The application of home parenteral nutrition in patients with advanced malignant bowel obstruction

Objective To observe the effect of HPN on the nutritional status, quality of life and survival time of patients with malignant bowel obstruction. Methods A retrospective analysis was performed on 85 patients with malignant bowel obstruction caused by advanced colorectal cancer. There were 39 patients who received home parenteral nutrition in treatment group, and the other 46 patients who didn′t receive treatment in control group. The body weight, BMI, serum protein (albumin and prealbumin), KPS score and quality of life (SF-36 index) after 1 and 2 months were observed. and then we compared the survival time and 3 months' survival rate between two groups. In treatment group, the effects of different factors on survival rate were analysed by logistic regression model. Complications of HPN and reasons for discontinuation of treatment were recorded. Results The SF-36 score、KPS score and serum albumin levels in both group decreased after 1 and 2 months compared with the baseline, but the treatment group has lower reduction. The SF-36 score in the treatment group were significantly higher than that in the control group after 1 month (43.61±3.81 vs 41.10±3.13, P 50 have significantly higher 6 month survival rate than KPS≤50 patients (OR=5.33, 95%CI=1.18~24.21, P=0.041) , patients without distant metastasis had significantly higher 6 month survival rate than patients with distant metastasis (OR=5.50, 95%CI=1.01~29.85, P=0.045) . Patients with enteral nutrition had higher 3 and 6 month survival rate than patients without enteral nutrition (OR=8.80,95%CI=0.99~78.11, P=0.034; OR=6.72, 95%CI=1.53~21.61, P=0.013) . Fifteen cases of complications occurred in treatment group. There were 7 patients discontinued treatment were due to complications, Thirteen patients were due to cost, and the other 19 patients were due to illness or death. Conclusion HPN can improve the nutritional status, physical level, quality of life and prolong the survival time in patients with malignant bowel obstruction caused by advanced colorectal cancer. BMI≥18.5kg/m2, KPS>50, distant metastasis and with enteral nutrition can get better therapeutic effect. Key words: Colorectal neoplasms; Intestinal obstruction; Home parenteral nutrition