Background: Patients with peritoneal carcinomatosis often experience intestinal failure throughout the course of their disease, and total parenteral nutrition (TPN) can be used as a temporary solution or as a bridge to definitive cytoreductive surgery. Guidelines for TPN are well established for inpatients and in 2014, guidelines were established for the initiation of TPN for outpatients in a home setting. However, the safety and efficacy of home start TPN in advanced oncology patients remain unknown. This study aims to explore the safety and efficacy of starting TPN in the home setting for patients with peritoneal carcinomatosis. Method: Health records of advanced cancer patients receiving TPN during 2009–2020 were retrospectively reviewed. Data pertaining to diagnosis, demographics, nutritional parameters, and outcomes including hospital readmission rates were collected. Safety was measured based on catheter-related complications and hospital admissions related to electrolyte or fluid imbalance due to TPN. Efficacy was determined by weight gain/stability and pre-albumin and albumin levels. The Fisher’s exact and Kruskal–Wallis tests were used to analyze the data. Results: Seventy TPN patients were identified, of which forty-two were home start (HS) and twenty-eight were in hospital (HP). The two groups were not significantly different in age, (HS: mean = 58.3 ± 13.9; HP: mean = 58.0 ± 13;p= 0.95), baseline body weight (p= 0.13), baseline albumin (p= 0.26) or pre-albumin (p= 0.48). At the end of treatment, the HS and HP groups had similar percentages of patients experiencing weight gain/stability (75% vs. 47%,p= 0.1), stable/increased pre-albumin (68% vs. 65%,p= 1), and stable/increased albumin levels (48% vs. 59%,p= 0.58). There was no difference in observed readmission between the groups (p= 0.79). At the end of treatment, 48% of the HS group and 36% of the HP group resumed an oral diet. Conclusions: This is the first study to present a comparison between home and hospital start TPN in advanced cancer patients, demonstrating that the initiation of outpatient TPN in the home setting is as safe and efficacious as TPN initiated in the hospital.
背景：腹膜癌病患者在病程中常出现肠功能衰竭，全肠外营养可作为临时解决方案或确定性细胞减灭术前的过渡措施。住院患者TPN应用指南已较为完善，2014年亦建立了居家患者启动TPN的指导原则。然而，居家启动TPN在晚期肿瘤患者中的安全性与有效性尚未明确。本研究旨在探讨腹膜癌病患者居家启动TPN的安全性与有效性。 方法：回顾性分析2009-2020年间接受TPN治疗的晚期癌症患者健康记录。收集诊断、人口统计学、营养参数及再入院率等结局指标数据。安全性通过导管相关并发症及TPN所致电解质/液体失衡相关住院情况评估；有效性通过体重增加/稳定情况、前白蛋白及白蛋白水平判定。采用Fisher精确检验与Kruskal-Wallis检验进行数据分析。 结果：共纳入70例TPN患者，其中居家启动组42例，医院启动组28例。两组在年龄（HS组：58.3±13.9岁；HP组：58.0±13岁；p=0.95）、基线体重（p=0.13）、基线白蛋白（p=0.26）及前白蛋白（p=0.48）方面均无显著差异。治疗结束时，HS组与HP组体重增加/稳定患者比例（75% vs. 47%，p=0.1）、前白蛋白稳定/升高比例（68% vs. 65%，p=1）及白蛋白稳定/升高比例（48% vs. 59%，p=0.58）均无统计学差异。两组再入院率无显著差异（p=0.79）。治疗结束时，HS组48%患者与HP组36%患者恢复经口进食。 结论：本研究首次对晚期癌症患者居家与医院启动TPN进行比较，证实居家启动门诊TPN与医院启动TPN具有同等安全性与有效性。
肿瘤(癌症)患者之家