OBJECTIVETo study the effect of enteral nutrition as replacement of mechanical bowel preparation on peritoneal and intraluminal disseminated tumor cells, recurrence and metastasis in patients with colorectal cancer.

METHODSA total of 120 colorectal cancer patients between March 2007 and December 2011 were enrolled prospectively and randomly divided into two groups. Group A (n=60) received preoperative bowel preparation with enteral nutrition fluid (30 ml·kg(-1)·d(-1)), without enema, taxative or antibiotics. Group B (n=60) underwent traditional intestinal preparation consecutively 3 days before operation, including fasting, oral antibiotic, and cleaning enema. All the patients received peritoneal lavage with 400 ml of normal saline at the time of laparotomy and 200 ml of the lavage fluid was collected. All the cases underwent distal colorectal lavage with 1000 ml of normal saline before anastomosis, and 500 ml of the lavage fluid was collected. Fluid samples were quickly sent for exfoliated cytological examination. The positive rates of exfoliated cancer cell in peritoneal cavity and intraluminal cavity, postoperative complication, recurrence and metastasis were compared between the two groups.

RESULTSIn group A, exfoliated cancer cells were found in 5 of 60 cases (8.3%) in peritoneal lavage fluid and in 9 of 60 cases (15.0%) in distal colorectal lavage fluid, while in group B, cancer cells were found in 13 of 60 cases (12.5%) and 19 of 60 cases (31.7%) respectively. There were significant differences between group A and B (P=0.041, P=0.031). Fifty-five patients in group A were followed up from 16 to 46 months after surgery, as well 57 patients in group B. Rates of local recurrence and distant metastasis in Group A and B were 5.5% vs. 7.0% and 10.9% vs. 10.5% respectively. There were no significant differences (P=0.733, P=0.984). There was no significant difference in 3-year survival rate between the two groups (80% vs. 78%, P=0.312).

CONCLUSIONSEnteral nutrition instead of traditional bowel preparation can decrease the positive rate of disseminated cancer cells in peritoneal cavity or colorectal lumen, while dose not affect recurrence and metastasis rates in patients with colorectal cancer.