Hypo-Calories with Micronutrients and Fat Emulsion of Pre-Operative Peripheral Parenteral Nutrition in Malnutrition Risk Rectal Cancer Patients: A Retrospective Cross-Sectional Study
Malnutrition has been recognized as a significant risk factor for the post operated patients, especially for those patients undergoing abdominal operations. This study evaluated the effect of hypo-calories with micronutrients of pre-operative peripheral parenteral nutrition support (PPPN) for rectal cancer patients. Retrospective cross sectional study method was used to investigate. We screened rectal cancer patients past year pre-operative with malnutrition risk from our cancer database and divided into 2 groups, received or not received PPPN and compared the post-operative outcomes. The results showed that the post-operative serum albumin of the 25 patients received PPPN averaged 2.5 ± 0.32 g/dl; significantly better than those of the 15 patients not received PPPN (non-PPPN), which averaged 1.92 ± 0.42 g/dl. The first ambulatory time required 3.0 ± 0.8 days for the PPPN, significantly shorter than those for the non-PPPN, which averaged 4.9 ± 2.4 days. Post-operative hospital days for the patients received PPPN were 18.2 ± 10.5 day, also significantly fewer than the non-PPPN, which averaged 33.7 ± 20.0 day. More than 25% of the non-PPPN was infected with sepsis, while none was infected in the PPPN patients. In conclusion, this study verified the benefits of micronutrients of pre-operative peripheral parenteral nutrition support for rectal cancer patients.
References
[1]
G. F. Reinhardt, J. W. Myscofski, D. B. Wilkens, P. B. Dobrin, J. E. Mangan Jr. and R. T. Stannard, “Incidence and Mortality of Hypoalbuminemic Patients in Hospital ized Veterans,” JPEN—Journal of Parenteral and En teral Nutrition, Vol. 4, No. 4, 1980, pp. 357-359.
doi:10.1177/0148607180004004357
[2]
A. S. Detsky, J. P. Baker, K. O’Rourke, N. Johnston, J. Whitwell, R. A. Mendelson and K. N. Jeejeebhoy, “Predicting Nutrition-Associated Complications for Patients Undergoing Gastrointestinal Surgery,” JPEN—Journal of Parenteral and Enteral Nutrition, Vol. 11, No. 5, 1987, pp. 440-446. doi:10.1177/0148607187011005440
[3]
J. A. Windsor and G. L. Hill, “Weight Loss with Physi ologic Impairment. A Basic Indicator of Surgical Risk,” Annals of Surgery, Vol. 207, No. 3, 1988, pp. 290-296.
doi:10.1097/00000658-198803000-00011
[4]
H. Yamanaka, M. Nishi, T. Kanemaki, N. Hosoda, K. Hioki and M. Yamamoto, “Preoperative Nutritional As sessment to Predict Postoperative Complication in Gastric Cancer Patients,” JPEN—Journal of Parenteral and En teral Nutrition, Vol. 13, No. 3, 1989, pp. 286-291.
doi:10.1177/0148607189013003286
[5]
J. M. Kinney, “Metabolic Responses of the Critically Ill Patient,” Critical Care Clinics, Vol. 11, No. 3, 1995, pp. 569-585.
[6]
S. Klein, J. Kinney, K. Jeejeebhoy, D. Alpers, M. Hel lerstein, M. Murray and P. Twomey, “Nutrition Support in Clinical Practice: Review of Published Data and Rec ommendations for Future Research Directions. National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nu trition,” JPEN—Journal of Parenteral and Enteral Nutri tion, Vol. 21, No. 3, 1997, pp. 133-156.
doi:10.1177/0148607197021003133
[7]
J. L. Mullen, M. H. Gertner, G. P. Buzby, G. L. Goodhart and E. F. Rosato, “Implications of Malnutrition in the Surgical Patient,” Archives of Surgery, Vol. 114, No. 2, 1979, pp. 121-125.
