Table 1.
Patient demographics of studies included.
| Article | Eligible Patient Cohort | Number of Patients (Total) | Surgical Procedure | Anaesthesia and Analgesia | Perioperative Nutrition | Stable Isotope Tracer | Sampling Timepoints Included (Pre-: Post-operative) |
|---|---|---|---|---|---|---|---|
| Tashiro et al., 1991 [11] | Gastric/colorectal surgery | 11 | Total gastrectomy: 7, hemicolectomy: 3, low anterior resection: 1 | Unknown | TPN exclusively, 1.5 g protein/kg/day and 35 kcal/kg/day | [15 N] Glycine; EP | Pre: Not specified Post: 72 h |
| Lattermann et al., 2002 [41] | General anaesthesia with epidural block/General anaesthesia only | 8/8 (16) | Hemicolectomy/colectomy: 2/5, sigmoid resection: 3/1, anterior resection: 3/1, Ileocolic resection: 0/1 | General anaesthesia with patients randomised to either epidural or IV morphine postoperatively | ∼36 h preoperative fast | L-[1–13C] Leucine; AV | Pre: 0 h Post: 2 h |
| Carli et al., 1997 [42] | Parenteral nutrition control group | 6 | All surgery for non-metastatic adenocarcinoma of the rectosigmoid colon | General anaesthesia with postoperative subcutaneous infusion of papaveretum (3–5 mg/h) for 3–4 days | 0.1 g nitrogen/kg/day and 20 kcal/kg/day. Nonprotein calories were 60% lipid and 40% carbohydrate. Oral intake was started 6 days before surgery under dietetic supervision, and was then changed to parenteral nutrition at 500 ml Vamin 14, 1 L Intralipid 10% and 1 L dextrose 10% 2 days before surgery and continued for 6 days afterward. | L-[1–13C] Leucine; AV | Pre: 0 h Post: 144 h |
| Carli and Halliday 1997 [6] | General anaesthesia with epidural block/general anaesthesia only | 6/6 (12) | Paramedian incision for non-metastatic adenocarcinoma of the rectosigmoid colon | General anaesthesia with patients randomised to either; epidural maintained for 48 h postoperatively supplemented with papaveretum (8–10 mg) given i.m. Every 8 h or continuous subcutaneous infusion of papaveretum set at 3–8 mg/h | 0.1 g nitrogen/kg/day and 20 kcal/kg/day. Nonprotein calories were 60% fat and 40% carbohydrate. Oral intake commenced 6 days before surgery under dietic supervision and changed to parenteral nutrition (500 ml Vamin 14, 1 L Intralipid 10%, 1 L dextrose 10%) 2 days before surgery. Discontinued at midnight day before surgery, recommenced at 4 h postoperatively and maintained for 2 days after surgery. | L-[1–13C] Leucine; FSR | Pre: 0 h Post: 48 h |
| Carli et al., 2011 [43] | Oral Glucose Nutrition/Oral Whey Nutrition | 6/7 (13) | Hemicolectomy/colectomy: 4/4, Sigmoid resection: 0/2, Anterior resection: 2/1 | General anaesthesia with epidural or intraoperative IV analgesia; postoperative epidural for 2 days or PCA with opioids | Preoperative fast of ∼24–36 h. Postoperatively, patients were allowed to drink clear fluids unless contraindicated. Clear fluids consisted of a small portion of apple juice (approximately 110 kcal) and Jell-O® (Kraft Foods, Northfield, Illinois) (approximately 70 kcal). | L-[1–13C] Leucine; AV | Pre: −168 h Post: 48 h |
| Tashiro et al., 1996 [12] | Gastric or colorectal surgery | 22 | Total gastrectomy, hemicolectomy or lower anterior resection, and lymph node dissection. | Unknown | Parenteral nutrition providing 1.5 g amino acid/kg/day and energy intake of 35 kcal/kg/day. No fat was provided as an energy source. PN was started 7 days prior to the operation and maintained across the study duration. Doses of protein and energy were maintained strictly the same throughout the study. | [15 N] Glycine; EP | Pre: Not specified Post: 72 h |
