(PM P32) A Conservative Approach To Enteral Feeding After Cytoreductive Surgery and HIPEC Leads To Improved Outcomes

Introduction: Early post-operative enteral nutrition is widely accepted as beneficial to patients by maintaining mucosal integrity, expediting return of bowel function, and reducing infectious complications. The physiologic insult to the gastrointestinal system after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are unique, therefore, early enteral nutrition strategies may not apply. We analyzed our experience during a transition to a more conservative enteral feeding approach in patients undergoing CRS and HIPEC for peritoneal malignancy.

Methods: Patients undergoing CRS and HIPEC from 2017-2019 were analyzed at a single institution. Patients were divided into 2 cohorts, based on the postoperative enteral feeding regimen. Group 1 was initiated on tube feeds (TF) on post-operative day 1 (POD1) and advanced by 10cc/day until caloric goal was reached. Group 2 was initiated on TF on POD1 and continued on trophic feeds at 10cc/hr until return of bowel function or 7 days at which point parenteral nutrition was initiated. Both groups were given a semi-elemental feed via a nasojejunal tube and tube feeds were ceased once appropriate. Patient demographics and perioperative outcomes were compared using two-tailed Fischer’s exact test.

Results: From 2017-2019, 37 patients (Group 1: 23, Group 2: 14) underwent CRS & HIPEC. There were no significant differences between groups in terms of age, sex, or peritoneal cancer index (PCI). There were no statistically significant differences between length of stay (14.5 vs 10.1 days, p=.11), return of bowel function (5.6 vs 5.1 days, p=.59), or mortality (4.5% vs 0%) between groups 1 and 2, respectively. Group 1 was associated with higher rates of ileus (43.5% vs 14.3%, p=.08), intestinal pneumatosis (8.7% vs 0%, p=.52), anastomotic leak (8.7% vs 0%, p=.52), and intra-abdominal abscess (13.0% vs 0%, p=.28). These did not meet statistical significance, however.

Conclusion: Patients undergoing CRS and HIPEC are susceptible to complications associated with aggressive, early enteral nutrition regimens and may benefit from more conservative approaches. Additional patients are needed to confirm trends seen in our data.