This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (91)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Nutritional and Metabolic Disorders  • Nutrition/ Malnutrition  • Alert me on articles by topic  Social Bookmarking   What's this?

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.

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

RELATED ARTICLE

Archives of Surgery Reader's Choice: Continuing Medical Education
Arch Surg. 2002;137(2):229-230.
FULL TEXT  

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  

Is There a Role for Bowel Rest in Nutrition Management of Crohn's Disease?
Wiese et al.
Nutr Clin Pract 2008;23:309-317.
ABSTRACT | FULL TEXT  

Arginine in the Critical Care Setting
Zhou and Martindale
J. Nutr. 2007;137:1687S-1692S.
ABSTRACT | FULL TEXT  

Perioperative Immunonutrition: Good Idea or More Hype?
Van Way
JPEN J Parenter Enteral Nutr 2006;30:539-540.
FULL TEXT  

Effect of severe short-term malnutrition on diaphragm muscle signal transduction pathways influencing protein turnover
Lewis et al.
J. Appl. Physiol. 2006;100:1799-1806.
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  

Medical and Ethical Aspects of Long-term Enteral Tube Feeding
McMahon et al.
Mayo Clin Proc. 2005;80:1461-1476.
ABSTRACT  

Immunonutrition and Upper Gastrointestinal Surgery: What Really Matters
Sax
Nutr Clin Pract 2005;20:540-543.
ABSTRACT | FULL TEXT  

Nutrition support for patients in the intensive care unit
Griffiths and Bongers
Postgrad. Med. J. 2005;81:629-636.
ABSTRACT | FULL TEXT  

Postoperative Mortality and Morbidity in French Patients Undergoing Colorectal Surgery: Results of a Prospective Multicenter Study
Alves et al.
Arch Surg 2005;140:278-283.
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  

Is the Use of Specialized Nutritional Formulations a Cost-Effective Strategy? A National Database Evaluation
Strickland et al.
JPEN J Parenter Enteral Nutr 2005;29:S81-S91.
ABSTRACT | FULL TEXT  

Targeting the Use of Specialized Nutritional Formulas in Surgery and Critical Care
Cresci
JPEN J Parenter Enteral Nutr 2005;29:S92-S95.
FULL TEXT  

Practical Recommendations for Immune-Enhancing Diets
Bistrian
J. Nutr. 2004;134:2868S-2872S.
ABSTRACT | FULL TEXT  

Role of Omega-3 Fatty Acid Supplementation in Inflammation and Malignancy
Jho et al.
Integr Cancer Ther 2004;3:98-111.
ABSTRACT  

Thirteen-Week Oral Toxicity Study of L-Arginine in Rats
Tsubuku et al.
International Journal of Toxicology 2004;23:101-105.
ABSTRACT | FULL TEXT  

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

OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02)
Evid. Based Nurs. 2003;6:e1-1.
FULL TEXT