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Randomized Controlled Trial
. 2022 Apr 1;14(7):1472.
doi: 10.3390/nu14071472.

Effects of Preoperative Oral Nutritional Supplements on Improving Postoperative Early Enteral Feeding Intolerance and Short-Term Prognosis for Gastric Cancer: A Prospective, Single-Center, Single-Blind, Randomized Controlled Trial

Feng-Jun He  1 , Mo-Jin Wang  2 , Kun Yang  2 , Xiao-Long Chen  2 , Tao Jin  1 , Li-Li Zhu  1 , Wen Zhuang  2
Affiliations
Randomized Controlled Trial

Effects of Preoperative Oral Nutritional Supplements on Improving Postoperative Early Enteral Feeding Intolerance and Short-Term Prognosis for Gastric Cancer: A Prospective, Single-Center, Single-Blind, Randomized Controlled Trial

Feng-Jun He et al. Nutrients. .

Abstract

Background: Early enteral nutrition (EN) after abdominal surgery can improve the prognosis of patients. However, the high feeding intolerance (FI) rate is the primary factor impeding postoperative EN.

Methods: Sixty-seven patients who underwent radical subtotal or total gastrectomy for gastric cancer (GC) were randomly allocated to the preoperative oral nutritional supplement group (ONS group) or dietary advice alone (DA group). Both groups were fed via nasojejunal tubes (NJs) from the first day after surgery to the fifth day. The primary endpoint is the FI rate.

Results: Of the patients, 66 completed the trial (31 in the ONS group, 35 in the DA group). The FI rate in the ONS group was lower than that in the DA group (25.8% vs. 31.4%, p = 0.249). The postoperative five-day 50% energy compliance rate in the ONS group was higher than that in the DA group (54.8% vs. 48.6%, p = 0.465). The main gastrointestinal intolerance symptoms were distension (ONS vs. DA: 45.2% vs. 62.9, p = 0.150) and abdominal pain (ONS vs. DA: 29.0% vs. 45.7%, p = 0.226). Postoperative nausea/vomiting rate and heartburn/reflux rate were similar between the two groups. We noted no difference in perioperative serum indices, short-term prognosis or postoperative complication rates between the two groups.

Conclusions: The study shows that short-term preoperative ONS cannot significantly improve FI and the energy compliance rate in the early stage after radical gastrectomy.

Keywords: enhanced recovery after surgery; enteral nutrition; feeding intolerance; gastric cancer; gastroenterostomy; oral nutritional supplements; randomized controlled trial.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CONSORT flow diagram of patient recruitment and randomization.
Figure 2
Figure 2
(a) Patterns from parenteral nutrition to oral overfeeding. (b) Average daily tube feeding amount of experimental group and control group after operation. (c–h) Abdominal distension, abdominal pain, nausea/vomiting and heartburn/reflux symptom scores were compared between experimental group and control group after operation. (g): Proportion of each symptom score in the total scores of gastrointestinal symptoms after surgery. (h): Postoperative mean daily total score of gastrointestinal symptoms.
Figure 2
Figure 2
(a) Patterns from parenteral nutrition to oral overfeeding. (b) Average daily tube feeding amount of experimental group and control group after operation. (c–h) Abdominal distension, abdominal pain, nausea/vomiting and heartburn/reflux symptom scores were compared between experimental group and control group after operation. (g): Proportion of each symptom score in the total scores of gastrointestinal symptoms after surgery. (h): Postoperative mean daily total score of gastrointestinal symptoms.
Figure 3
Figure 3
Changes in serological indicators. (a) Perioperative blood glucose fluctuation. (b) Perioperative prealbumin (PAB) fluctuation. (c) Perioperative fluctuation of serum total albumin (TB). (d) Perioperative serum albumin (ALB) fluctuation. (e) Perioperative c-reactive protein fluctuation (CRP). (f) Perioperative interleukin-6 (IL-6) fluctuation. (g) Changes in serum procalcitonin (PCT) levels during perioperative period. (h) Perioperative white blood cell (WBC) fluctuation. (i) Changes in Serum Lymphocyte Count.
Figure 3
Figure 3
Changes in serological indicators. (a) Perioperative blood glucose fluctuation. (b) Perioperative prealbumin (PAB) fluctuation. (c) Perioperative fluctuation of serum total albumin (TB). (d) Perioperative serum albumin (ALB) fluctuation. (e) Perioperative c-reactive protein fluctuation (CRP). (f) Perioperative interleukin-6 (IL-6) fluctuation. (g) Changes in serum procalcitonin (PCT) levels during perioperative period. (h) Perioperative white blood cell (WBC) fluctuation. (i) Changes in Serum Lymphocyte Count.
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