Early postoperative glutamine-supplemented parenteral nutrition versus enteral immunonutrition in cancer patients undergoing major gastrointestinal surgery

Abstract

Purpose: The aim of this study was to determine whether the type of postoperative feeding, glutamine-supplemented parenteral nutrition or enteral immunonutrition, can modify morbidity and outcome in malnourished cancer patients undergoing major surgery in the gastrointestinal tract.

Patients and methods: Twenty-nine consecutive malnourished patients undergoing major elective surgery for carcinoma of the stomach (n=8), pancreas (n=8), liver (n=1), and colon (n=12), were randomly assigned to receive from the first postoperative day either enteral immunonutrition or glutamine-supplemented parenteral nutrition, for at least 5 consecutive days. Postoperative major and minor morbidity and mortality were recorded. Data analysis was done using the Fisher's exact test.

Results: Fifteen patients received glutamine-supplemented parenteral nutrition and 14 received enteral immunonutrition. The overall incidence of postoperative complications was 33.3% in the parenteral nutrition group versus 50% in the enteral nutrition group (p=0.2). Subdividing postoperative complications into different types, the rates of major complications were similar in both groups of patients (13.3 and 21.4% respectively, p=0.4). Similarly, there were no significant differences between the two groups considering minor postoperative noninfectious complications, infectious complications, and mortality.

Conclusion: In malnourished cancer patients undergoing major gastrointestinal surgery, morbidity and mortality are not significantly influenced by the type of postoperative feeding.