1817 CLINICAL IMPACT OF EARLY ENTERAL VERSUS PARENTERAL NUTRITION FOLLOWING CYSTECTOMY EVALUATED IN A PROSPECTIVE RANDOMIZED TRIAL

You have accessJournal of UrologyBladder Cancer: Invasive/Metastatic Disease III1 Apr 20101817 CLINICAL IMPACT OF EARLY ENTERAL VERSUS PARENTERAL NUTRITION FOLLOWING CYSTECTOMY EVALUATED IN A PROSPECTIVE RANDOMIZED TRIAL Beat Roth, Fiona C. Burkhard, and Urs E. Studer Beat RothBeat Roth More articles by this author , Fiona C. BurkhardFiona C. Burkhard More articles by this author , and Urs E. StuderUrs E. Studer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1755AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current opinion favours the use of postoperative early enteral over parenteral nutrition, although the benefits in cystectomy patients have never been clearly shown. The aim of this study was to evaluate the clinical impact of early enteral versus total parenteral nutrition following cystectomy. METHODS 108 consecutive patients undergoing cystectomy for malignancy of the urinary bladder were prospectively randomized into 2 groups: group A (n=49) with postoperative parenteral and group B (n=59) with postoperative early enteral nutrition. The primary endpoint was the occurrence of postoperative complications with particular respect for infections, and secondary endpoints were recovery of bowel function (flatulence, passage of stool, nausea, vomiting), length of postoperative hospital stay, and nutritional biochemical variables. RESULTS There was no difference in preoperative nutritional status based on clinical (body mass index) and biochemical parameters (albumin, prealbumin, total protein), comorbidities, intraoperative blood loss and duration of operation between the two groups. Median patient age was 65.5 years (range: 35-77) in group A and 68.5 years (range: 36-84) in group B. 37 (76%) and 36 (61%) ileal orthotopic bladder substitutes, 8 (16%) and 15 (25%) ileal conduits, and 4 (8%) and 8 (14%) ileal continent reservoirs were performed in group A and B respectively. Postoperative complications occurred in 18 (37%) patients fed parenterally versus 10 (17%) fed enterally (p=0.019). There were significantly more infective complications in the parenterally than in the enterally fed group (16% vs 4%; p=0.021), whereas there was no difference in complications other than infection. There was no effect of nutrition type on gastrointestinal recovery and length of postoperative hospital stay. Serum albumin did not differ between two groups, whereas serum prealbumin and serum total protein were significantly lower on postoperative day 7 in enterally than in parenterally fed patients, but not on postoperative day 12. These biochemical differences could not been observed in malnourished (BMI <18.5, prealbumin <0.2g/l, albumin <30g/l and/or total protein <60g/l) patients. CONCLUSIONS Postoperative early enteral nutrition is an effective, safe and less costly nutrition method following cystectomy and ileal urinary diversion. Postoperative parenteral nutrition is associated with a higher incidence of complications, mainly infection. We therefore favor postoperative early enteral nutrition following cystectomy. Bern, Switzerland© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e705 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Beat Roth More articles by this author Fiona C. Burkhard More articles by this author Urs E. Studer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Topic: Bladder and Urothelial Cancer Treatments
Subfield: Surgery
Field: Medicine
Domain: Health Sciences