A Clinical Study on Gastric Cancer Patients Administered EN and PN Versus PN Alone in Enhanced Recovery After Surgery

Overview

Journal Ann Med Surg (Lond)

Publisher Wolters Kluwer

Specialty Medical Education

Date 2024 Mar 11

PMID 38463057

Authors

Xin Fan

Yachen Xu

Rong Wan

Liwen Zhang

He Han

Jixiang Chen

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Enhanced recovery after surgery (ERAS) recommends avoiding enteral nutrition (EN) due to undesirable sequelae such as pulmonary aspiration and infections. Not using of EN in nongastric resections under ERAS pathways is often successful. However, parenteral nutrition (PN) alone followed by early postoperative oral feeding in gastric cancer patients, recommended by the ERAS guidelines, has unclear benefit and is only adopted after gastric resection. This study aimed to compute the postoperative outcomes of EN and PN compared to those of the ERAS-recommended nutritional pathway. Our secondary objective was to compare postoperative complications between the two groups.

Materials And Methods: Of 173 gastrectomy patients, 116 patients were in the combined group (EN and PN), whereas 57 patients were in the PN alone group. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) version 26.0.0 software. The data were analyzed by one-way ANOVA, the independent sample -test, or, in the case of several independent samples, by the Kruskal-Wallis test. Categorical data were analyzed by Pearson's χ test or Fisher's exact test.

Results: The observed indices included C-reactive protein (CRP), platelet (PLT), white blood cells (WBC), hemoglobin (Hb), albumin, and PRE-albumin. The secondary outcomes included length of hospital stay (LOS), cost, incidence of pulmonary infection, and total incidence of infection.

Conclusion: The combined mode of nutrition is feasible and is not associated with postoperative complications in gastric cancer patients under ERAS.

Citing Articles

Efficacy and Safety of a Combination of Enteral and Parenteral Nutrition Support in the Postoperative Period for Patients with Gastrointestinal Cancer: A Systematic Review and Meta-Analysis.

Cai M, Yang B, Zheng Y, Ding L Balkan Med J. 2025; 42(1):14-26.

PMID: 39757453 PMC: 11725663. DOI: 10.4274/balkanmedj.galenos.2024.2024-10-65.

References

Xiaoyong W, Xuzhao L, Deliang Y, Pengfei Y, Zhenning H, Bin B . Construction of a model predicting the risk of tube feeding intolerance after gastrectomy for gastric cancer based on 225 cases from a single Chinese center. Oncotarget. 2017; 8(59):99940-99949. PMC: 5725142. DOI: 10.18632/oncotarget.21966. View

Probst P, Keller D, Steimer J, Gmur E, Haller A, Imoberdorf R . Early combined parenteral and enteral nutrition for pancreaticoduodenectomy - Retrospective cohort analysis. Ann Med Surg (Lond). 2016; 6:68-73. PMC: 4761695. DOI: 10.1016/j.amsu.2016.02.002. View

Martos-Benitez F, Gutierrez-Noyola A, Soto-Garcia A, Gonzalez-Martinez I, Betancourt-Plaza I . Program of gastrointestinal rehabilitation and early postoperative enteral nutrition: a prospective study. Updates Surg. 2018; 70(1):105-112. DOI: 10.1007/s13304-018-0514-8. View

Weindelmayer J, Mengardo V, Gasparini A, Sacco M, Torroni L, Carlini M . Enhanced Recovery After Surgery can Improve Patient Outcomes and Reduce Hospital Cost of Gastrectomy for Cancer in the West: A Propensity-Score-Based Analysis. Ann Surg Oncol. 2021; 28(12):7087-7094. PMC: 8519899. DOI: 10.1245/s10434-021-10079-x. View

Kim S, McClave S, Martindale R, Miller K, Hurt R . Hypoalbuminemia and Clinical Outcomes: What is the Mechanism behind the Relationship?. Am Surg. 2017; 83(11):1220-1227. DOI: 10.1177/000313481708301123. View

