Parenteral Nutrition Before Surgery in Patients with Upper Gastrointestinal Tract Resection
Authors:
L. Lakyová; J. Belák; J. Vajó; M. Kudláč; J. Radoňak
Authors‘ workplace:
II. chirurgická klinika LF UPJŠ, Košice
Published in:
Čas. Lék. čes. 2008; 147: 222-227
Category:
Original Article
Overview
Background.
The aim of this retrospective analysis was the evaluation of the effect of parenteral nutrition before surgery in malnourished patients on the reduction of risks during postoperative period after upper gastrointestinal tract resection. 57 patients with the diagnosis of oesophageal or stomach carcinoma were included into the selected group. Patients were divided into three groups: I. group: resecabile tumor, parenteral nutrition, malnutrition, II. group: nonresecabile tumor, parenteral nutrition, malnutrition, III. group: resecabile tumor, without parenteral nutrition, well nourished.
Methods and Results.
In the group of malnourished patients, seven days after the applied parental nutrition, a statistical significant difference in the elevated values of proteins (I.: 62 ± 3.8→70 ± 1.75, II.: 59.7 ± 3.2→69.2 ± 1.2) and albumin (I: 32.6 ± 1.95→38.0 ± 1.09, II.: 31.1 ± 1.2→37.5 ± 0.9) p < 0.001 were achieved. Complications associated with the insertion of central venous catheter decreased as follows: plugged catheter (17.6%), local erythema (7.5%), pneumothorax (5%), phlebotrombosis (5%), haemothorax (0.4%). Postoperative complications did not achieve statistical significance (p < 0,05) in the groups I.–III. The highest incidence of wound and anastomosis dehiscention and sepsis was noticed in the first group, the lowest in the third group. Brochopneumonia had the highest occurrence in the second group, the lowest in the third group.
Conclusions.
Preoperative parenteral nutrition as a prevention of complications after resection surgery on stomach and oesophagus is beneficial in the middle and high grade of malnourished patients, despite of higher costs and prolonged hospitalization, considering the comparable percentage of postoperative complications in the group of non-malnourished and malnourished patients. The nutritional supplementation should take at least seven days.
Key words:
parenteral nutrition, preoperative preparation, malnutrition, carcinoma of upper gastrointestinal tract.
Sources
1. Argiles, J. M.: Cancer-associated malnutrition. Europan Journal of Oncology Nursing, 2005, 9, s. 39–50.
2. Riccardi, D., Allen, K.: Nutritional Management of Patients with Esophageal and Esophagogastric Junction Cancer. Journal of the Moffitt Cancer Center, 1999, 6, s. 64–72.
3. Fearon, K. CH.: Nutritional support in cancer. Clinical Nutrition, 2001, 20, s. 187–190.
4. Schwenk, W., Günther, N., Haase, O. et al.: Changes in perioperative treatment for elective colorectal resections in Germany 1991 and 2001/2002. Zentralbl Chir., 2003, 128, s. 1086–1092.
5. Lanoir, D., Chambrier, C., Vergnon, P.: Perioperative artificial nutrition in elective surgery: an impact study of French guidelines. Clinical Nutrition, 1998, 17, s. 153 –157.
6. Bauer, J., Capra, S., Ferguson, M.: Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. European Journal of Clinical Nutrition, 2002, 56, s. 779–785.
7. Swinton, N., Kasymjanova, G., Steinberg, T.: Do most newly diagnosed advanced NSCLC patients need nutritional intervention? Journal of Clinical Oncology, Part I., 2007, 25, s. 9108.
8. Philosophical Transactions of the Royal Society of London, 1656, stručný opis, Londýn, 1809, s. 45.
9. Pavia, R., Barresi, P., Piermanni, V. et al.: Treatment of the esophageal cancer: the impact of peri-operative parenteral nutrition. Recenti Prog. Med., 2006, 97, s. 219–224.
