Document Detail


Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma.
MedLine Citation:
PMID:  7969324     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Resection of hepatocellular carcinoma is associated with high rates of morbidity and mortality. Since intensive nutritional support can reduce the catabolic response and improve protein synthesis and liver regeneration, we performed a prospective study to investigate whether perioperative nutritional support could improve outcome in patients undergoing hepatectomy for hepatocellular carcinoma. METHODS: We studied 124 patients undergoing resection of hepatocellular carcinoma. Sixty-four patients (39 with cirrhosis, 18 with chronic active hepatitis, and 7 with no associated liver disease) were randomly assigned to receive perioperative intravenous nutritional support in addition to their oral diet, and 60 patients (33 with cirrhosis, 12 with chronic active hepatitis, and 15 with no associated liver disease) were randomly assigned to a control group. The perioperative nutritional therapy consisted of a solution enriched with 35 percent branched-chain amino acids, dextrose, and lipid emulsion (50 percent medium-chain triglycerides) given intravenously for 14 days perioperatively. RESULTS: There was a reduction in the overall postoperative morbidity rate in the perioperative-nutrition group as compared with the control group (34 percent vs. 55 percent; relative risk, 0.66; 95 percent confidence interval, 0.45 to 0.96), predominantly because of fewer septic complications (17 percent vs. 37 percent; relative risk, 0.57; 95 percent confidence interval, 0.34 to 0.96). There were also a reduction in the requirement for diuretic agents to control ascites (25 percent vs. 50 percent; relative risk, 0.57; 95 percent confidence interval, 0.37 to 0.87), less weight loss after hepatectomy (median loss, 0 kg vs. 1.4 kg, P = 0.01), and less deterioration of liver function as measured by the change in the rate of clearance of indocyanine green (-2.8 percent vs. -4.8 percent at 20 minutes, P = 0.05). These benefits were seen predominantly in the patients with underlying cirrhosis who underwent major hepatectomy. There were five deaths during hospitalization in the perioperative-nutrition group, and nine in the control group (P not significant). CONCLUSIONS: Perioperative nutritional support can reduce complications after major hepatectomy for hepatocellular carcinoma associated with cirrhosis.
Authors:
S T Fan; C M Lo; E C Lai; K M Chu; C L Liu; J Wong
Related Documents :
15714174 - Efficacy of valganciclovir administered as preemptive therapy for cytomegalovirus disea...
2294844 - Emergency surgery for severe acute cholangitis. the high-risk patients.
8244264 - A prospective study of biliary cytology in 100 patients with bile duct strictures.
6693074 - Extrahepatic biliary atresia.
20031794 - Anticoagulation control and prediction of adverse events in patients with atrial fibril...
20708284 - High-dose preoperative chemoradiotherapy in esophageal cancer patients does not increas...
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  331     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1994 Dec 
Date Detail:
Created Date:  1994-12-08     Completed Date:  1994-12-08     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1547-52     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Carcinoma, Hepatocellular / surgery*,  therapy
Female
Hepatectomy*
Hospital Mortality
Humans
Liver Neoplasms / surgery*,  therapy
Male
Middle Aged
Morbidity
Parenteral Nutrition*
Postoperative Complications / prevention & control

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Patterns of asthma mortality in Philadelphia from 1969 to 1991.
Next Document:  Results of long-term treatment with orthophosphate and pyridoxine in patients with primary hyperoxal...