided into two groups: group 1 includes patients with feeding jejunostomy and group 2 is patients with nasoenteral tube. Results: 25 Patients included in this study (19 males & 6 females). All cases were primarily diagnosed as esophageal cancer, middle and lower 1/3 esophagus or proximal gastric carcinoma infiltrating cardia by clinical data associated with abdominal sonar and/or C.T scan and upper endoscopy with biopsy. There was no significant difference in catheter related complications (P value 0.238). There was no operative mortality. Conclusion: Early postoperative enteral nutrition was feasible and safe for patients undergoing esophagectomy. There is no significant difference between NE and FJ. Enteral nutrition either through nasoenteral or feeding jejunostomy is an effective method for postoperative nutritional support in this type of major surgery.

The role of nutritional assessment and early enteral nutrition for combined pancreas and kidney transplant candidates

Early post-operative enteral nutrition is an important part of perioperative management and is strongly supported by ESPEN Guidelines. However, there is limited evidence into the use of Early Enteral Nutrition (EEN) after combined Pancreas and Kidney Transplantation (PKT). We know malnutrition in type-1 diabetics with end stage renal failure (ESRF) is a common problem and a significant risk factor. Therefore, we introduced EEN in our patients. We monitored and recorded nutritional data on 29 PKT recipients who underwent transplantation between Oct 2007 and Jan 2010 without a nutritional assessment or EEN [Monitored Group (MG)] and on 30 PKT recipients between Feb 2010 and Dec 2013 who received a nutritional assessment and EEN (Naso-jejunal feed or oral intake with supplementation, according to their nutritional status) [Fed Group (FG)]. The end-point was to assess patients' daily post-transplant nutritional intake. This was calculated as a percentage of estimated nutritional requirements using the Schofield equation with a 25% added stress factor and relevant activity factor. Following a literature search and realistic targets our aim was to reach >60% requirements: achievement of ≥60% energy requirements by day-7 (7d-60%) and at the time of discharge (total-60%) [13,14]. There was no significant difference between MG and FG patients in cold ischemic time (CIT), recipient-age and donor-age, Length of Stay and donor-creatinine. In contrast, FG patients were less frequently in predialysis status 41.4% vs. 26.7%, p=0.001; and had higher incidence of BMI <22.5kg/m2 63.3% vs. 48.3%, p=<0.005. In outcomes, FG patients more frequently achieved a higher average % of nutritional requirements in the first week 39.69% vs. 22.37%, p=<0.005; as well as during whole in-patient stay 57.24% vs. 44.43%, p=<0.005 (Table 3, Figs.1 and 2). The FG spent a greater proportion during the first week 66.7% vs. 31%, p=<0.005; and of whole their admission 93.3% vs. 75.9%, p=<0.005; meeting more than 60% of nutritional requirements. Most important, the need for parenteral nutrition within the FG was significantly lower, 7.1% vs. 20.7%, p<0.005 (Table3). Our results show that these patients benefit from planned EEN and receive better nutritional support when compared to the patients managed with the historic, reactive approach to nutritional care. Nutritional intake in the first week as well as during the whole admission was superior in patients receiving active EEN despite a more difficult post-operative course due to higher incidence of re-operations compared to the control group. Also the need for parenteral nutrition was significantly lower in this group. In addition, pre-transplant nutritional assessment is beneficial and accurately highlights those who may be at risk of malnutrition pre and post-operatively.

The curative effect of early use of enteral immunonutrition in postoperative gastric cancer: a meta-analysis.

