| Effect of route of delivery and formulation of postoperative nutritional support in patients undergoing major operations for malignant neoplasms. | |
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MedLine Citation:
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PMID: 9366716 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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L Gianotti; M Braga; A Vignali; G Balzano; A Zerbi; P Bisagni; V Di Carlo |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Archives of surgery (Chicago, Ill. : 1960) Volume: 132 ISSN: 0004-0010 ISO Abbreviation: Arch Surg Publication Date: 1997 Nov |
Date Detail:
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Created Date: 1997-12-16 Completed Date: 1997-12-16 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9716528 Medline TA: Arch Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1222-9; discussion 1229-30 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Scientific Institute San Raffaele, University of Milan, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Enteral Nutrition* Female Gastrectomy* Gastrointestinal Neoplasms / immunology, surgery* Humans Male Middle Aged Pancreaticoduodenectomy* Parenteral Nutrition, Total* Prospective Studies Regression Analysis |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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