Objective. To improve perioperative outcomes in patients with malignant GIT tumors and pre-existing NI through early use of a semi-elemental therapeutic formula in combination with continuous infusion of serotonin adipinate. Material and methods. This was a prospective, randomized, single-center pilot study including 44 patients aged >65 years after elective GIT surgery for malignant neoplasms with documented NI (≥2 points on NRS-2002) and GII (≥3 points on the LIFE scale). All patients received a low-rate intravenous infusion of serotonin adipinate (20 mg/day) until resolution of GII. Early enteral nutritional support was initiated simultaneously: in the main group, a semi-elemental whey protein hydrolysate-based formula (Peptamen Intense) was used; in the control group, a standard polymeric formula (Nutricomp Intensive) was administered. The severity of GII was assessed using the LIFE scale; plasma serotonin levels, amino acid profile (methionine, arginine, valine, citrulline, etc.), laboratory markers of nutritional status and their dynamics were evaluated on postoperative days 1, 2, and 5. Results. In both groups, serotonin supplementation led to a rapid normalization of initially reduced plasma serotonin levels (from 49.8 ng/mL 19; 71.2 to values within the reference range already by postoperative day 1, with subsequent stabilization). In the main group, the semi-elemental formula provided a more pronounced nutritional effect: by day 5 there was a significant restoration (p<0.05) of initially decreased methionine, arginine, and valine concentrations compared with the control group. A less pronounced catabolic trend was observed for citrulline, a marker of functional enterocyte mass, along with a more favorable course of GII according to the LIFE scale (p<0.05) in the main group. Significant negative correlations were identified between GII severity and arginine levels (r=–0.994; 95% CI –0.9968; –0.9890, p=0.01) and citrulline levels (r=–0.614; 95% CI –0.819; –0.271, p=0.04), indicating active utilization of these amino acids in reparative processes under combined therapy. Conclusion. The results of this pilot study demonstrate the potential of early use of a semi-elemental enteral formula on the background of prokinetic therapy with serotonin adipinate to optimize postoperative restoration of GIT function and correction of malnutrition in oncologic patients with pre-existing NI and GII. The data obtained indicate a more favorable dynamics of the amino acid profile (methionine, arginine, valine, citrulline) and a trend toward less severe GII on the LIFE scale compared with a standard polymeric formula. However, given the small sample size and short follow-up period, these findings require confirmation in larger multicenter studies.
Simutis et al. (Thu,) studied this question.