Feeding tube placement during cytoreductive surgery and heated intraperitoneal chemotherapy does not improve postoperative nutrition and is associated with longer length of stay and higher readmission rates

详细信息    查看全文

• 作者：Sean P. Dineen ; MD ; ^{sean.dineen@uky.edu" class="auth_mail" title="E-mail the corresponding author} ; Kristen A. Robinson ; MPAS ; PA-C ; Christina L. Roland ; MD ; Karen A. Beaty ; MPAS ; PA-C ; Safia Rafeeq ; MD ; Paul F. Mansfield ; MD ; Richard E. Royal ; MD ; Keith F. Fournier ; MD
• 关键词：Cytoreduction ; HIPEC ; Carcinomatosis ; Nutrition ; Feeding tube
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：200
• 期：1
• 页码：158-163
• 全文大小：292 K

文摘

Patients with colorectal cancer and peritoneal carcinomatosis (CRC/PC) may benefit from cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC). Nutritional support is frequently required for patients after CRS/HIPEC. It remains unclear if placement of feeding access is of benefit in regard to improving postoperative nutrition in this patient population.

Materials and methods

Patients with CRC/PC who underwent complete cytoreduction were evaluated. Preoperative and postoperative nutritional data and discharge outcomes were retrospectively recorded. The presence of a feeding tube and PCI scores were recorded by review of operative notes. Readmission rates were calculated for patients at 30 d and 60 d after discharge from hospital.

Results

Forty-one patients underwent CRS/HIPEC, 25 had feeding tube placement at the time of surgery. Weight loss was common after HIPEC as 38 of 41 patients demonstrated weight loss. The mean weight loss was 7.6%. total parenteral nutrition was required at discharge in four patients (7.9%); three of these patients had feeding access placed. There was no difference in the degree of weight loss between groups (7.1 ± 3.7% no tube versus 7.9 ± 5.8% patients with tube; P = 0.608). The mean decrease in albumin was 12.7% but was not significantly different in patients with feeding access and those without (10.0% versus 14.75%; P = 0.773). Sixty-day readmission rates were higher in patients with feeding tubes (36% compared with 0%, P < 0.01).

Conclusions

Significant nutritional loss is common after CRS/HIPEC for patients with CRC/PC. Feeding tube placement does not prevent this and appears to be related to higher readmission rates and longer length of stay.