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 a complex laparotomy, including upper abdominal surgery.
Methods
Patients aged 18–75 years, undergoing an elective laparotomy and with a preoperative suspicion of gynecologic malignancy, were eligible. Exclusion criteria included infectious conditions, intestinal obstruction, severe malnutrition, American Society of Anesthesiologists score ≥4, intestinal resection, 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 1, 2007, and November 17, 2007, a total of 143 patients were randomized to receive either EOF or TOF. Hospital stay for patients who received EOF (n = 71) was 4.7 vs. 5.8 days for the TOF group (n = 72) (P = 0.006). The mean level of postoperative satisfaction was significantly higher in the EOF group (82.8 vs. 71.7 mm, P ≤ 0.001). Patients who received the TOF scheme had significantly higher overall postoperative complications (39 vs. 17% in EOF group, P = 0.003) and infective complications (14% in TOF group vs. 3% in EOF group, P = 0.017). Variables such as nausea and vomiting, analgesic and antiemetic requirement as well as level of pain and quality of life were not different between groups.
Conclusions
On the basis of these findings, the policy of EOF should be used after a complex gynecologic oncologic laparotomy.
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Acknowledgment
We thank the patients who participated in this trial, as well as the following individuals who participated in various phases of the trial: Gabriela Parma, MD, Dorella Franchi, MD, Maria Teresa Lapresa, MD (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; and the data manager group from the Gynecologic Department, European Institute of Oncology, Milan, Italy: Sara Boveri, Mariella Siano, Maira Boggiogero, Amalia Di Dia, and Laura Mella for their careful work. In addition, we thank Herbert Kotz, MD, and Edward Trimble, MD (National Cancer Institute, National Institute of Health, Bethesda, MD) for offering important and constructive comments on the manuscript, and Nadia Caroppo, MD (Gynecologic Department, European Institute of Oncology), and Mary Ryan, MLS (National Institutes of Health Library, Bethesda, MD), for editing the manuscript. Finally, we recognize the 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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Minig, L., Biffi, R., Zanagnolo, V. et al. Reduction of Postoperative Complication Rate with the Use of Early Oral Feeding in Gynecologic Oncologic Patients Undergoing a Major Surgery: A Randomized Controlled Trial. Ann Surg Oncol 16, 3101–3110 (2009). https://doi.org/10.1245/s10434-009-0681-4
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DOI: https://doi.org/10.1245/s10434-009-0681-4