Early postoperative enteral feeding improves whole body protein kinetics in upper gastrointestinal cancer patients

• Published in: The American journal of surgery 1997-09, Vol.174 (3), p.325-330
• Main Authors: Hochwald, Steven N., Harrison, Lawrence E., Heslin, Martin J., Burt, Michael E., Brennan, Murray F.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cancer; Catabolism; Energy expenditure; Energy Intake; Enteral feeding; Enteral Nutrition; Fatty acids; Feeding; Feeds; Gastrointestinal Neoplasms - metabolism; Gastrointestinal Neoplasms - surgery; Gastrointestinal tract; Glucose - administration & dosage; Human Growth Hormone - metabolism; Humans; Infusions, Intravenous; Insulin; Insulin-Like Growth Factor I - metabolism; Intravenous administration; Kinetics; Leucine; Malignancy; Malnutrition; Medical sciences; Morbidity; Mortality; Nitrogen balance; Ostomy; Oxidation; Pancreatic Hormones - metabolism; Postoperative Care; Postoperative period; Prospective Studies; Protein metabolism; Protein turnover; Proteins; Proteins - metabolism; Respiratory quotient; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(97)00095-0

Patients with upper gastrointestinal (Gl) tract malignancies are at increased risk for malnutrition, as well as postoperative morbidity and mortality. As data clearly documenting the benefit of early postoperative enterai feeding in upper Gl cancer patients as compared with no feeding are sparse, we examined the protein kinetic effects of early enterai feeding and compared it with standard postoperative care (ie, intravenous fluid). Twenty-nine patients undergoing resection of an upper Gl tract malignancy were prospectively randomized to either enterai feeding (FEED, n = 12) starting on postoperative day (POD) 1 via a jejunostomy tube or intravenous fluid (IVF, n = 17). On POD 5, all patients underwent resting energy expenditure determination and a protein metabolic study using the isotope 14C-leucine to determine whole body (WB, μmol leu/kg/min) protein kinetics. Respiratory quotient and insulin (μU/ mL) levels were significantly increased in patients receiving enterai feeding (0.85 ± 0.02,19.8 ± 4.5 versus 0.78 ± 0.02, 9.3 ± 0.8, FEED versus IVF, P < 0.05). Free fatty acids (meq/dL) were significantly lower in FEED group (0.36 ± 0.04) as compared with IVF group (0.85 ± 0.07, P < 0.0001). While there were no significant differences in WB protein oxidation (0.10 ± 0.01 versus 0.10 ± 0.02) or synthesis (0.81 ± 0.09 versus 0.68 ± 0.08, IVF versus FEED), WB protein catabolism was significantly less (0.91 ± 0.10 versus 0.37 ± 0.09, P = 0.002), and WB protein net balance was converted to positive in FEED group (−0.10 ± 0.01 versus 0.30 ± 0.03, IVF versus FEED, P < 0.001). Early enterai feeding decreases fat oxidation and whole body protein catabolism while improving net nitrogen balance. By significantly improving protein metabolism, enteral feeding may decrease postoperative morbidity and mortality in upper Gl cancer patients.