A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer

Background & Aims:Perioperative nutrition with specialized enteral diets improves outcome when compared with standard formulas. A post-hoc analysis suggested preoperative administration as the most important period. Thus, we designed a study to understand prospectively whether preoperative supplementation could be as efficacious as the perioperative approach and superior to a conventional treatment (no artificial nutrition) in reducing postoperative infections and length of hospital stay. Methods:A total of 305 patients with preoperative weight loss <10% and cancer of the gastrointestinal tract were randomized to receive the following: (1) oral supplementation for 5 days before surgery with 1 L/day of a formula enriched with arginine, ω-3 fatty acids, and RNA, with no nutritional support given after surgery (preoperative group, n = 102); (2) the same preoperative treatment plus postoperative jejunal infusion with the same enriched formula (perioperative group, n = 101); and (3) no artificial nutrition before and after surgery (conventional group; n = 102). Results:The 3 groups were comparable for all baseline and surgical characteristics. Intention-to-treat analysis showed a 13.7% incidence of postoperative infections in the preoperative group, 15.8% in the perioperative group, and 30.4% in the conventional group (P= 0.006 vs. preoperative; P= 0.02 vs. perioperative). Length of hospital stay was 11.6 ± 4.7 days in the preoperative group, 12.2 ± 4.1 days in the perioperative group, and 14.0 ± 7.7 days in the conventional group (P= 0.008 vs. preoperative and P= 0.03 vs. perioperative). Conclusions:Preoperative supplementation is as effective as perioperative administration in improving outcome. Both strategies seem superior to the conventional approach.