***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Objective To evaluate the potential clinical , metabolic , and economic advantages of enteral nutrition over total parenteral nutrition . Design Prospect i ve , r and omized clinical trial . Setting Department of surgery in a university hospital . Patients Two hundred and fifty-seven patients with cancer of the stomach ( n = 121 ) , pancreas ( n = 110 ) , or esophagus ( n = 26 ) were r and omized to receive postoperative total parenteral nutrition ( TPN group , n = 131 ) or early enteral nutrition ( EEN group , n = 126 ) . The nutritional goal was 25 kcal/kg/day . The two nutritional formulas were isocaloric and isonitrogenous , and they were continued until oral intake was at least 800 kcal/day . Measurements Morbidity , mortality , length of hospital stay , and treatment costs were evaluated in all patients . In 40 consecutive patients , selected nutritional , immunologic and inflammatory variables were studied . Moreover , intestinal oxygen tension was evaluated by micropolarographic implantable probes . Main Results The nutritional goal was reached in 100/126 ( 79.3 % ) patients in the EEN group and in 128/131 ( 97.7 % ) patients in the TPN group ( p < .001 ) . In the EEN group , hyperglycemia ( serum glucose , > 200 mg/dL ) was observed in 4.7 % of the patients vs. 9.1 % in the TPN group ( p = NS ) . Alteration of serum electrolyte levels was 3.9 % in the EEN group vs. 13.7 % in the TPN group ( p < .01 ) . No significant difference was found in nutritional , immunologic , and inflammatory variables between the two groups . The overall complication rate was similar ( 40.4 % for TPN vs. 35.7 % , for EEN;p = .52 ) . No difference was detected for either infectious or noninfectious complications , length of hospital stay , and mortality . From postoperative day 5 , intestinal oxygen tension recovered faster in the EEN group than in the TPN group ( 43 ± 5 mm Hg vs. 31 ± 4 mm Hg at day 7;p < .001 ) . EEN was four-fold less expensive than TPN ( $ 25 vs. $ 90.60/day , respectively ) . Conclusion EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinical ly require postoperative artificial nutrition Glutamine has been demonstrated to be an important source of fuel for the gut . The purpose of this study was to evaluate the effect of glutamine-supplemented hyperalimentation on gut immune function .  Thirty-six female Fischer rats were r and omized into three groups : group 1 ( chow ) was fed rat chow and water ad libitum , group 2 ( total parenteral nutrition ) received a st and ard hyperalimentation formula , and group 3 ( total parenteral nutrition-glutamine ) received a hyperalimentation solution that contained 2 % glutamine . Animals were maintained on their respective diets for 2 weeks and then killed . Mesenteric lymph nodes were harvested for culture , bile was assayed for secretory IgA , and bowel was excised to assay bacterial adherence . Results indicated that glutamine-supplemented total parenteral nutrition protects against bacterial translocation from the gut seen with st and ard formulas . This effect may be mediated by the secretory IgA immune system We investigated the impact of early enteral nutrition ( EEN ) and parenteral nutrition ( PN ) on prealbumin ( PA ) and high-sensitivity C-reactive protein ( hs-CRP ) in patients after gastric cancer surgery . Sixty-eight selected patients undergoing gastric cancer surgery were r and omly divided into the EEN ( N = 34 ) and PN ( N = 34 ) groups . Body weight ( BW ) , serum albumin ( ALB ) , transferrin ( TF ) , PA , hs-CRP , length of hospital stay , cost of postoperative nutritional support , and incidence of complications were compared between groups . On postoperative day 7 , the BW , TF , ALB , and PA for both groups were significantly decreased compared with the values obtained on preoperative day 1 ( P < 0.01 ) . A significant decrease was observed in TF and PA in the PN group compared with the EEN group ( P < 0.01 ) . There was no significant difference in BW and ALB between the two groups ( P > 0.05 ) . The hs-CRP level of both groups was significantly higher than on preoperative day 1 . There was a significant increase in hs-CRP in the PN group compared with the EEN group ( P < 0.01 ) . The anal exhaust time , length of hospital stay , and nutritional support cost were significantly shorter or lower in the EEN group than in the PN group ( P < 0.01 ) . There was no significant difference in the incidence of complications between the two groups ( P > 0.05 ) . EEN helps regulate the postoperative response of patients after gastric cancer surgery , promotes rehabilitation , and accelerates the recovery of gastrointestinal function .  