Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK.
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Nutr Cancer. 2021;73(9):1638-1643. doi: 10.1080/01635581.2020.1810713. Epub 2020 Aug 31.
The role of total parenteral nutrition (TPN) in cancer patients is controversial, but it may be a treatment option for some patients with indolent but advanced small intestinal neuroendocrine neoplasms (SI-NENs). The aim of this study is to investigate whether home TPN was associated with long-term survival and to assess the indications, duration and complications of TPN in patients with advanced SI-NENs. Patients with advanced SI-NENs who received home TPN were retrospectively included. Electronic records were reviewed for clinical information. Five patients receiving home TPN were identified out of 1011 patients with SI-NENs in our center. The median duration of TPN administration was 12 mo. Small bowel obstruction was the most common reason for TPN initiation. TPN-related complications included two catheter infections, one thrombosis and one episode of TPN-related transaminitis. At the last follow-up, three patients had died and two were alive. The median survival was 12 mo. Overall estimated 1-yr probability of survival on home TPN by Kaplan-Meier analysis was 40%. In conclusion, home TPN may be a treatment option in highly selected advanced SI-NEN patients with severe gastrointestinal tract dysfunction. The initiation of home TPN is associated with long-term survival (≥1 yr), and complication rates appear acceptable.
肠外营养（TPN）在癌症患者中的作用存在争议，但对于一些惰性但晚期的小肠类癌（SI-NENs）患者，它可能是一种治疗选择。本研究旨在探讨家庭 TPN 是否与长期生存相关，并评估晚期 SI-NEN 患者 TPN 的适应证、持续时间和并发症。我们回顾性纳入了在我中心接受家庭 TPN 的晚期 SI-NEN 患者。电子病历用于回顾性收集临床资料。在我中心的 1011 例 SI-NEN 患者中，发现了 5 例接受家庭 TPN 的患者。TPN 治疗的中位时间为 12 个月。小肠梗阻是 TPN 起始的最常见原因。TPN 相关并发症包括两例导管感染、一例血栓形成和一例 TPN 相关转氨基酶升高。最后一次随访时，3 例患者死亡，2 例患者存活。中位生存时间为 12 个月。通过 Kaplan-Meier 分析，家庭 TPN 后 1 年的总体估计生存率为 40%。总之，家庭 TPN 可能是严重胃肠道功能障碍的晚期 SI-NEN 患者的一种治疗选择。家庭 TPN 的启动与长期生存（≥1 年）相关，并发症发生率似乎可以接受。