| Hammarqvist et al., 2001 [44] | Glutamine PN group | 8 | Colon resection: 4, rectum resection: 3, retroperitoneal resection: 1 | General anaesthesia. 3 patients were also provided with epidural blockade, although this was not provided continuously throughout the study period. | Postoperative parenteral nutrition containing 0.15 g nitrogen/kg/day including an amino acid solution, supplemented with 0.28 g glutamine/kg/day. Energy provided as glucose and fat, calculated as 1.2-fold of caloric need as determined by Harris-Benedict formula. 75% of parenteral nutrition dose administered in first day after operation (25% across following 2 days). | L-[2H5] Phenylalanine; FSR | Pre: 0 h Post: 72 h |
| Essén et al., 1993 [45] | Saline/Parenteral nutrition | 8/9 (17) | Cholecystectomy | Unable to source full-text article. | Saline or parenteral nutrition for 3 days postoperatively. | L-[1–13C] Leucine; FSR | Pre: Unknown Post: 72 h |
| Tjäder et al., 1996 [7] | Saline | 7 | Cholecystectomy - subcostal incision | General anaesthesia, with diazepam (5 mg) and pancuronium (0.1 mg/kg) for neuromuscular block, with postoperative IV injections of pethidine (synthetic opioid). | Saline perioperatively 3 ml/kg/h, followed by 35 ml/kg/day postoperatively. | L-[2H5] Phenylalanine; FSR | Pre: 0 h Post: 24 h |
| López-Hellín et al., 2004 [46] | Fasted/Parenteral nutrition | 21/8 (29) | Left hemicolectomy: 9; right hemicolectomy: 5; front rectum resection: 4; Miles' resection: 1; gastrectomy: 1; sigmoidectomy: 1 (21). Left hemicolectomy: 3; Miles' resection: 2; front rectum resection: 1; right hemicolectomy: 1; gastrectomy: 1 (8). |
Unknown | Preoperative hypocaloric parenteral nutrition: CHO (28 kJ/kg/day), Amino acids (1 g/kg/day) - followed by either: preoperative fast and postoperative parenteral nutrition of glucose (28 kJ/kg/day) OR TPN (56.1 kJ/kg/day CHO, 56.1 kJ/kg/day Fat, 1.5 g/kg/day Amino acids) administered pre- and post-operatively for 24 h. | [15 N] Glycine; EP | Pre: −72 h Post: 24 h |
| Essén et al., 1992 [8] | Cholecystectomy patient group | 7 | Cholecystectomy - subcostal incision | General anaesthesia, with diazepam (5 mg) and pancuronium-bromide (0.1 mg/kg) for neuromuscular block. | Acute fasted study. | L-[1–13C] Leucine; FSR | Pre: 0 h Post: Immediately after surgery |
| Lattermann et al., 2001 [47] | General anaesthesia/General anaesthesia with epidural block | 7/7 (14) | Elective cystoprostatectomy - Ileal neobladder: 6/6, Ileal conduit: 1/1 | General anaesthesia/General anaesthesia with epidural block. Epidural terminated immediately after surgery – both patient cohorts received IV Piritramide postoperatively. | Parenteral nutrition from 24 h postoperatively until 10 h before postoperative measurement. 2 g/kg/day xylitol and amino acids, equivalent to 0.15 g of N/kg/day. | [15N2] Urea; AV | Pre: −72 h Post: 72 h |
| Tashiro et al., 1996b [31] | Gastric or colorectal surgery | 22 | Total gastrectomy: 11, Hemicolectomy: 4, Low anterior resection: 6, Miles' operation: 1 | Unknown | Parenteral nutrition providing 1.5 g of protein and 40 kcal/kg/day, commenced at least 5 days prior to surgery and maintained throughout study period. | [15 N] Glycine; EP | Pre: Not specified Post: 72 h |
| Carli et al., 1990 [9] | Total abdominal hysterectomy | 6 | Menorrhagia | Unknown | 0.1 g of nitrogen/kg body weight and 1200–1400 calories (5021–5858 kJ)/day was commenced 7 days before surgery by oral intake. The same amount of nitrogen and calories was administered intravenously after surgery starting 4 h from the end of surgery when the cardiorespiratory conditions were stable. The parenteral nutritional support, based on a mixture of glucose, lipid and amino acids (KabiVitrum), was then continued for 4 days after surgery until patients were able to tolerate the pre-operative oral diet again. | L-[1–13C] Leucine: AV | Pre: −48 h Post: 48 h |
FSR: fractional synthetic rate; AV: arterio-venous; EP: end-product.