Furthermore , EEN has the advantage of being inexpensive The benefits of early enteral feeding ( EEN ) have been demonstrated in gastrointestinal surgery . But , the impact of EEN has not been eluci date d yet . We assessed the postoperative nutritional status of patients who had undergone pancreaticoduodenectomy ( PD ) according to the postoperative nutritional method and compared the clinical outcomes of two methods . A prospect i ve r and omized trial was undertaken following PD . Patients were r and omly divided into two groups ; the EEN group received the postoperative enteral feed and the control group received the postoperative total parenteral nutrition ( TPN ) management .  Thirty-eight patients were included in our analyses . The first day of bowel movement and time to take a normal soft diet was significantly shorter in EEN group than in TPN group . Prealbumin and transferrin were significantly reduced on post-operative day ( POD ) 7 and were slowly recovered until POD 90 in the TPN group than in the EEN group . EEN group rapidly recovered weight after POD 21 whereas it was gradually decreased in TPN group until POD 90 . EEN after PD is associated with preservation of weight compared with TPN and impact on recovery of digestive function after PD AIM To investigate the potential role of perioperative nutrition in reducing complications and mortality in malnourished gastrointestinal cancer patients . METHODS Four hundred and sixty-eight elective moderately or severely malnourished surgical patients with gastric or colorectal cancers defined by the subjective global assessment ( SGA ) were r and omly assigned to 7 d preoperative and 7 d postoperative parenteral or enteral nutrition vs a simple control group . The nutrition regimen included 24.6+/-5.2 kcal /kg per d non-protein and 0.23+/-0.04 g nitrogen /kg per d. Control patients did not receive preoperative nutrition but received 600+/-100 kcal non-protein plus or not plus 62+/-16 g crystalline amino acids postoperatively . RESULTS Complications occurred in 18.3 % of the patients receiving nutrition and in 33.5 % of the control patients ( P=0.012 ) . Fourteen patients died in the control group and 5 in those receiving nutrition . There were significant differences in the mortality between the two groups ( 2.1 % vs 6.0 % , P=0.003 ) . The total length of hospitalization and postoperative stay of control patients were significantly longer ( 29 vs 22 d , P=0.014 ) than those of the studied patients ( 23 vs 12 d , P=0.000 ) . CONCLUSION Perioperative nutrition support is beneficial for moderately or severely malnourished gastrointestinal cancer patients and can reduce surgical complications and mortality BACKGROUND Enteral nutrition ( EN ) is now used more frequently than total parenteral nutrition ( TPN ) for nutritional support after resection for esophageal cancer . But consensus regarding which type of nutrition should be used does not exist . We studied the effect of TPN and EN on patients ' nutritional status and immune function in the immediate postoperative period after esophageal cancer resection . METHODS We enrolled 30 patients ( 27 men and 3 women ) who underwent subtotal esophagectomy .  The patients were r and omly assigned to TPN or EN group . Either TPN or EN was begun on postoperative day 1 . On postoperative days 1 , 3 , and 7 , three endpoints were measured : albumin , C-reactive protein , and Th1/Th2 balance . RESULTS All patients completed the study .  