Do total parenteral nutrition and bowel rest reduce the risk for perforation in patients with gastrointestinal tract lymphoma receiving chemotherapy?

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 67-68; p. 110515
• Main Authors: Wong, Yu-Jun, Lum, Huey-Ming, Fook-Chong, Stephanie, Lim, Soon-Thye, Salazar, Ennaliza
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2019; Elsevier Limited
• Subjects: Age; Biopsy; Chemotherapy; Confidence intervals; Demographics; Gastrointestinal system; Gastrointestinal tract; Health risks; Infections; Intestine; Large intestine; Lymphoma; Medical records; Nutrition; Parenteral nutrition; Patients; Perforation; Pneumonia; Prophylactic; Rest; Risk; Small intestine; Stomach; Survival; Total parenteral nutrition; Singapore; Chemotherapy; Gastrointestinal tract; Perforation; Prophylactic; Lymphoma; Total parenteral nutrition
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2019.03.023

•Perforation increases infection risk and mortality in gastrointestinal tract (GIT) lymphoma.•Aggressive and small bowel lymphoma managed on an inpatient basis has higher perforation risk.•Prophylactic total parenteral nutrition (TPN) does not reduce perforation in patients with GIT lymphoma receiving chemotherapy.•Prophylactic TPN prolonged hospitalization stay and increased infection risk.•Routine prophylactic TPN in GIT lymphoma is not recommended. 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.