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Abstract:
Sixty-six patients with locally advanced or diffuse gastrointestinal cancer or suffering from major complications due to surgery or radiation therapy, were treated with continuous parenteral hyperalimentation at the Istituto Nazionale Tumori of Milan for a cumulative period of 2101 study-days. Patients were divided into 4 groups: Group 1, malnourished patients with advanced gastrointestinal malignancy; Group 2, patients with gastrointestinal fistulae due to simple surgical complications or to radiation injury of the bowel; Group 3, patients with major postoperative complications; Group 4, surgical patients with gastric or colo-rectal carcinoma treated preoperatively. Mean infusional regime for the various groups included 42-56 Cal/kg/day and 1.5 to 2.4 g amino acid/kg/day, and the duration of the treatment ranged from 7 to 144 days. The results obtained show that protein calorie depletion of cancer patients may depend on malnutrition and that it can be reversed by parenteral nutrition, in patients, that are candidates for surgical treatment or those who qualify for chemotherapy and/or radiotherapy. Parenteral nutrition has a fundamental role in patients with fistulae, even if much attention must be paid to the external care of the fistula and the wound. In addition, nutritional support by intravenous feeding has proven essential for a successful outcome of patients with major postoperative complications. Preoperative protein repletion and central venous nutrition in patients who require gastrintestinal surgery represent a modern advance in the field of cancer surgery.