The clinical efficacy of early enteral immunonutrition in postoperative gastric cancer patients is uncertain. The aim of this study is to assess its clinical efficacy. Use of the search engine database incuding the PubMed, the Cochrane library, Web of Science, Medline, and Embase, which present comparative studies of early efficacy of enteral immune nutrition and standard enteral nutrition after gastric cancer operation. We used the RevMan 5.3 software to meta-analyze the CD4, CD8, CD4/CD8, the length of hospitalization, postoperative complications, and postoperative weight loss. A total of 6 randomized control articles were included in this study, which comprised 606 patients. Among them, there were 308 cases of early postoperative enteral nutrition in patients with gastric cancer, and 298 cases were in standard enteral nutrition. Early postoperative enteral immune nutrition on seventh day of the CD4, CD8, and CD4/CD8 value greatly compared with standard enteral nutrition, CD4 (WMD=2.71, CI: 2.71~7.79, P<0.01), CD8 (WMD=2.71, CI: 2.71~7.79, P<0.01), CD4/CD8 (WMD=0.29, CI: 0.29~0.65, P<0.01). Postoperative complications occurred in patients with gastric cancer after operation (OR=0.46, CI 0.46 to 0.46, P<0.01), the postoperative weight loss (WMD=1.00, CI 1.00 to 2.82, P<0.01), length of hospitalization, and the value of early postoperative enteral immune nutrition group were lower than the group pf early standard enteral nutrition. The treatment which could improve the clinical efficacy of patients should be considered for future management of postoperative gastric cancer.

The Effects of Early Post-Operative Soluble Dietary Fiber Enteral Nutrition for Colon Cancer.

We examined colon cancer patients who received soluble dietary fiber enteral nutrition (SDFEN) to evaluate the feasibility and potential benefit of early SDFEN compared to EN. Sixty patients who were confirmed as having colon cancer with histologically and accepted radical resection of colon cancer were randomized into an SDFEN group and an EN group. The postoperative complications, length of hospital stay (LOH), days for first fecal passage, and the difference in nutritional status, immune function and inflammatory reaction between pre-operation and post-operation were all recorded. The statistical analyses were performed using the t-test and the chi square test. Statistical significance was defined as p < 0.05. After the nutrition support, differences in the levels of albumin, prealbumin and transferrin in each group were not statistically significant (p > 0.05); the levels of CD4+, IgA and IgM in the SDFEN group were higher than that of the EN group at seven days (p < 0.05); the levels of TNF-α and IL-6 in the SDFEN group were lower than that of the EN group at seven days (p < 0.05); and patients in the SDFEN group had a significantly shorter first flatus time than the EN group (p < 0.05). Early post-operative SDFEN used in colon cancer patients was feasible and beneficial in immune function and reducing inflammatory reaction, gastrointestinal function and speeding up the recovery.

Comparison of postoperative early enteral nutrition and parenteral nutrition in infants with congenitalcholedochal cyst

Objective To evaluate the application and clinical effectiveness of early enteral nutrition (EEN) used after operation in infants with congenital choledochal cyst (CCC). Methods This randomised controlled trial enrolled 68 patients receiving choledochal cyst excision plus biliary reconstruction (Roux-en-Y anastomosis) for CCC in Department of General Surgery of Affiliated Nanjing Children's Hospital of Nanjing Medical University between January 2014 and December 2015.The infants were randomly divided into EEN group(n=34)and total parenteral nutrition (TPN) group(n=34). The EEN group received enteral nutrition 48 hours after surgery, while the TPN group was given conventional parenteral nutrition after surgery. The body mass, prealbumin, retinol binding protein, hemoglobin, immunoglobulin and lymphocyte count were compared between the two groups on day 1 after admission and day 7 after operation. The time of first defecation, the time of gastric tube removal, the amount of gastrointestinal drainage, and the incidence of complications after surgery were also compared between the two groups. Results A total of 68 infants completed the clinical observation. There were no significant differences in the preoperative body mass, height, disease distribution, and nutritional indexes between the two groups. Compared with the TPN group, the time of first defecation [(69.20±9.37)hours vs. (84.73±5.12)hours], the time of gastric tuberemoval [(110.48±5.47)hours vs.(134.90±6.97)hours], and the amount of gastrointestinal drainage [(202.31±32.89)ml vs.(258.70±25.52)ml] were all shorter/lower in the EEN group (all P 0.05). After a follow-up period of 3 to 24 months, we found that the patients in both groups had good recovery and nutritional status. Conclusion EEN after surgery for CCC in infants is a reliable, safe, and effective technique and may be beneficial for the recovery of gastrointestinal function, the improvement of nutritional status and immunity, and the outcome after surgery. Key words: Choledochal cyst; Enteral nutrition; Parenteral nutrition; Infant

