Resum

Objectives:

The main objective was to assess the effectiveness of early postoperative enteral feeding with an arginine, omega-3 fatty acids and RNA-supplemented formula in improving the wound healing process in patients undergoing surgery for gastric cancer. The assessment was done both measuring local hydroxyproline deposition as an index of reparative collagen synthesis and qualitative indicators of wound healing, including the presence or absence of complications derived from the healing process failure. As a secondary objective, it was assessed the effectiveness of early postoperative administration of the formula in reducing the number of infectious complications. Additional outcome variables were overall morbidity and length of hospital stay.

Summary background data:

Early postoperative immunonutrition has invariably demonstrated significant improvements in the patients' immunological status , inflammatory response and patient outcome. Even though one of the most frequent complications in patients with neoplastic disease and associated malnutrition is the delay or failure of surgical wound healing, the influence of early immunonutrition on the wound healing process has not yet been evaluated.

Methods:

Sixty patients of both genders with a preoperative diagnosis of gastric cancer were prospectively randomized in a double-blind fashion to receive early enteral feeding with either an arginine, omega-3 fatty acids, and RNA-supplemented formula or an isocaloric, isonitrogenous control formula, both administered through a jejunostomy tube for 7 days. Six out of them did not complete the study and were excluded from the statistical analysis. Hydroxyproline deposition in subcutaneously placed catheters (Goodson and Hunt method), postoperative wound healing complications and infectious complications were analyzed as main outcome variables.

Results:

Patients treated with immunonutrition showed higher local hydroxyproline levels (59.7 nmol (5.0 - 201.8), vs. 28.0 nmol (5.8 - 89.6) p: 0.0018), significantly lower episodes of surgical wound healing complications (0 Vs 8 (26.7%) p: 0.005), significantly lower number of infectious complications (2 (6.7%) vs. 9 (30%) p: 0.01) and lower overall morbidity (4 (13.3%) vs. 13 (43.3%) p: 0.01) when compared to patients treated with standard enteral nutrition. Median length of hospital stay was shorter for patients treated with the study formula (13 days vs. 15 days, p: 0.02). Multivariate analysis to evaluate the endpoint 'presence of any postoperative complication' found the feeding group to be a significant predictor after adjusting by patient age and initial weight (OR=2.49 p: 0.001).

Conclusions:

Early postoperative enteral nutrition with a formula supplemented with arginine, omega 3 fatty acids and RNA increased hydroxyproline synthesis, improved surgical wound healing and significantly reduced the number of postoperative infections and the general morbidity in patients undergoing gastrectomy for gastric cancer.

La difusió d'aquesta tesi per mitjà del servei TDX ha estat autoritzada pels titulars dels drets de propietat intel.lectual únicament per a usos privats emmarcats en activitats d'investigació i docència. No s'autoritza la seva reproducció amb finalitats de lucre ni la seva difusió i posada a disposició des d'un lloc aliè al servei TDX. No s'autoritza la presentació del seu contingut en una finestra o marc aliè a TDX (framing).

Aquesta reserva de drets afecta tant al resum de presentació de la tesi com als seus continguts. En la utilització o cita de parts de la tesi és obligat indicar el nom de la persona autora.