Early enteral feeding is beneficial for patients after pelvic exenteration surgery – A randomised controlled trial2

BACKGROUND Postoperative feeding practices vary after pelvic exenteration surgery due to the lack of nutrition research in this specific surgical area. Postoperative ileus is common after pelvic exenteration surgery and early enteral feeding is often avoided due to the lack of evidence and belief this may induce postoperative ileus in this patient cohort. The aim of this study was to determine the effects of early enteral feeding after pelvic exenteration surgery on return of bowel movement and postoperative ileus. METHODS A randomised controlled trial was conducted in patients undergoing pelvic exenteration surgery from November 2018 to June 2020. Forty participants received standard nutrition care (total parenteral nutrition) and 47 participants received trophic enteral feeding (20mL/hr) via a nasogastric tube in addition to standard care until participants were upgraded to free fluids. Time to first bowel movement and rates of postoperative ileus were the main outcome measures. RESULTS There was no significant difference between arms for time to first bowel movement, however postoperative ileus rates were significantly less in participants who were enterally fed (p = 0.036) in the per-protocol analysis. Regressions showed the longer patients were kept nil by mouth after surgery, the greater the time was to first bowel movement; and the greater postoperative complication rates (p<0.0005). CONCLUSIONS Early enteral feeding can be commenced safely to improve gastrointestinal function after pelvic exenteration surgery. This article is protected by copyright. All rights reserved.