Effect of early enteral nutrition on patients with digestive tract surgery: A meta-analysis of randomized controlled trials.

Postoperative early enteral nutrition (EEN) is useful for the effective recovery of patients that have undergone surgery. However, the feasibility and efficacy of EEN in patients with digestive tract surgery remain inconclusive. In the present meta-analysis, the PubMed, EMBASE, Web of Science, The Cochrane Library, China National Knowledge Infrastructure and VIP databases were searched to identify controlled trials of patients with and without EEN following digestive tract surgery between October, 1966 and December, 2014. Methodological quality assessment was carried out for each of the included studies. For estimation of the analysis indexes, relative risk (RR) was used as the effect size of the the categorical variable, while the weighted mean difference (MD) was used as the effect size of the continuous variable. The meta-analysis was conducted using RevMan 5.2 software. Eleven randomized controlled trials involving 1,095 patients were included in the meta-analysis. The results revealed that, EEN in patients with digestive tract surgery was more effective in decreasing the incidence of infectious [RR=0.50, 95% confidence interval (CI): 0.38, 0.67; P<0.01] and non-infectious complications (RR=0.72, 95% CI: 0.43, 1.22; P<0.05) and shortening the length of first bowel action (MD=−4.10, 95% CI: −5.38, −2.82; P<0.05). It also had a significant influence on increasing the serum albumin (MD=2.87, 95% CI: 1.03, 4.71; P<0.05) and serum prealbumin (MD=0.04, 95% CI: 0.02, 0.05; P<0.05) levels. In conclusion, the results of the study have shown that EEN in patients with digestive tract surgery improved the nutritional status, reduced the risk of postoperative complications, shortened the length of hospital stay and promoted the functional recovery of the digestive system.

Perioperative nutritional support in patients with digestive tract cancer

Tumor patients are high-risk group of malnutrition, and the characteristics of pathophysiology of digestive tract tumor can aggravate the malnutrition, so the perioperative nutritional support should be planed and implemented for these patients. However, the understanding of nutritional support is still insufficient. Reducing preoperative fasting time, reasonable preoperative nutritional support, early postoperative enteral nutrition and multiple forms in combination are the optimal strategy of the perioperative nutritional treatment and management. As the condition of cancer patients is always complicated, in the practice of clinical implementation, medical guidelines, patients condition and clinical experience of the medical practitioners should be combined to accelerate the effect of nutritional support and to improve the outcome of the patients.

Low fat-containing elemental formula is effective for postoperative recovery and potentially useful for preventing chyle leak during postoperative early enteral nutrition after esophagectomy

Transthoracic esophagectomy using 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most aggressive gastrointestinal surgeries. Early enteral nutrition (EN) for TTE-3FL patients is useful and valid for early recovery; however, EN using a fat-containing formula risks inducing chyle leak. In the present study, we retrospectively examined esophageal cancer patients treated byTTE-3FL and administered postoperative EN to elucidate the validity of lowering the fat levels in elemental formulas to prevent postoperative chyle leak and improve postoperative recovery. A total of 74 patients who received TTE-3FL for esophageal cancer were retrospectively examined. Patients were classified into two groups according to the type of postoperative EN: Group LF patients received a low-fat elemental formula, and Group F patients received a standard fat-containing polymeric formula. The following clinical factors were compared between the groups: EN start day, maximum EN calories administered, duration of respirator use, length of ICU stay, incidence of postoperative infectious complications, use of parenteral nutrition (PN), and incidence of postoperative chyle leak. Patients in Group LF were started on EN significantly earlier after surgery and they consumed significantly higher maximum EN calories compared to Group F patients (P<0.01). Duration of respirator use and length of ICU stay were also significantly shorter, and TPN was used significantly less in Group LF compared to Group F (P<0.05). Postoperative chyle leak was observed in six patients in total (8.1%); five patients in Group F and one patient in Group LF, although there was no significant difference in frequency of chyle leak per patient between Group LF and Group F. Early EN using low-fat elemental formula after esophagectomy with three-field lymphadenectomy was safe and valid for postoperative recovery and potentially useful in preventing chyle leak.

