Does perioperative nutrition improve clinical outcomes in patients undergoing upper gastrointestinal surgery?: A network meta-analysis.

Abstract

Each year in Canada, more than 2000 patients undergo surgical resection for treatment of esophageal, pancreatic or stomach cancer. However, resection of upper gastrointestinal (GI) malignancies is associated with significant mortality and morbidity. One reason for the high rate of complications in this population of patients is preoperative malnutrition. To counteract the effects of malnutrition, post-operative nutritional support is often provided to these patients. Nutrition can be provided directly into the central circulation by total parenteral nutrition (TPN) or into the GI tract via a nasojejunal tube (a catheter passed through the nose into the small bowel) or a surgically placed jejunostomy tube (through the anterior abdominal wall and into the small bowel). It remains unclear which method of nutrient delivery, if any, provides the best overall patient outcomes. For this reason, we have undertaken a network meta-analysis to evaluate the effects of the various perioperative nutritional delivery methods on clinical outcomes in patients undergoing upper gastrointestinal surgery.