[ Vol. 9 No. 3 ] (September - December 2008 )
Early enteral nutrition after surgery for the upper gastrointestinal cancer patients

Ryoji Fukushima MD, PhD
Department of Surgery, Teikyo University School of Medicine Tokyo Japan


Malnutrition is a common and significant problem in patients with upper gastrointestinal cancer. It is well known that perioperative nutritional support is important in reducing postoperative morbidity and mortality. Experimental and clinical investigation reveals that early enteral nutrition after surgery should be preferred to parenteral nutrition. However, surgeons often prefer postoperative parenteral nutrition despite a functioning gastrointestinal tract. According to a survey by the Japanese society for parenteral and enteral nutrition in 2002, almost up to 80% of patients who underwent total gastrectomy received TPN. The reason for the surgeons to prefer parenteral feeding may be the concerns for possible adverse effects of early feeding such as increased risk of anastomotic dehiscence, abdominal distention, diarrhea, or the feeding tube related complications.

In recent years, we have been performing postoperative early enteral feeding to those who underwent esophageal resection, total gastrectomy or pancreatoduodenectomy. A catheter-feeding jejunostomy was placed at the end of surgery. Jejunal feeding was started on the next day of surgery using a peristaltic pump at 15-20 ml/hour. The amount of nutrition given was 250-300 ml/day (1kcal/ml) on POD 1 and the amount was gradually increased to 900-1250 ml/day on POD 5. Additional fluids and electrolytes were given intravenously according to clinical requirement. Base on our experience, we would like to show the safety and feasibility of postoperative early enteral nutrition in those who underwent major digestive surgery for cancer.


The 12th PENSA Congress

October 18-20 2007, Century Park Hotel. Manila, Philippines 
Page: 31