Influencing factors and interventional strategies for early enteral nutrition after gastric carcinoma surgery.

The aim of this study is to investigate the factors influencing early enteral nutrition (EN) to develop guidelines after gastric carcinoma (GC) surgery, and to propose appropriate interventions. A total of 118 GC patients have administrated EN 24 h after surgery and were divided into standard-achieving and nonstandard-achieving groups based on meeting 60% of energy needs. The clinical data of these two groups were retrospectively analyzed and compared. The intraoperative blood loss, proportion of those with body mass ≤60 kg, and those cases tolerating EN in the standard-achieving group were significantly greater than in the nonstandard-achieving group, and the differences were statistically significant (P < 0.05). Gender, age, operative time, catheter length, American Society of Anesthesiologists risk class, and postoperative exhaust time showed no statistically significant differences (P > 0.05). However, logistic regression analysis revealed that intraoperative blood loss, body mass, and EN tolerance were independent risk factors influencing achievement of standards for early postoperative EN in GC patients (P < 0.05). Individual differences should be considered when performing EN, and individualized nutritional support should be provided to improve the standard-achieving rate.

The use of nasointestinal feeding tubes in postoperative enteral nutrition of long gap esophageal atresia

Objective To assess the benefit of intraoperatively placed nasointestinal feeding tubes for early postoperative enteral nutrition. Methods The retrospective study was carried out on 19 cases of infants with long gap esophageal atresia who underwent one-stage operation in Xinhua Hospital from January 2006 to December 2013.Patients were divided into two groups according to whether the transanastomotic nasointestinal feeding tubes(TNFT) were placed.Demographics, associated anomalies, operative findings, complications, duration of enteral nutrition(EN), length of stay were analyzed. Results Thirty-seven patients had long gap esophageal atresia and nineteen underwent one-stage operation.Eight patients were identified as TNFT group while eleven patients were identified as nonfeeding tube(NFT) group.There was no significant differences between the two groups in gestational age, birth weight, associated anomalies, anastomotic leak, weight gain, ICU-free days and length of stay(P>0.05). But the ventilator-free days(23.5 d vs.19.3 d), first EN time(0.8 d vs.9.1 d) and total EN feeding time(15.9 d vs.21.4 d) between the two groups were significantly different(P<0.05). Conclusion Intraoperatively placed TNFT may lead to earlier EN feeding and shorter parenteral nutrition duration, but a larger prospective study would be required to prove the benefits and ensure the safety. Key words: Long gap esophageal atresia; Nasointestinal feeding tubes; Enteral nutrition

Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis.

