Randomised controlled trial of Early Enteral Nutrition (EEN) versus Conventional Management (CON) in patients undergoing major resection for upper gastrointestinal cancer

Rachael Barlow¹, Wyn Lewis², Geoff Clarke², Sarah Hunt¹, Tim Harvard², Malcolm Puntis¹, Tricia Price¹
¹Cardiff University, Cardiff, United Kingdom, ²Cardiff and Vale NHS Trust, Cardiff, United Kingdom Proffered paper presentation

Background

Gastrointestinal cancer accounts for approximately 37,000 deaths in the UK per year, and overall survival remains poor. Although EEN after major surgery is becoming more popular in the UK, the evidence required to change practice is inconclusive, and by tradition patients have been kept “nil by mouth” for protracted periods (Stroud 2006).

Aims

To determine if EEN improved clinical outcome in terms of length of hospital stay (LOHS), postoperative morbidity and mortality and health related quality of life (HRQoL).

Method

One hundred and twenty-one patients [median age 64 years (range 35-82), 83 male, 38 female, 60 oesophageal, 33 gastric, 28 pancreatic cancer] were recruited across 3 NHS Trusts over a 3-year period. There were two randomisation groups, Group A (EEN) received early enteral nutrition via a needle catheter jejunostomy, commenced within 12 hours of leaving the operating theatre. Group B (CON) received conventional management remaining ‘nil by mouth’ until deemed safe by the operating surgeon to commenced oral diet and fluids. All patients in the study had a feeding jejunostomy inserted intra-operatively. Six patients were deemed palliative at the time of surgery and hence were therefore not eligible for randomisation.

Results

Median LOHS for the CON group was 19.0 days (Range 14-27 days); EEN group was 16 days (Range 13-20.75 days) U=1181.5, p=0.009. There were no statistically significant differences in HRQoL between the groups however there was a trend towards improved HRQoL in the EEN group at 6, 12 weeks and 6 months post discharge. Major complications were less frequent in the EEN group.

Summary of Results	CON Group	EEN Group	Test statistic (p)
Anastomotic leak % (N)	8/55 (8)	1/60 (1)	7.10 (0.01)
Wound infection %(N)	16/55 (16)	3/60 (3)	13.1 (0.001)
Chest Infection % (N)	10/55 (10)	4/60 (4)	3.34 (0.064)

EEN resulted in a cost saving of £1421.17 (£926.17-£5,242.18) per patient based on the difference in LOHS and the difference in the statistically significant major complications between the two groups.

Conclusion

EEN was cost effective, reduced patients’ duration of hospital stay and improved outcomes.