Tian Y, Cao S, Li L, He Q, Xia L, Jiang L . Effects of perioperative enhanced recovery after surgery pathway management versus traditional management on the clinical outcomes of laparoscopic-assisted radical resection of distal gastric cancer: study protocol for a randomized controlled trial. Trials. 2020; 21(1):369. PMC: 7193340. DOI: 10.1186/s13063-020-04272-8. View

Seres D, Valcarcel M, Guillaume A . Advantages of enteral nutrition over parenteral nutrition. Therap Adv Gastroenterol. 2013; 6(2):157-67. PMC: 3589130. DOI: 10.1177/1756283X12467564. View

Cheng X, Lin J, Tu S . Etiology and Prevention of Gastric Cancer. Gastrointest Tumors. 2016; 3(1):25-36. PMC: 5040890. DOI: 10.1159/000443995. View

Weimann A . Influence of nutritional status on postoperative outcome in patients with colorectal cancer - the emerging role of the microbiome. Innov Surg Sci. 2019; 3(1):55-64. PMC: 6754043. DOI: 10.1515/iss-2017-0039. View

10.

Taniguchi H, Sasaki T, Fujita H, Kobayashi H, Kawasaki R, Ogata T . Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program. Clin Nutr ESPEN. 2018; 23:184-193. DOI: 10.1016/j.clnesp.2017.10.002. View

11.

Rosania R, Chiapponi C, Malfertheiner P, Venerito M . Nutrition in Patients with Gastric Cancer: An Update. Gastrointest Tumors. 2016; 2(4):178-87. PMC: 4924460. DOI: 10.1159/000445188. View

12.

Parks L, Routt M, De Villiers A . Enhanced Recovery After Surgery. J Adv Pract Oncol. 2019; 9(5):511-519. PMC: 6505539. View

13.

Herbert G, Sutton E, Burden S, Lewis S, Thomas S, Ness A . Healthcare professionals' views of the enhanced recovery after surgery programme: a qualitative investigation. BMC Health Serv Res. 2017; 17(1):617. PMC: 5580205. DOI: 10.1186/s12913-017-2547-y. View

14.

Desiderio J, Stewart C, Sun V, Melstrom L, Warner S, Lee B . Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center. J Gastric Cancer. 2018; 18(3):230-241. PMC: 6160527. DOI: 10.5230/jgc.2018.18.e24. View

15.

Yeung S, Hilkewich L, Gillis C, Heine J, Fenton T . Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after elective colorectal surgery. Am J Clin Nutr. 2017; 106(1):44-51. DOI: 10.3945/ajcn.116.148619. View

16.

Ding J, Sun B, Song P, Liu S, Chen H, Feng M . The application of enhanced recovery after surgery (ERAS)/fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis. Oncotarget. 2017; 8(43):75699-75711. PMC: 5650458. DOI: 10.18632/oncotarget.18581. View

17.

Pih G, Na H, Ahn J, Jung K, Kim D, Lee J . Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion. BMC Gastroenterol. 2018; 18(1):101. PMC: 6025834. DOI: 10.1186/s12876-018-0825-8. View

18.

Mortensen K, Nilsson M, Slim K, Schafer M, Mariette C, Braga M . Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg. 2014; 101(10):1209-29. DOI: 10.1002/bjs.9582. View

19.

Luo Y, Qian Y . Effect of combined parenteral and enteral nutrition for patients with a critical illness: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020; 99(3):e18778. PMC: 7220180. DOI: 10.1097/MD.0000000000018778. View

20.

Soeters P, Wolfe R, Shenkin A . Hypoalbuminemia: Pathogenesis and Clinical Significance. JPEN J Parenter Enteral Nutr. 2018; 43(2):181-193. PMC: 7379941. DOI: 10.1002/jpen.1451. View