Objective To compare the clinical effects of early enteral and parenteral nutrition, and to study their effects on cytokine release, cellular immune function and protein metabolism in early postoperative patients with gastrointestinal cancer.
Methods Thirty-six patients with gastrointestinal cancer were randomly divided into early postoperative enteral nutrition (EN) group (19 cases) and parenteral nutrition (PN) group (17 cases), and they were supported with EN or PN during postoperative period of 1-7 days, respectively. The levels of serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured by ELISA. The total lymphocyte count (TLC) and subgroups of lymphocyte (CD3, CD4, CD8, CD4/CD8 and NK cell) were determined with flow cytometer. The urea and creatinine of the 24 h excretory urine were examined at four different phases: preoperative (pre), 1st d, 3rd d and 5th d after operation (pod). The clinical recovery indicators and the complication incidence were also observed.
Results All the patients followed the project of nutritional support and relevant examinations, and there was no severe complication and no patient died during the research. The IL-1β, IL-6 and IL-10, the 24 h urea and creatinine increased, while the serum TNF-α and TLC (except 3, 5 pod of EN group) decreased. There was no marked change of the proportion of lymphocyte subgroups after operation and there was no significant difference of the changes of IL-1β, IL-10 and TNF-α between the two groups as well. The levels of IL-6 (3, 5 pod), the 24 h urea (3, 5 pod) and creatinine (3, 5 pod) were significantly lower in EN group than those in PN group （P＜0.05）, whereas TLC (3, 5 pod) were significantly higher than that in EN group （P＜0.05）. In addition, the postoperative infection incidence （10.5% vs 35.3%）, fever duaration, rehabilitation time and medical cost were significantly lower in EN group than those in PN group （P＜0.05）.
Conclusion The early postoperative EN has an advantage over PN in the patients with gastrointestinal cancer, which could decrease the release of cytokine and suppress protein
metabolism resulting from operational stress, and could reduce the incidence of postoperative infection and inflammatory reaction time. They could also improve the cellular immune function and decrease the rebilitation duration and medical cost.
Citation： LUO Shicheng,GUO Jianhui,ZHU Jun,ZHUO Weidong,ZHANG Liping. Early Postoperative Enteral Versus Parenteral Nutrition in Patients with Gastrointestinal Cancer: A Randomized Controlled Trial. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2007, 14(3): 324-328. doi: Copy