Peripheral parenteral nutrition improves short-term nutritional status and inflammatory reaction after colorectal resection surgery: A randomized clinical trial

BACKGROUND: Major colorectal surgery induces a substantial metabolic and inflammatory response, which contributes to postoperative catabolism and delayed recovery. This study aims to investigate the impact of early postoperative peripheral parenteral nutrition on inflammatory response and short-term nutritional status after colorectal resection compared with conventional saline treatment. METHODS: This is an open-label, randomized controlled superiority trial. Adult patients undergoing elective or emergency colorectal resection were allocated in a 1:1 ratio to receive either peripheral parenteral nutrition or 5% dextrose-normal saline with identical electrolyte supplementation for 5 postoperative days. The outcomes were postoperative complications, inflammatory markers, and short-term nutritional parameters. A modified intention-to-treat analysis was performed. RESULTS: A total of 207 patients were included in the final analysis (103 peripheral parenteral nutrition, 104 control). Baseline and operative characteristics were comparable between groups. Overall postoperative complications (35% vs 42.3%, P = .278) and major complications (Clavien-Dindo ≥3) (25% vs 28.9%, P = .696) did not differ significantly between the 2 groups. Patients receiving dextrose-saline demonstrated significantly higher procalcitonin levels on postoperative day 3 (ratio of medians, 1.69; 95% confidence interval, 1.15-2.49; P = .008) and a significantly more negative nitrogen balance (β = -5.6; 95% confidence interval, -7.9 to -3.3; P < .001) compared with the peripheral parenteral nutrition group. CONCLUSION: Early postoperative administration of peripheral parenteral nutrition following colorectal resection was safe and was associated with attenuation of the inflammatory response and improvement in nitrogen balance. These results highlight the role of peripheral parenteral nutrition as a supportive nutritional strategy in the postoperative care of patients undergoing colorectal resection (NCT06737211).