Abstract Background Post-operative nutritional management of pelvic exenteration (PE) patients differs between treatment centres. Early enteral nutrition (EN) has emerged as the favourable regimen for abdominal surgery reported to reduce ileus rates and hospital stay. However, PE is a high-risk procedure associated with significant complications. Therefore, some centres routinely give parenteral nutrition (PN) post-operatively. This study aimed to examine the appropriate post-operative nutritional regimen for PE patients. Method A retrospective audit was conducted on 97 patients who had undergone PE for recurrent rectal cancer between July 2020-July 2022. 70 patients received EN through oral intake or nasogastric tube and 27 received PN. Outcomes included the time taken from surgery to start EN successfully, surgical complications and length of hospital stay. Surgical complications were classified using the Clavien-Dindo Index. Statistical analysis included two sample t-tests, chi-squared tests and linear regression. Results A significant proportion of PN recipients experienced major surgical complications compared to EN recipients (44.4% vs 15.7%, p=0.009). Major surgical complications were significantly associated with a longer length of stay (p=0.01). However, in patients with minor or no surgical complications, the earlier a successful oral diet was started, the shorter the length of stay (p=0.0009). In these patients, EN recipients experienced a significantly shorter length of stay compared to PN recipients (18.0+/-10.4 vs 26.4+/-10.0, p=0.006). There was no difference in ileus rates. Conclusion The data supports the use of early enteral nutrition post-operatively where the risk of post-operative complications is low. However, major surgical complications influence the route of nutritional administration.
Hadden et al. (Fri,) studied this question.