Effects of Preoperative Oral Nutritional Supplements on Improving Postoperative Early Enteral Feeding Intolerance and Short-Term Prognosis for Gastric Cancer: A Prospective, Single-Center, Single-Blind, Randomized Controlled Trial

Abstract

Background: Early enteral nutrition (EN) after abdominal surgery can improve the prognosis of patients. However, the high feeding intolerance (FI) rate is the primary factor impeding postoperative EN. Methods: Sixty-seven patients who underwent radical subtotal or total gastrectomy for gastric cancer (GC) were randomly allocated to the preoperative oral nutritional supplement group (ONS group) or dietary advice alone (DA group). Both groups were fed via nasojejunal tubes (NJs) from the first day after surgery to the fifth day. The primary endpoint is the FI rate. Results: Of the patients, 66 completed the trial (31 in the ONS group, 35 in the DA group). The FI rate in the ONS group was lower than that in the DA group (25.8% vs. 31.4%, p = 0.249). The postoperative five-day 50% energy compliance rate in the ONS group was higher than that in the DA group (54.8% vs. 48.6%, p = 0.465). The main gastrointestinal intolerance symptoms were distension (ONS vs. DA: 45.2% vs. 62.9, p = 0.150) and abdominal pain (ONS vs. DA: 29.0% vs. 45.7%, p = 0.226). Postoperative nausea/vomiting rate and heartburn/reflux rate were similar between the two groups. We noted no difference in perioperative serum indices, short-term prognosis or postoperative complication rates between the two groups. Conclusions: The study shows that short-term preoperative ONS cannot significantly improve FI and the energy compliance rate in the early stage after radical gastrectomy.

Surgical Prehabilitation in Patients with Gastrointestinal Cancers: Impact of Unimodal and Multimodal Programs on Postoperative Outcomes and Prospects for New Therapeutic Strategies—A Systematic Review

“…With such limited exposure, these interventions are less likely to demonstrate benefits on early postoperative outcomes. Our findings support that at least two weeks of surgical prehabilitation are necessary to expect an impact [ 28 , 29 , 30 , 32 , 38 ]. Unfortunately, in GI cancer resections, time is often considered of the essence to avoid disease progression, although this concept is challenged [ 59 , 60 ].…”

“…He et al compared a 1-week EN intervention to dietary advice alone in patients with malignant gastric cancer [ 28 ]. Most patients were malnourished.…”

“…Despite a strong consensus among experts, there is currently a lack of scientific evidence. In this review, most negative studies had a nutritional intervention of only one week [ 28 , 29 , 30 , 32 , 38 ]. This suggests that such intervention may be too short to impact postoperative outcomes of GI cancers.…”

Effects of different nutritional support methods based on nutritional risk screening on postoperative nutritional status of patients with gastrointestinal tumors：A non-randomized controlled trial

“…Some clinical trials have found that nutritional interventions during 90 days of hospitalization and after discharge can improve the nutritional status, grip strength and in ammatory prognostic indicators of malnourished patients, but have little bene t in reducing readmission rates and improving weight loss [12][13] . However, other clinical trials found that nutritional interventions during 30 days in hospital and after discharge could not signi cantly improve the perioperative serum index, short-term prognosis or postoperative complication rate of malnourished patients [14][15] . Long-term nutrition interventions seem to be more effective than short-term interventions.…”

Effects of whole nutritional formula foods on nutritional improvement and intestinal flora in malnourished rats

“…Early enteral nutrition (EN) can reduce the inflammatory response, nourish the intestinal mucosa, prevent bacterial translocation, and reduce postoperative infectious complications (He et al, 2022).…”