You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 132 No. 11, November 1997 TABLE OF CONTENTS
  Archives
  •  Online Features
  PAPERS
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

Effect of Route of Delivery and Formulation of Postoperative Nutritional Support in Patients Undergoing Major Operations for Malignant Neoplasms

Luca Gianotti, MD, ScD; Marco Braga, MD; Andrea Vignali, MD; Gianpaolo Balzano, MD; Alessandro Zerbi, MD; Pietro Bisagni, MD; Valerio Di Carlo, MD

Arch Surg. 1997;132(11):1222-1230.


Abstract

Objective
To study the effect of the route of delivery and formulation of postoperative nutritional support on host defense, protein metabolism, infectious complications, and outcome.

Design
Prospective, randomized, clinical trial.

Setting
Department of Surgery at a university hospital.

Patients
Two hundred sixty candidates for pancreaticoduodenectomy or gastrectomy for cancer.

Interventions
Patients were randomly allocated into 3 groups during surgery. Starting 6 hours after operation, the first group received a standard enteral formula (standard group; n=87); the second, the same enteral formula enriched with arginine, {omega}-3 fatty acids, and RNA (immunonutrition group; n=87); and the third, total parenteral nutrition (parenteral group; n=86). The 3 regimens were isocaloric and isonitrogenous. The nutritional goal was 105 kJ/kg per day.

Main Outcome Measures
Immune response by phagocytosis ability of polymorphonuclear cells, interleukin (IL)-2 receptor levels, and delayed hypersensitivity response; protein synthesis by IL-6 and prealbumin; tolerance of enteral feeding; incidence of postoperative complications; and length of hospital stay.

Results
The immunonutrition group had a significantly better recovery of the immune parameters on postoperative day 8 compared with the other groups. Linear regression analysis showed an inverse correlation between IL-6 and preambulin levels (r=0.766) only in the immunonutrition group. Only 11 patients (6.3%) in both enteral groups did not reach the nutritional goal. Postoperative infection rate was 14.9% (13/87) in the immunonutrition group, 22.9% (20/87) in the standard group, and 27.9% (24/86) in the parenteral group (P=.06). Mean±SD length of hospital stay was 16.1±6.2,19.2±7.9, and 21.6±8.9 days in the immunonutrition, standard, and parenteral groups, respectively (P=.01 vs standard group; P=.004 vs parenteral group).

Conclusions
Early postoperative enteral feeding is a valid alternative to parenteral feeding in patients undergoing major surgery. Immunonutrition enhances the host response, induces a switch from acute-phase to constitutive proteins, and improves outcome.

Arch Surg. 1997;132:1222-1230



Author Affiliations

From the Department of Surgery, Scientific Institute San Raffaele, University of Milan, Milan, Italy.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation
August et al.
JPEN J Parenter Enteral Nutr 2009;33:472-500.
FULL TEXT  

Nutrition Support in Surgical Oncology
Huhmann and August
Nutr Clin Pract 2009;24:520-526.
ABSTRACT | FULL TEXT  

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient:: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)
McClave et al.
JPEN J Parenter Enteral Nutr 2009;33:277-316.
FULL TEXT  

Nutrition Support in Adult Trauma Patients
Todd et al.
Nutr Clin Pract 2006;21:421-429.
ABSTRACT | FULL TEXT  

Effects of Omega-3 Fatty Acids on Cancer Risk: A Systematic Review
MacLean et al.
JAMA 2006;295:403-415.
ABSTRACT | FULL TEXT  

Modulation of Systemic Inflammatory Response after Cardiac Surgery
Raja and Dreyfus
Asian Cardiovasc. Thorac. Ann. 2005;13:382-395.
ABSTRACT | FULL TEXT  

Assessing the Metabolic and Clinical Consequences of Early Enteral Feeding in the Malnourished Patient
Flesher et al.
JPEN J Parenter Enteral Nutr 2005;29:108-117.
ABSTRACT | FULL TEXT  

Preoperative Immunonutrition: Cost-Benefit Analysis
Braga and Gianotti
JPEN J Parenter Enteral Nutr 2005;29:S57-S61.
ABSTRACT | FULL TEXT  

Reducing Costs and Patient Morbidity in the Enterally Fed Intensive Care Unit Patient
Farber et al.
JPEN J Parenter Enteral Nutr 2005;29:S62-S69.
ABSTRACT | FULL TEXT  

Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis
Marik and Zaloga
BMJ 2004;328:1407.
ABSTRACT | FULL TEXT  

Immunonutrition: problematic or problem solving?
McCowen and Bistrian
Am. J. Clin. Nutr. 2003;77:764-770.
ABSTRACT | FULL TEXT  

Protective nutrients and functional foods for the gastrointestinal tract
Duggan et al.
Am. J. Clin. Nutr. 2002;75:789-808.
ABSTRACT | FULL TEXT  

Nutritional Approach in Malnourished Surgical Patients: A Prospective Randomized Study
Braga et al.
Arch Surg 2002;137:174-180.
ABSTRACT | FULL TEXT  

Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients
American Society for Parenteral and Enteral Nutrit
JPEN J Parenter Enteral Nutr 2002;26:1SA-138SA.
 

Should Immunonutrition Become Routine in Critically Ill Patients?: A Systematic Review of the Evidence
Heyland et al.
JAMA 2001;286:944-953.
ABSTRACT | FULL TEXT  

Immune-Enhancing Diets: Products, Components, and Their Rationales
Schloerb
JPEN J Parenter Enteral Nutr 2001;25:S3-S7.
 

Effect of Immune Enhancing Formulas (IEF) in General Surgery Patients
Sax
JPEN J Parenter Enteral Nutr 2001;25:S19-S23.
 

Effects of Immune-Enhancing Diets on Infectious Morbidity and Multiple Organ Failure
Moore
JPEN J Parenter Enteral Nutr 2001;25:S36-S43.
 

The Effects of Immune-Enhancing Diets (IEDs) on Mortality, Hospital Length of Stay, Duration of Mechanical Ventilation, and Other Parameters
McClave
JPEN J Parenter Enteral Nutr 2001;25:S44-S50.
 

Outcome and Cost-effectiveness of Perioperative Enteral Immunonutrition in Patients Undergoing Elective Upper Gastrointestinal Tract Surgery: A Prospective Randomized Study
Senkal et al.
Arch Surg 1999;134:1309-1316.
ABSTRACT | FULL TEXT  

A Prospective, Randomized Clinical Trial on Perioperative Feeding With an Arginine-, Omega-3 Fatty Acid-, and RNA-Enriched Enteral Diet: Effect on Host Response and Nutritional Status
Gianotti et al.
JPEN J Parenter Enteral Nutr 1999;23:314-320.
ABSTRACT  

Infusion Protocol Improves Delivery of Enteral Tube Feeding in the Critical Care Unit
Spain et al.
JPEN J Parenter Enteral Nutr 1999;23:288-292.
ABSTRACT  

Perioperative Immunonutrition in Patients Undergoing Cancer Surgery: Results of a Randomized Double-blind Phase 3 Trial
Braga et al.
Arch Surg 1999;134:428-433.
ABSTRACT | FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1997 American Medical Association. All Rights Reserved.