• M Braga, L Gianotti, G Radaelli, A Vignali, G Mari, O Gentilini, and V Di Carlo.
• Department of Surgery, Scientific Institute San Raffaele Hospital, Milan, Italy. braga.marco@hsr.it
• Arch Surg Chicago. 1999 Apr 1;134(4):428-33.

HypothesisPerioperative administration of a supplemented enteral formula may reduce the rate of postoperative infections.DesignProspective, randomized, double-blind clinical trial.SettingDepartment of surgery at a university hospital.PatientsTwo hundred six patients with neoplasm of colorectum, stomach, or pancreas.InterventionPatients were randomized to drink 1 L/d of either a control enteral formula (n = 104) or the same formula enriched with arginine, RNA, and omega3 fatty acids (n = 102) for 7 consecutive days before surgery. The 2 diets were isoenergetic and isonitrogenous. Jejunal infusion with the same formulas was started 6 hours after operation and continued until postoperative day 7.Main Outcome MeasuresRate of postoperative infectious complications and length of hospital stay.ResultsBoth groups were comparable for age, sex, weight loss, Karnofsky scale score, nutritional status, hemoglobin level, duration of surgery, blood loss, and rate of homologous transfusion. Intent-to-treat analysis showed a 14% (14/102) infectious complication rate in the supplemented group vs 30% (31/104) in the control group (P = .009). In the eligible population, the postoperative infection rate was 11% (9/85) in the supplemented group vs. 24% (21/86) in the control group (P = .02). The mean +/- SD length of postoperative stay was 11.1+/-4.4 days in the supplemented group and 12.9+/-4.6 in the control group (P = .01).ConclusionPerioperative administration of a supplemented enteral formula significantly reduced postoperative infections and length of stay in patients undergoing surgery for cancer.

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