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Early Oral Versus “Traditional” Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intestinal Resection: a Randomized Controlled Trial

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A randomized controlled trial was performed to assess the outcome of early oral postoperative feeding (EOF) compared with traditional oral feeding (TOF) in gynecologic oncology patients undergoing laparotomy with associated intestinal resection.

Methods

Patients aged 18–75 years, undergoing elective laparotomy, and with preoperative diagnosis of gynecologic malignancy, were eligible. Exclusion criteria included infectious conditions, intestinal obstruction, severe malnutrition, American Society of Anesthesiologists (ASA) score ≥4, and postoperative stay in the intensive care unit lasting >24 h. Patients allocated to EOF received liquid diet in the first postoperative day and then regular diet. Patients received traditional feeding scheme until resolution of postoperative ileus to start liquid diet. The primary end-point of the trial was length of hospital stay.

Results

Between January 1st, 2007 and March 15th, 2008, 40 patients were randomized to receive either EOF or TOF. Hospital stay in patients who received EOF (n = 18) was 6.9 days versus 9.1 days in the TOF group (n = 22) (P = 0.022). Requirements for analgesic and antiemetic drugs, intensity of pain, intestinal function recovery, mean levels of postoperative satisfaction, postoperative complications, and quality-of-life scores did not differ between the two groups.

Conclusion

Early resumption of oral intake is feasible and safe in gynecologic oncology patients undergoing intestinal resection as part of a planned surgical procedure. Moreover, significant reduction in length of hospital stay was demonstrated.

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Acknowledgement

The authors would like to thank the following individuals who participated in various phases of the trial: Gabriela Parma M.D., Dorella Franchi, M.D., Maria Teresa Lapresa, M.D. (Gynecologic Department, European Institute of Oncology, Milan, Italy), who actively participated in the care of protocol patients during recovery and who explicitly followed the protocol guidelines of this trial; Anna Rita Sabbatini (Dietetic and Clinical Nutrition, European Institute of Oncology, Milan, Italy) for her helpful advice and for providing the postoperative feeding schemes for each branch of treatment; Sara Boveri, Mariella Siano, Maira Boggiogero, Amalia Di Dia, and Laura Mella for their careful work. In addition, the authors would like to thank Herbert Kotz, M.D., Itzhak Avital, M.D., and Edward Trimble, M.D. (National Cancer Institute, National Institute of Health, Bethesda, MD, USA) for offering important and constructive comments on the manuscript, and Nadia Caroppo (Gynecologic Department, European Institute of Oncology), M.D. and Mary Ryan, M.L.S. (National Institutes of Health Library, Bethesda, MD, USA) for editing the manuscript. Finally, the authors recognize the great efforts made by the nursing staff of the Gynecologic Department, European Institute of Oncology, Milan, Italy for their active participation in the execution of this study: Emanuela D’anna, Alessandra Saraca, Daniela D’Aronzo, Silvia Borini, Eliana Misurelli, Chiara Foroni, Brigitta Mori, V. Chamizo Fernandez, Paola Biffi, Hanna Gruchala, Michela Cerone, Lara Buscarini, Alessandra Marras, and Liberata Anedda.

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Authors and Affiliations

  1. Department of Gynecology, European Institute of Oncology, Milan, Italy

    L. Minig MD, V. Zanagnolo MD, L. Bocciolone MD, N. Colombo, F. Landoni MD, M. Peiretti MD, G. Roviglione MD & A. Maggioni MD

  2. Department of Abdomino-Pelvic Surgery, European Institute of Oncology, Milan, Italy

    R. Biffi MD

  3. Department of Anesthesiology, European Institute of Oncology, Milan, Italy

    A. Attanasio MD

  4. Department of Gynecologic Nurses, European Institute of Oncology, Milan, Italy

    C. Beltrami RN

  5. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    E. Botteri PhD & S. Iodice PhD

  6. National Cancer Institutes, National Institute of Health, Bldg 10 B3B69C, Bethesda, MD, USA

    L. Minig MD

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  1. L. Minig MD
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Correspondence to L. Minig MD.

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Minig, L., Biffi, R., Zanagnolo, V. et al. Early Oral Versus “Traditional” Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intestinal Resection: a Randomized Controlled Trial. Ann Surg Oncol 16, 1660–1668 (2009). https://doi.org/10.1245/s10434-009-0444-2

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  • DOI: https://doi.org/10.1245/s10434-009-0444-2

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