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Nutritional Approach in Malnourished Surgical Patients
A Prospective Randomized Study
Marco Braga, MD;
Luca Gianotti, MD, ScD;
Luca Nespoli, MD;
Giovanni Radaelli, PhD;
Valerio Di Carlo, MD
Arch Surg. 2002;137:174-180.
Hypothesis Perioperative administration of a supplemented enteral formula may decrease postoperative morbidity.
Design Randomized clinical trial.
Setting Department of surgery at a university hospital.
Patients One hundred ninety-six registered malnourished patients (weight loss  10%) who were candidates for major elective surgery for malignancy of the gastrointestinal tract.
Intervention After randomization (n = 150), one group received postoperative enteral feeding with a standard diet within 12 hours of surgery (control group; n = 50). Another group orally received 1 L/d for 7 consecutive days of a liquid diet enriched with arginine,  -3 fatty acids, and RNA (preoperative group; n = 50). After surgery, patients were given the same standard enteral formula as the control group. A third group orally received 1 L/d for 7 consecutive days of the enriched liquid diet. After surgery, patients were given enteral feeding with the same enriched formula (perioperative group; n = 50).
Main Outcome Measures Postoperative complications and length of hospital stay.
Results The 3 groups were comparable for baseline demographics, biochemical markers, comorbidity factors, and surgical variables. The intent-to-treat analysis showed that the total number of patients with complications was 24 in the control group, 14 in the preoperative group, and 9 in the perioperative group (P = .02, control group vs perioperative group). Postoperative length of stay was significantly shorter in the preoperative (13.2 days) and perioperative (12.0 days) groups than in the control group (15.3 days) (P = .01 and P = .001, respectively, vs the control group).
Conclusion Perioperative immunonutrition seems to be the best approach to support malnourished patients with cancer.
From the Department of Surgery, San Raffaele University (Drs Braga, Gianotti, Nespoli, and Di Carlo), and the Department of Informative Systems and Statistics, University of Milan (Dr Radaelli), Milan, Italy.
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