A number of prospective clinical trials have addressed the role of total parenteral nutrition in the cancer patient. The results have been somewhat conflicting. Which of the following statement(s) have been proven correct by prospective trials?

a. Preoperative TPN is beneficial in surgical patients with severe preoperative nutrition

c. Routine use of perioperative (including prior to the procedure) TPN is of benefit in patients undergoing hepatectomy for hepatoma

Numerous clinical trials have failed to yield a consensus with regard to the efficacy of TPN in cancer patients. In 1991, a multicenter VA cooperative trial demonstrated that preoperative TPN is of benefit in surgical patients (many of whom had cancer) with severe preoperative malnutrition. Another study examined the use of routine postoperative TPN following major pancreatic resection. Patients randomized to receive TPN starting on postoperative day 1 were noted to have an increased incidence of intra-abdominal abscesses as well as a tendency towards increased incidence in peritonitis and bowel obstruction. These investigators concluded that routine use of postoperative TPN was not indicated and may, in fact, be harmful following pancreatic resection. In another study, however, perioperative (starting 7 days prior to the planned procedure) TPN for patients undergoing hepatectomy for hepatocellular carcinoma demonstrated that this regimen statistically reduced infectious complications compared to patients who did not receive TPN. This was one of the few studies that demonstrated that routine TPN (without the requirement of severe preoperative malnutrition) was of benefit. The use of TPN in patients receiving bone marrow transplantation has also been shown to be a valuable component of overall care.