Department of Gastroenterology and Hepatology, Singapore General Hospital; Department of Gastroenterology and Hepatology, Changi General Hospital.
Department of Gastroenterology and Hepatology, Singapore General Hospital.
Nutrition. 2019 Nov-Dec;67-68:110515. doi: 10.1016/j.nut.2019.03.023. Epub 2019 Jun 20.
Gastrointestinal tract (GIT) lymphoma is associated with a risk for perforation while the patient is receiving chemotherapy. The role of total parenteral nutrition (TPN) and bowel rest in preventing perforation is unknown. The aim of this study was to examine the clinical outcomes of TPN and bowel rest in patients with GIT lymphoma who were receiving chemotherapy.
We reviewed all patients with GIT biopsy-proven lymphoma in our institution between 2013 and 2017. Patients were stratified into two groups, with and without TPN and bowel rest during chemotherapy. We identified 158 patients with GIT lymphoma. Of these, 47 (29.7%) received TPN and bowel rest before chemotherapy. Patients who received TPN were younger, more likely to have aggressive lymphoma in the small or large bowel. The primary outcome was to compare the perforation rate between the two groups. Secondary outcome analysis included infection rate and survival.
Patients with perforation had significantly poorer survival. Perforation rate was similar between the TPN and the non-TPN groups (8.5% versus 2.7%, P = 0.197). Overall survival was similar between the two groups (P = 0.659). The TPN group had a higher infection rate (odds ratio, 5.32; 95% confidence interval, 1.36-20.8) after adjustment for covariates (age, types of lymphoma, and location of lymphoma).
The present study demonstrated that TPN and bowel rest did not reduce the risk for perforation among patients with GIT lymphoma who were receiving chemotherapy. As the practice of prophylactic TPN and bowel rest was associated with higher infection risk and longer hospitalization, we do not recommend such practice for all patients with GIT lymphoma receiving chemotherapy.
胃肠道（GIT）淋巴瘤患者在接受化疗时存在穿孔风险。全肠外营养（TPN）和肠道休息预防穿孔的作用尚不清楚。本研究旨在探讨接受化疗的 GIT 淋巴瘤患者中 TPN 和肠道休息的临床结果。
我们回顾了 2013 年至 2017 年期间我院经 GIT 活检证实的所有淋巴瘤患者。患者分为接受化疗时接受 TPN 和肠道休息与不接受 TPN 和肠道休息两组。我们确定了 158 例 GIT 淋巴瘤患者。其中，47 例（29.7%）在化疗前接受 TPN 和肠道休息。接受 TPN 的患者更年轻，更有可能患有小肠或大肠侵袭性淋巴瘤。主要结局是比较两组的穿孔率。次要结局分析包括感染率和生存率。
穿孔患者的生存率显著降低。TPN 组和非 TPN 组的穿孔率相似（8.5%与 2.7%，P=0.197）。两组的总生存率相似（P=0.659）。调整协变量（年龄、淋巴瘤类型和淋巴瘤位置）后，TPN 组感染率较高（优势比 5.32；95%置信区间 1.36-20.8）。
本研究表明，接受化疗的 GIT 淋巴瘤患者中，TPN 和肠道休息并不能降低穿孔风险。由于预防性 TPN 和肠道休息的做法与更高的感染风险和更长的住院时间相关，因此我们不建议所有接受化疗的 GIT 淋巴瘤患者都采用这种做法。
