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Enteral nutrition led to fewer postoperative complications than did parenteral feeding in gastrointestinal cancer

Ronald L. Koretz, MD
[+] Article, Author, and Disclosure Information

*See Glossary.

†Information provided by author.

Source of funding: Italian Society for Parenteral and Enteral Nutrition.

For correspondence: Dr. F. Bozzetti, Residenza Querce, Segrate (Milano), Italy. E-mail dottfb@tin.it.

Ann Intern Med. 2002;136(3):93. doi:10.7326/ACPJC-2002-136-3-093
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Question: In malnourished patients having elective surgery for gastrointestinal cancer, is enteral nutrition (EN) better than parenteral nutrition (PN) for reducing postoperative complications?

Design: Randomized {allocation concealed*}†, unblinded,* controlled trial with follow-up to discharge.

Setting: 10 Italian centers.

Patients: 317 patients who were ≥ 18 years of age (mean age 64 y, 58% men) and had weight loss ≥ 10% of usual body weight in the previous 6 months, histologically confirmed cancer, and planned major elective surgery. Exclusion criteria were hepatic, renal, or cardiac dysfunction; Karnofsky performance status < 60; pregnancy; ongoing infection; and intestinal anastomosis of the large bowel without a diverting stoma. Follow-up was complete.

Intervention: Patients were allocated to EN (n = 159) or PN (n = 158). Patients in the EN group had a jejunostomy feeding catheter or a nasojejunal feeding tube placed during surgery. PN was given by central venous catheter.

Main outcome measures: Postoperative complications. Secondary outcome measures were length of postoperative hospital stay, adverse events, and treatment switchover.

Main results: Analysis was by intention to treat. Fewer patients in the EN group than in the PN group had postoperative complications (P = 0.005); the mean length of postoperative hospital stay was shorter in the EN group (P = 0.009) (Table). More patients in the EN group than in the PN group had adverse events (abdominal distention and cramps, diarrhea, and vomiting) (P < 0.001) (Table) and more switched treatments (8.8% vs 0%, P < 0.001).

Conclusion: In malnourished patients having elective surgery for gastrointestinal cancer, enteral nutrition led to a lower complication rate and shorter postoperative hospital stay than did parenteral nutrition but was not as well tolerated.

Enteral nutrition (EN) vs parenteral nutrition (PN) for malnourished patients having surgery for gastrointestinal cancer‡

Outcomes at dischargeENPNRRR (95% CI)NNT (CI)
Overall postoperative complications34%49%31% (10 to 48)7 (4 to 22)
Adverse events35%14%153% (64 to 294)5 (4 to 9)
Mean difference (CI)
Length of postoperative stay (mean d)13.415.01.6 (0.5 to 2.7)

‡Abbreviations defined in Glossary; RRR, RRI, NNT, NNH, mean difference, and CI calculated from data in article.





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