• Marco Braga, Luca Gianotti, Luca Nespoli, Giovanni Radaelli, and Valerio Di Carlo.
• Department of Surgery, San Raffale University, Milan, Italy.
• Arch Surg Chicago. 2002 Feb 1;137(2):174-80.

HypothesisPerioperative administration of a supplemented enteral formula may decrease postoperative morbidity.DesignRandomized clinical trial.SettingDepartment of surgery at a university hospital.PatientsOne hundred ninety-six registered malnourished patients (weight loss > or = 10%) who were candidates for major elective surgery for malignancy of the gastrointestinal tract.InterventionAfter randomization (n = 150), one group received postoperative enteral feeding with a standard diet within 12 hours of surgery (control group; n = 50). Another group orally received 1 L/d for 7 consecutive days of a liquid diet enriched with arginine, omega-3 fatty acids, and RNA (preoperative group; n = 50). After surgery, patients were given the same standard enteral formula as the control group. A third group orally received 1 L/d for 7 consecutive days of the enriched liquid diet. After surgery, patients were given enteral feeding with the same enriched formula (perioperative group; n = 50).Main Outcome MeasuresPostoperative complications and length of hospital stay.ResultsThe 3 groups were comparable for baseline demographics, biochemical markers, comorbidity factors, and surgical variables. The intent-to-treat analysis showed that the total number of patients with complications was 24 in the control group, 14 in the preoperative group, and 9 in the perioperative group (P =.02, control group vs perioperative group). Postoperative length of stay was significantly shorter in the preoperative (13.2 days) and perioperative (12.0 days) groups than in the control group (15.3 days) (P =.01 and P =.001, respectively, vs the control group).ConclusionPerioperative immunonutrition seems to be the best approach to support malnourished patients with cancer.

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