10. Goonetilleke, K. S., Siriwardena, A. K.: Systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy. JOP, 2006, 11, s. 5.
11. Gabor, S,, Renner, H,. Matzi, V., Ratzenhofer, B.: Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction. Br. J. Nutr., 2005, 93, s. 509–513.
12. Braga, M., Gianotti, L., Gentilini, O., Parisi, V.: Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. Crit. Care Med., 2001, 29, s. 242–248.
13. Lakyová, L., Radoňák, J., Stebnický, M. et al.: Enterálna výživa po resekčných výkonoch na pažeráku. Slovenská chirurgia, 2007, 4, s. 30–34.
14. Braga, M., Gianotti, L., Nespoli, L.: Nutritional approach in malnourished surgical patients. Arch Surg., 2002, 137, s. 174–180.
15. Cooper, S. C., Hulley, C. M., Grimley, C. E., Howden, J.: Perioperative peripheral parenteral nutrition for patients undergoing esophagectomy for cancer: a pilot study of safety, surgical, and nutritional outcomes. Int. Surg., 2006, 91, s. 358–364.
16. Liao, Q., Zhao, Y. P., Wang, W. B. et al.: Perioperative nutrition support of the patients with pancreatic head cancer. Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 2005, 27, s. 579–582.
17. Bozzetti, F., Gavazzi, C., Miceli, R. et al.: Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. JPEN J. Parenter. Enteral. Nutr., 2000, 24, s. 7–14.
18. Radoňak, J., Vajó, J., Belák, J., Stebnický, M.: All-in-One systém parenterálnej výživy v rámci intenzívnej starostlivosti v chirurgii. Plzeňský lékařský sborník, 1992, 65, s. 23–25.
19. Farriol, M., Pons, M., Roca, N. et al.: Preoperative chemotherapy and total parenteral nutrition in colon cancer. Nutr. Hosp., 2006 , 21, s. 303–306.
20. Wu, G. H., Liu, Z.H., Wu, Z.H., Wu, Z.G.: Perioperative artificial nutrition in malnourished gastrointestinal cancer patients. World J Gastroenterol., 2006, 21, s. 2441–2444.
21. Komorowski, A. L., Łobaziewicz, W., Kołodziejski, L., Duda, K.: Early results of esophagectomy and total or proximal gastrectomy without perioperative administration of total parenteral nutrition. Wiad. Lek., 2003, 56, s. 122–126.
22. Koretz, R. L.: Do data support nutrition support? Part I: Intravenous nutrition, 2007, 107, s. 988–996.
23. Jin, D., Phillips, M., Byles, J. E.: Effects of parenteral nutrition support and chemotherapy on the phasic composition of tumor cells in gastrointestinal cancer. JPEN J. Parenter. Enteral. Nutr., 1999, 23, s. 237–241.
24. Mikula, J., Uhliariková, H., Očenášová, M.: Výživa u onkologických pacientov. Interná medicína, 2004, 7, s. 413–415.
25. McCowen, K. C., Friel, C., Sternberg, J. et al.: Hypocaloric total parenteral nutrition: effectiveness in prevention of hyperglycemia and infectious complications – a randomized clinical trial. Crit. Care Med., 2000, 28, s. 3606–3611.
26. Van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C.: Intensive insulin therapy in the critically ill patients. N. Engl. J. Med., 2001, 345, s. 1359–1367.
27. Ikeda, K., Kimura, Y., Iwaya, T.: Perioperative nutrition for gastrointestinal surgery. Nippon Geka Gakkai Zarshi, 2004, 105, s. 218–222.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain managementArticle was published in
Journal of Czech Physicians
Most read in this issue
- Risk Factors of Atelectasis Following Pulmonary Lobectomy
- Somatostatin Analogues in the Treatment of Carcinoid
- Peripheral Nerve Injury and the Degree of Motor Involvement in Parkinson’s Disease: A Correlation Study
- Sacral Nerve Stimulation in the Treatment of Anal Incontinence