Faculty of Medicine, University of Milan, via Festa del Perdono, 20100, Milan, Italy.
Support Care Cancer. 2019 Dec;27(12):4393-4399. doi: 10.1007/s00520-019-04948-1. Epub 2019 Jul 17.
The role of parenteral nutrition in the treatment of malignant bowel obstruction is underestimated since palliative literature mainly focuses on gastric aspiration, nothing per os and antisecretory therapy. The purpose of this review is the appraisal of the literature with a focus on the potential contribution of parenteral nutrition.
Literature included in a recent meta-analysis and in a Cochrane review on parenteral nutrition in malignant bowel obstruction and updated through PUBMED until March 2019 has been reviewed.
Prompt withholding of food intake, nasogastric aspiration and then the use of antisecretory agents represent the milestones of treatment which are applied to all patients with malignant bowel obstruction. After this initial approach, excluding few surgical patients and those defined as imminently dying, there is a heterogeneous group of patients achieving a benefit in a few days but with a prompt recurrence of symptoms as they attempt to reassume some food intake. Parenteral nutrition in hospital or at home addresses to these patients provided their life expectancy is likely to depend on progressive nutritional deterioration due to the prolonged starvation more than on the tumour spread. These patients on home parenteral nutrition can survive a few months with some indefinite benefit on quality of life whereas untreated patients have a survival of few weeks.
Parenteral nutrition should be considered in selected patients who benefit from standard palliative treatment of malignant obstruction and are obliged to maintain a total bowel rest for weeks or months.
由于姑息治疗文献主要侧重于胃抽吸、无口服和抗分泌治疗，因此肠外营养在恶性肠梗阻治疗中的作用被低估了。本综述的目的是评估文献，重点关注肠外营养的潜在贡献。
综述了最近的一项荟萃分析和一项关于恶性肠梗阻肠外营养的 Cochrane 综述中包含的文献，并通过 PUBMED 进行了更新，截至 2019 年 3 月。
及时停止进食、鼻胃抽吸，然后使用抗分泌剂是治疗的里程碑，适用于所有恶性肠梗阻患者。在这种初始方法之后，排除少数手术患者和那些被定义为即将死亡的患者，还有一组异质性患者在几天内受益，但随着他们试图重新摄入一些食物，症状会迅速复发。对于这些患者，住院或家庭肠外营养可以解决问题，前提是他们的预期寿命可能由于长时间饥饿导致营养恶化，而不是肿瘤扩散，需要依赖肠外营养。这些接受家庭肠外营养的患者可以存活数月，生活质量得到一定程度的改善，而未经治疗的患者则只能存活数周。
对于接受标准姑息治疗恶性梗阻且需要数周或数月完全禁食的选定患者，应考虑肠外营养。
