Tadashi Yoshida, MD, PhD, Shigenori Homma, MD, PhD, Yosuke Ohno, MD, PhD, Nobuki Ichikawa, MD, PhD, Susumu Shibasaki, MD, PhD, Norihiko Takahashi, MD, PhD, Hideki Kawamura, MD, PhD, Akinobu Taketomi, MD, PhD. Hokkaido University Grduate School of Medicine
Background/Aim: Preoperative enteral nutrition and bowel cleansing is desirable even for patients with circumferential colorectal cancer to reduce the postoperative complications. We evaluated the safety and efficacy of enteral nutrition protocol using Elental® before laparoscopic colorectal resection (LCR).
Methods: We performed elective LCR on 208 patients for primary colorectal cancers between December 2012 and November 2015. Four patients with complete obstruction and four patients who refused Elental® intake were excluded in this study. Among 200 patients, 50 circumferential colorectal cancer patients were fasted and given Elental® at 900 kcal/day (1 mL/kcal) for about 9 days before LCR (group E). Elental® is composed of amino acids and contains only small amounts of fatty acids. The 150 patients with non-circumferential cancer were given normal food and mechanical bowel preparation (MBP) (group C).
Results: Group E patients were considered at poor risk compared with those in group C because of their large tumors (groups E vs. C: 60.5±19.2 vs. 32.2±17.1 mm), advanced-stage cancer, and low prognostic nutritional index (45.9±7.0 vs. 49.9±5.5). No severe adverse effect was obtained during taking Elental®. In addition, their large bowels were well irrigated without MBP, and their gastrointestinal tracts were not dilated. The surgical time (212.5±106.1 vs. 198.3±83.2 min), and amount of blood loss (64.7±265.6 vs. 38.1±124.2 g) were almost equivalent between two groups. The incidence of postoperative complications, including surgical-site infections, was not significantly different between two groups [E (n=50) vs. C (n=150): 2 vs. 5%]. The details of postoperative complications (Clavien-Dindo classification grade ≥3) in group E were one case of wound dehiscence (2%) and one case of ureteral stenosis (2%). In Group C, acute myocardial infarction (1 case, 0.7%), bile leakage (1 case, 0.7%, associated with liver resection), acute cholecystitis (1 case, 0.7%), and intraabdominal hemorrhage (1 case, 0.7%) and anastomotic leakage (3 cases, 2%). The starting dates for drinking fluids (1.0±0.2 vs. 1.0±0.2 postoperative day) and eating (5.0±2.0 vs. 4.4±1.8 postoperative day) and postoperative hospitalization (14.3±11.0 vs. 13.7±17.6 days) were similar in the two groups. Despite the disadvantages in group E, the operative outcomes and postoperative courses were equivalent in the two groups.
Conclusions: Elemental diet using Elental® was a safe, effective strategy along with cleansing the gastrointestinal tract without MBP for patients with obstructive colorectal cancer before LCR.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78998
Program Number: P233
Presentation Session: Poster (Non CME)
Presentation Type: Poster