Application value of early-stage enteral nutritional support in patients with hepatocellular carcinoma after hemihepatectomy

Objective To investigate the application value of early-stage enteral nutritional support in patients with hepatocellular carcinoma (HCC) after hemihepatectomy. Methods Sixty-seven HCC patients who underwent hemihepatectomy from October 2010 to December 2012 in Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled in this prospective study. The patients were randomly divided into two groups using random digit table: the early enteral nutrition (EEN) group [n=32, 17 males, 15 females, mean age of (48±13) years old] and the parenteral nutrition (PN) group [n=35, 22 males, 13 females, mean age of (51±10) years old]. The informed consents of all patients were obtained and the ethical committee approval was received. Patients in both groups received standard anatomical hemihepatectomy and gastric tubes were withdrawn 24 h after operation. Routine treatments such as liver protection drugs, human albumin and so on were given to the patients according to the specific condition. Patients in EEN group were given Ensure nutrient solution orally from 24 h till 7 d after operation. Patients in PN group were given intravenous nutrition from 24 h till 7 d after operation. The changes of perioperative levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (ALB) of patients in two groups were observed. The application of human albumin, the length of gastrointestinal function recovery and adverse reactions of gastrointestine after operation were observed and the length of hospital stay and hospitalization cost were calculated. The measurement data between two groups was compared using t test or Wilcoxon rank sum test. Results In EEN group, the preoperative level of ALT was (33±17)U/L, AST was (35±19)U/L, ALB was (36±1)g/L. In PN group, the preoperative level of ALT was (34±14)U/L, AST was (32±18)U/L, ALB was (37±2)g/L. There was no significant difference between two groups (t=0.264, 0.664, 1.618; P>0.05). In EEN group, the levels of ALT, AST, ALB on the 3rd day after operation were (153±57)U/L, (108±46)U/L, (32±4)g/L respectively. In PN group, the levels of ALT, AST, ALB on the 3rd day after operation were (149±62)U/L, (104±45)U/L, (31±5)g/L respectively. In EEN group, the levels of ALT, AST, ALB on the 7th day after operation were (63±38)U/L, (65±44)U/L, (37±3)g/L respectively. In PN group, the levels of ALT, AST, ALB on the 7th day after operation were (68±32)U/L, (61±39)U/L, (35±5)g/L respectively. There was no significant difference in the levels of ALT, AST, ALB on the 3rd day and the 7th day after operation between two groups (t=0.274, 0.360, 0.898 and-0.584, 0.394, 2.004; P>0.05). The total volume of intravenous human albumin given to the patients after operation in EEN group was significantly less than that in PN group [(70±25)g vs. (90±35)g; t=-2.708, P 0.05). The median of total hospitalization cost in EEN group was significantly less than that in PN group [53(45-72) thousand yuan vs. 59(51-79) thousand yuan; Z=-2.34, P<0.05]. Conclusions Early-stage enteral nutritional support is useful for the recovery of gastrointestinal function of HCC patients after hemihepatectomy and it can also reduce the hospitalization cost. Key words: Carcinoma, hepatocellular; Hepatectomy; Enteral nutrition; Parenteral nutrition, to-tal; Gastrointestinal motility; Fees, medical