doi:10.1001/archsurg.1979.01370260011001
[8]
J. Gibbs, W. Cull, W. Henderson, J. Daley, K. Hur and S. F. Khuri, “Preoperative Serum Albumin Level as a Pre dictor of Operative Mortality and Morbidity: Results from the National VA Surgical Risk Study,” Archives of Sur gery, Vol. 134, No. 1, 1999, pp. 36-42.
doi:10.1001/archsurg.134.1.36
[9]
R. M. Salvino, R. S. Dechicco and D. L. Seidner, “Pe rioperative Nutrition Support: Who and How,” Cleveland Clinic Journal of Medicine, Vol. 71, No. 4, 2004, pp. 345-351. doi:10.3949/ccjm.71.4.345
[10]
J. Alverdy, H. S. Chi and G. F. Sheldon, “The Effect of Parenteral Nutrition on Gastrointestinal Immunity. The Importance of Enteral Stimulation,” Annals of Surgery, Vol. 202, No. 6, 1985, pp. 681-684.
doi:10.1097/00000658-198512000-00003
[11]
K. A. Kudsk, J. Li and K. B. Renegar, “Loss of Upper Respiratory Tract Immunity with Parenteral Feeding,” Annals of Surgery, Vol. 223, No. 6, 1996, pp. 629-635, 635-688. doi:10.1097/00000658-199606000-00001
[12]
J. Meyer, R. W. Yurt, R. Duhaney, D. G. Hesse, K. J. Tracey, Y. Fong, D. Richardson, S. Calvano, P. Dineen, G. T. Shires, et al., “Differential Neutrophil Activation before and after Endotoxin Infusion in Enterally versus Parenterally Fed Volunteers,” Surgery, Gynecology & Obstetrics, Vol. 167, No. 6, 1988, pp. 501-509.
[13]
J. MacFie, N. P. Woodcock, M. D. Palmer, A. Walker, S. Townsend and C. J. Mitchell, “Oral Dietary Supplements in Pre and Postoperative Surgical Patients: A Prospective and Randomized Clinical Trial,” Nutrition, Vol. 16, No. 9, 2000, pp. 723-728. doi:10.1016/S0899-9007(00)00377-4
[14]
M. H. Torosian, “Perioperative Nutrition Support for Patients Undergoing Gastrointestinal Surgery: Critical Analysis and Recommendations,” World Journal of Sur gery, Vol. 23, No. 6, 1999, pp. 565-569.
doi:10.1007/PL00012348
[15]
M. Ferguson, S. Capra, J. Bauer and M. Banks, “Devel opment of a Valid and Reliable Malnutrition Screening Tool for Adult Acute Hospital Patients,” Nutrition, Vol. 15, No. 6, 1999, pp. 458-464.
doi:10.1016/S0899-9007(99)00084-2
[16]
E. Isenring, G. Cross, L. Daniels, E. Kellett and B. Koczwara, “Validity of the Malnutrition Screening Tool as an Effective Predictor of Nutritional Risk in Oncology Outpatients Receiving Chemotherapy,” Support Care Cancer, Vol. 14, No. 11, 2006, pp. 1152-1156.
doi:10.1007/s00520-006-0070-5
[17]
E. A. Isenring, J. D. Bauer, M. Banks and D. Gaskill, “The Malnutrition Screening Tool is a Useful Tool for Identifying Malnutrition Risk in Residential Aged Care,” Journal of Human Nutrition Dietetics, Vol. 22, No. 6, 2009, pp. 545-550.
doi:10.1111/j.1365-277X.2009.01008.x
[18]
A. Lev-Ran, M. Johnson, D. L. Hwang, J. Askanazi, C. Weissman and M. Gersovitz, “Double-Blind Study of Glycerol vs Glucose in Parenteral Nutrition of Postsurgi cal Insulin-Treated Diabetic Patients,” JPEN—Journal of Parenteral and Enteral Nutrition, Vol. 11, No. 3, 1987, pp. 271-274. doi:10.1177/0148607187011003271
[19]
“Perioperative Total Parenteral Nutrition in Surgical Pa tients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group,” New England Journal of Me dicine, Vol. 325, 1991, pp. 525-532.
doi:10.1056/NEJM199108223250801
