0.103 lmmxATE POST-WEmTIvE ENTEmL e.N) VEFiSuS PAmmEmL lvmmmxm rp.tq INESU-

GASTRIC SURGERY FOR CANCER : A CONTFlOLLEO PROSPECTIVE STUDY. F.Tandonnet, G.Nitenberg, *M.!+nry-Amar, mD.Elias, B.Escudier, B.Leclercq. (Unit&s de R&animation, de *Statistiques et de HChirurgie, Institut G.Roussy, Villejuif, France).

The respective advantages of E.N. and P.N. following major surgery remain controversial. The aim of this study was to compare the tolerance, the efficacy, the safety and the cost/effectiveness of the two methods. Thirty five patients with gastric (n=l9) or oesophagal cancer (n=l6) were randomized after tumor resection to receive either E.N. (nml8) via needle catheter (KT) jejunostomy or PN (n-17) via subclavian central venous KT for 2 weeks post operatively. Nutritive ratio : 55% G- 30% L - 15% P, was the same for both groups. E.N. was p

7 ided by an isotonic complete

nutritive solution containing small peptides (steraldiet ,Dubernard Lab.) and PN by an equivalent solution. In the EN group, a 2 or 3 day additional peripheral PN was

associated until enters1 nutritional autonomy. Nutritional status was assessed on D-l,

Dl, D7, D14 by means of weight, triceps skinfold, midarm muscle circumference, albumin, prealbumin, transferrin and cellular immunity. Nitrogen (N) balance was calculated daily.Results: There was no significant difference between the 2 groups for pre and post operative nutritional parameters and meen cumulative N.Balance (EN : -

1.6f3.5g vs PN :-1.322.9 g).Intestinal transit recovered earlier in the EN group (4*2 days vs 7f3 days -p <O.DS), usually with a transient diarrhoea. EN was always well tolerated. There were no mechanical or septic complications related to the methods of nutrition, except in one case where a subphrenic abcess occured because of a feeding KT dislodgement. Cost comparison showed that EN is about 4 times less expensive than PN. We conclude that, in this high risk population of patients with esogastric surgery for cancer (1) Imnediate post operative E.N. using an isotonic "small peptides" diet is as efficacious as isocalorio, isonitrogenous P.N., with both comparable tolerance and safety. (2) Earlier return of transit and highly significant cost-saving with EN via needle jejunostcmy (allowing prolonged use during subsequent radiotherapy or chemotherapy) strongly suggest the overall superiority of this method over PN.

0.104 METABOLIC RESPONSE TO THE INTRAJEJUNAL INFUSION OF D(-)&HYDROXYBUTYRATE IN PATIENTS

REFED AFTER A MAJOR ABDOMINAL SURGERY J.Kolanowski,O.Osswald,M.Reynaert (Dept. of Medicine,Metabolism,Nutrition and Intensive Care Units, University of Louvain,UCL, Brussels,Belgium)

While endogenous ketosis is a consequence of several catabolic states, it has been

reported that an oral or i.v. load of exogenous 3-hydroxybutyrate (30HB) induces in normal subjects an increase in insulin secretion, reduces lipolysis and gluconeogenesis and may exert a protein sparing effect. Therefore, the usefulness of 30HB given as a SuPPlement to enteral refeeding after severe surgery was evaluated in 5 patients given on the second day of refeeding a 6-h intrajejunal infusion of 250 mm01 of the natural form (d(-)isomer) of 30HB as a supplement to a continuous 24-h infusion of nutrients providing in the average 228 g carbohydrates, 68 g lipids and 143 g proteins (including 54 g arginine since 30HB was administered as arginine salt). The changes in plasma ketones, glucose, NEFA, insulin and urea levels were determined at 1,2,4 and 6h of 30HB infusion. Plasma 30HB levels increased progressively from 0.10+0.03 to 0.28+0.07 mM and plasma acetoacetate from 0.09+0.04 before to 0.23+0.02 mM at the end of infision. This slight increase in ketonemia was not associated with any detectable increase in ketonu- ria which suggests that the administered 30HB was rapidly metabolized. The concomitant progressive increase in glycemia, from 6.69+1.10 mM to 9.17+0.55 mM, was associated with a rapid rise in plasma insulin levels, after lh of infusion,

from-45213 @J/ml before to 84+22 pU/ml already which was followed by a progressive drop in plasma NEFA levels,

from 599+142 before to 350244 PM. Nitrogen balance was equilibrated on the day of ketone administ;ation (+2.59+1.89 g/24h) and plasma urea levels remained unchanged. On the following day of refeeding, when the subjects received the similar nutritional support but without 30HB supplement, g/24h.

the nitrogen balance became negative, averaging -8.73+1.68

It appears therefore that the use of a(-) 30HB as a nutritional supplement may be useful in some catabolic states not associated with endogenous ketosis such as in sepsis, severe trauma or during refeeding after a major surgery.

82