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Parenteral Nutrition Solutions

Preparation of parenteral nutrition (PN): Among winuf(1820cc for central vein, 1,450cc for peripheral vein), smofkabaven(986cc for central vein, 1206cc for peripheral vein), and nutriplex(1875cc for central vein, 1,250cc for peripheral vein) Amount of PN: Total energy expenditure (TEE) of the patients will be calculated with Harris-Benedict Equation, activity factor, and stress factor. The amount of calorie from oral intake will be subtracted from TEE then the remainder will be provided through PN.

Route of PN Injection: PICC (percutaneously-inserted central catheter) will be secured for PN for the central vein. PN for the peripheral vein will be injected directly through peripheral superficial vein.

* Day0 : fasting(NPO) + crystalloid fluid
* POD#1 : Keep fasting, then start sips of water in the evening + crystalloid fluid
* POD#2 : Semifluid diet (SFD) + crystalloid fluid
* POD#3 : Semifluid diet (SFD) + PN
* POD#4-7: Soft blended diet (SBD) + PN

* Day0 : fasting(NPO) + crystalloid fluid
* POD#1 : Keep fasting, then start sips of water in the evening + crystalloid fluid
* POD#2 : Semifluid diet (SFD) + dextrose 5% water
* POD#3 : Semifluid diet (SFD) + dextrose 5% water
* POD#4-7: Soft blended diet (SBD)

* Day0 : fasting(NPO) + crystalloid fluid
* POD#1 : Keep fasting, then start sips of water in the evening + crystalloid fluid
* POD#2 : Semifluid diet (SFD) + crystalloid fluid
* POD#3 : Semifluid diet (SFD) + PN
* POD#4-7: Soft blended diet (SBD) + PN

Hyuk-Joon Lee, Professor

Sa-Hong Kim, Fellow

Hyuk-Joon Lee, MD, PhD

* If a patient undergoes gastrectomy, which is a kind of major abdominal operation, he/she loses more than 5% of his/her body weight in 2 months after surgery. This point is one of the criteria of 'risk of malnutrition' according to Nutrition Risk Screening (NRS 2002) and the patient who corresponds to this criterion needs nutritional support.
* According to Nutrition Risk Screening (NRS 2002), moderate malnutrition is defined as the state that the patient orally intakes 25\~50% of recommended requirements; severe malnutrition is less than 25%.
* Meanwhile, when oral nutrition support was provided to patients after gastric cancer surgery, the patients' average daily intake during the first three months was about a half of the recommended requirements.

  * Putting together the facts i) that the patient underwent major abdominal operation, ii) that the weight loss rate exceeded 5% for two months, iii) that the average daily intake of patients during the first three months was about half of the recommended amount, the patients are eligible to be classified as a group who require nutritional support according to NRS 2002.

Therefore, it is intended to verify the efficacy and safety of supplemental parenteral nutrition by comparing Arm A, who are provided oral intake with supplemental parenteral nutrition, Arm B, who are provided oral intake only after curative gastric cancer surgery.

With at least 5 days of supplemental parenteral nutrition, we expect minimized body weight loss, favorable blood test result, eligibility for chemotherapy compliance, increased quality of life (QoL), decreased infection rate, decreased hospital stay, and decreased mortality.

Supplemental Parenteral Nutrition During Postgastrectomy in Nutritionally at Risk Patient

The Effect of Postoperative Supplemental Parenteral Nutrition (SPN) in Gastric Cancer Patients Who Underwent Gastrectomy: A Multicenter Prospective Randomized Controlled Trial

Sharing the specific individual participant data sets is not mandatory.

Complete blood count : Hb (hemoglobin) : g/dl

Complete blood count : WBC (white blood cell) : cells/mm3

Complete blood count : TLC (total lymphocyte count) : cells/mm3

Blood chemistry : total cholesterol (mg/dl)

Blood chemistry : AST (aspartate aminotransferase) : IU/L

Blood chemistry : ALT (alanine aminotransferase) : IU/L

Blood chemistry : CRP (C-reactive protein) : mg/dl

ECOG(Eastern Cooperative Oncology Group) performance status: 0\~5 (higher scores mean a worse outcome) 0 : Fully active, able to carry on all pre-disease performance without restriction 5 : Death

ASA(American Society of Anaesthesiologists) score : 1\~6 (higher scores mean a worse outcome)

1 : A normal healthy patient 6 : A declared brain-dead patient whose organs are being removed for donor purposes

EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30) : EORTC QLQ-C30 Scoring Manual (Fayers et al., 2001).

EORTC QLQ-STO22 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Stomach 22) : Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-STO 22, to assess quality of life in patients with gastric cancer (J.M Blazeby el al. 2004).

SF-36 (36-Item Short Form Health Survey) : 0\~100 (higher scores mean a worse outcome)

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