Skip to main content
Log in

Patient-controlled Dietary Schedule Improves Clinical Outcome after Gastrectomy for Gastric Cancer

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Although studies have shown that early oral feeding after abdominal surgery is feasible, the optimal dietary schedule has not been established. This study was conducted prospectively to compare the clinical outcome of patient-controlled dietary schedule with that of conventional dietary schedule after gastric resection for early cancer. Patients in the patient-controlled diet (PC) group (n = 53) received a solid diet on demand; patients in the conventional regimen (CR) group (n = 50) received a solid diet from postoperative day (POD) 10. All patients underwent distal gastrectomy for early gastric cancer. A liquid diet was tolerated by the PC group on POD 2, and a solid diet was taken on POD 6 after gastrectomy, earlier than in the CR group. The postoperative hospital stay was 18.5 ± 5.9 days (10–40) in the PC group, versus 21.7 ± 8.8 days (14–57) in the CR group (p = 0.02). Patients in the PC group had a higher daily oral intake of calories on POD 10 than those in the CR group (p = 0.02). Changes in body weight and serum albumin during the postoperative period and after discharge, and the incidence of complications and variances from clinical pathways did not show significant differences between the two groups. The PC schedule was feasible after distal gastrectomy for early gastric cancer. It improved the clinical outcome, with a shorter postoperative hospital stay and a higher oral energy intake on early phase, compared with the CR schedule. Moreover, the PC approach was useful for establishing the optimal dietary schedule and improving the clinical pathway.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Braga M, Vignali A, Gianotti L, et al. Immune and nutritional effects of early enteral nutrition after major abdominal operations. Eur. J. Surg. 1996;162:105–112

    CAS  PubMed  Google Scholar 

  2. Gianotti L, Braga M, Vignali A, et al. Effect of route of delivery and formulation of postoperative nutritional support in patients undergoing major operations for malignant neoplasms. Arch. Surg. 1997;132:1222–1230

    CAS  PubMed  Google Scholar 

  3. Bufo AJ, Feldman S, Daniels GA, et al. Early postoperative feeding. Dis. Colon Rectum 1994;37:1260–1265

    Article  CAS  PubMed  Google Scholar 

  4. Jeffery KM, Harkins B, Cresei GA, et al. The clear liquid diet is no longer a necessity in the routine postoperative management of surgical patients. Am. Surg. 1996;62:167–170

    CAS  PubMed  Google Scholar 

  5. Reissman P, Teoh TA, Cohen SM, et al. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann. Surg. 1995;222:73–77

    CAS  PubMed  Google Scholar 

  6. Ortiz H, Armendariz P, Yarnoz C. Is early postoperative feeding feasible in elective colon and rectal surgery? Int. J. Colorectal Dis 1996;11:119–121

    Article  CAS  Google Scholar 

  7. Han-Geurts IJM, Jeekel J, Tilanus HW, et al. Randomized clinical trial of patient-controlled versus fixed regimen feeding after elective abdominal surgery. Br. J. Surg. 2001;88:1578–1582

    Article  CAS  PubMed  Google Scholar 

  8. Bisgaad T, Kehlet H. Early oral feeding after elective abdominal surgery what are the issues? Nutrition 2002;18:944–948

    Article  Google Scholar 

  9. Nygren J, Thorell A, Ljungqvist O. New developments facilitating nutritional intake after gastrointestinal surgery. Curr. Opin. Clin. Nutr. Metab. Care 2003;6:593–597

    PubMed  Google Scholar 

  10. Haga Y, Wada Y, Takeuchi H, et al. Estimation of surgical costs using a prediction scoring system. Arch. Surg. 2002;137:481–485

    Article  PubMed  Google Scholar 

  11. Gutiérrez SMB, Mizota T, Rakue Y. Comparison of four health systems: Cuba, China, Japan and the USA, an approach to reality. Southeast Asian J. Trop. Med. Public Health 2003;34:937–946

    PubMed  Google Scholar 

  12. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy–JCOG study 9501. J. Clin. Oncol. 2004;22:2767–2773

    Article  PubMed  Google Scholar 

  13. Japanese Gastric Cancer Association. Japanese Classification of Gastric carcinoma, 13th edition, 1999

  14. Heslin MJ, Latkanny L, Leung D, et al. A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Ann. Surg. 1997;226:567–580

    Article  CAS  PubMed  Google Scholar 

  15. Carr CS, Ling KD, Boulos P, et al. Randomized trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection. B. M. J. 1996;312:8698–8671

    Google Scholar 

  16. Podore PC, Throop EB. Infrarenal aortic surgery with a 3-day hospital stay: a report on success with a clinical pathway. J. Vasc. Surg. 1999;29:787–792

    Article  CAS  PubMed  Google Scholar 

  17. Basse L, Jakobsen DH, Billesbølle P, et al. A clinical pathway to accelerate recovery after colonic resection. Ann. Surg. 2000;232:51–57

    Article  CAS  PubMed  Google Scholar 

  18. Sweeny AB, Flora HS, Chaloner EJ, et al. Integrated care pathways for vascular surgery: An analysis of the first 18 months. Postgrad. Med. J. 2002;78:175–177

    Article  Google Scholar 

  19. Mathias JR, Fernandez A, Sninsky CA, et al. Nausea, vomiting, and abdominal pain after Roux-en-Y anastomosis: motility of the jejunal limb. Gastroenterology 1985;88:101–107

    CAS  PubMed  Google Scholar 

  20. Hawalsi A, Schroder DM, Lloyd LR, et al. Elective conventional colectomy in the era of laparoscopic surgery. Am. Surg. 1996;62:589–593

    CAS  PubMed  Google Scholar 

  21. Ortiz H, Armendariz P, Yarnoz C. Early postoperative feeding after elective colorectal surgery is not a benefit unique to laparoscopy-assisted procedures. Int. J. Colorectal Dis. 1996;11:246–249

    Article  CAS  PubMed  Google Scholar 

  22. Di Fronzo LA, Cymerman J, O’Connell TX. Factors affecting early postoperative feeding following elective open colon resection. Arch. Surg. 1999;134:941–946

    Article  CAS  PubMed  Google Scholar 

  23. Binderow SR, Cohen SM, Wexner SD, et al. Must early postoperative oral intake be limited to laparoscopy? Dis. Colon Rectum 1994;37:584–589

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Motohiro Hirao M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hirao, M., Tsujinaka, T., Takeno, A. et al. Patient-controlled Dietary Schedule Improves Clinical Outcome after Gastrectomy for Gastric Cancer. World J. Surg. 29, 853–857 (2005). https://doi.org/10.1007/s00268-005-7760-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-7760-x

Keywords

Navigation