Early postoperative enteral nutrition (EN) after esophagectomy in esophageal cancer patient has been reported to be correlated with a better rehabilitation than parenteral nutrition (PN). However, a robust conclusion has not been achieved. Therefore, we performed a meta-analysis to compare the postoperative EN and PN in patients with esophageal cancer undergoing esophagectomy. Three electronic databases were searched for eligible studies to be included in the meta-analysis. The summary relative risk/weighted mean difference (RR/WMD) estimates and corresponding 95% confidence interval (CI) were calculated using fixed- and random-effects models. Ten studies met the inclusion criteria. The analysis demonstrated that the early postoperative EN could significantly decrease the pulmonary complications (RR = 0.37, 95% CI = 0.22-0.62, P = 0.00, test for heterogeneity: I(2) = 0.0%, P = 0.89) and anastomotic leakage (RR = 0.46, 95% CI = 0.22-0.96, P = 0.04, test for heterogeneity: I(2) = 0.0%, P = 0.66) compared with PN. On the eighth postoperative day, the EN group had a higher levels of albumin (WMD = 1.84, 95% CI = 0.47-3.21, P = 0.01, test for heterogeneity: I(2) = 84.5%, P = 0.00) and prealbumin (WMD = 12.96, 95% CI = 3.63-22.29, P = 0.01, test for heterogeneity: I(2) = 0.0%, P = 0.63) compared with the PN group. However, there was no difference in digestive complications between these two approaches (RR = 1.30, 95% CI = 0.79-2.13, P = 0.30, test for heterogeneity: I(2) = 0.0%, P = 0.97). For patients with esophageal cancer following esophagectomy, the early postoperative EN support could decrease the morbidity of severe complications, such as pulmonary complications and anastomotic leakage, and maintain patients at a better nutritional status than parenteral nutrion support.

Clinical value of enhanced recovery after surgery in the radical resection for hilar cholangiocarcinoma

Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in patients undergoing postoperative early enteral nutrition (EEN) with radical resection for hilar cholangiocarcinoma. Methods The clinical data of 48 patients with hilar cholangiocarcinoma who were admitted to the Drum Tower Clinical Medical College of Nanjing Medical University from July 2006 to September 2014 were retrospectively analyzed. All the 48 patients underwent radical resection for hilar cholangiocarcinoma, including 24 patients receiving postoperative EEN (EEN group) and 24 patients receiving total parenteral nutrition (TPN group). The serologic indices and liver function were detected regularly after operation. Ten percent of albumin (Alb) 10 g was administered by intravenous infusion when Alb <30 g/L. The indexes of all the 48 patients were compared in the 2 groups at postoperative day 3 and 7, including the serologic indices and liver function, the exhaust time, the volume of Alb infusion, the complications (incisional infection, abdominal infection, pleural effusion, peritoneal effusion and bile leakage) and the duration of hospital stay. The patients were followed up by outpatient examination and telephone interview till September 2014. The measurement data with normal distribution were presented as ±s, comparison between groups and count data were analyzed using the t test and chi-squared test, respectively. Results Patients in the 2 groups were cured successfully and discharged, and no patient died perioperatively. Patients in the EEN group had a good tolerance for EEN and no occurrence of EEN-related complications was detected. The level of the GGT was (108±73) U/L in the EEN group, which was significantly lower than (225±121) U/L in the TPN group at postoperative day 3 (t =4. 041, P 0.05). The postoperative time to anal exsufflation and the duration of hospital stay were (73±18) hours and (15±4 ) days in the EEN group, which were significantly different from (97±21) hours and (18±4) days in the TPN group, and the volume of Alb infusion was (44±29) g in the EEN group, which was significantly lower than (101±92) g in the TPN group (t =4. 295, 2. 615, 2. 916, P <0.05). All the 48 patients were followed up for 1 to 71 months (mediantime, 10 months), no patients received reoperation or re-admitted to the hospital due to complications. Conclusion The application of postoperative EEN in enhanced recovery of patients undergoing radical resection for hilar cholangiocarcinoma is safe and effective, it could accelerate the recovery of enteral function, shorten the postoperative duration of hospital stay and reduce the supplement of extrinsic Alb, which is helpful for the fast recovery of patients. Key words: Cholangiocarcinoma, hilar; Early enteral nutrition; Enhanced recovery after surgery

Effect of early postoperative enteral nutrition on nutrition status and immune function in gastric cancer patients

Effect of early postoperative enteral nutrition on nutrition status and immune function in gastric cancer patients