Anastomotic leaks occurred in 6 patients in the TPN group and 7 patients in the EN group . Albumin , Th1/Th2 balance , and C-reactive protein did not differ between the groups . Th1/Th2 balance was not different regardless of the preoperative treatment or complications . CONCLUSIONS No differences in immune function , nutritional state , or inflammatory response were seen between patients supported with TPN and those supported with EN . The results of our study suggest that perioperative nutritional support can be safely performed either with TPN or EN BACKGROUND Although current opinion favours the use of enteral over parenteral nutrition , the clinical benefits of early postoperative nutrition in patients undergoing elective surgery have never been clearly shown . We aim ed to test the hypothesis that postoperative enteral nutrition is better ( fewer postoperative complications ) than parenteral nutrition containing similar energy and nitrogen amounts ( 112 kJ kg(-1 ) day(-1 ) and 1.4 g aminoacid kg(-1 ) day(-1 ) ) . METHODS We did a r and omised multicentre clinical trial in patients with gastrointestinal cancer who were malnourished and c and i date s for major elective surgery . 159 patients were assigned to enteral nutrition and 158 to parenteral nutrition .  The primary endpoint was the occurrence of postoperative complications , and secondary endpoints were length of postoperative hospital stay , adverse effects , and treatment crossover . Analysis was by intention to treat . FINDINGS Postoperative complications occurred in 54 ( 34 % ) patients fed enterally versus 78 ( 49 % ) fed parenterally ( relative risk 0.69 , 95 % CI 0.53 - 0.90 , p=0.005 ) . Length of postoperative stay was 13.4 days and 15.0 days in the enteral nutrition and parenteral nutrition groups , respectively ( p=0.009 ) . Adverse effects occurred in 56 ( 35 % ) patients fed enterally versus 22 ( 14 % ) patients fed parenterally ( 2.50 , 1.61 - 3.86 , p<0.0001 ) . 14 ( 9 % ) patients on enteral nutrition had to switch to parenteral nutrition , whereas none of those fed parenterally crossed over to enteral feeding . INTERPRETATION We conclude that early enteral nutrition significantly reduces the complication rate and duration of postoperative stay compared with parenteral nutrition , although parenteral nutrition is better tolerated than enteral nutrition OBJECTIVE To investigate the potential benefits of postoperative nutrition in malnourished patients with gastrointestinal cancer . METHODS A total of 646 malnourished patients with gastrointestinal cancer defined by the subjective global assessment ( SGA ) were r and omly divided into parenteral nutrition group ( n=215 ) , enteral nutrition group ( n=215 ) and conventional group ( n=216 ) . Two nutritional regimens were design ed to be isocaloric 125.5 kJ(30 kcal).kg(-1).d(-1 ) and isonitrogenous 0.25 g.kg(-1).d(-1 ) for 7 postoperative days . Conventional group did not receive artificial nutrition before and after surgery . Postoperative complications , mortality and postoperative length of hospital stay were compared . RESULTS All baseline and surgical characteristics were comparable among 3 groups . Overall postoperative mortality was 1.5 % , and no difference was observed among 3 groups . Postoperative complications occurred in 61(28.4 % ) patients in enteral nutrition group , 72(33.5 % ) in parenteral nutrition group , and 97 ( 44.9 % ) in conventional group ( P=0.000 vs enteral nutrition group ; P=0.001 vs parenteral nutrition group ) . Postoperative length of hospital stay was ( 9.8+/-3.4 ) d in enteral nutrition group , ( 11.2+/-5.0 ) d in parenteral nutrition group , and ( 14.5+/-7.1 ) d in conventional group ( P=0.001 vs enteral nutrition group ; P=0.003 vs parenteral nutrition group ) . CONCLUSIONS Postoperative artificial nutrition support is beneficial to the malnourished patients with gastrointestinal cancer , which improves postoperative outcome . Early enteral nutrition significantly reduces the infectious complication rate and length of postoperative hospital stay as compared with parenteral nutrition Background Each year approximately 3000 patients in the United Kingdom undergo surgery for esophagogastric cancer .  Jejunostomy feeding tubes , placed at the time of surgery for early postoperative nutrition , have been shown to have a positive impact on clinical out 
    Output:
    
EN after major abdominal surgery provided better outcomes compared with TPN in patients with gastrointestinal cancer