l-Alanin-l-glutamine supplementation improves the outcome after colorectal surgery for cancer


Mustafa Kerem MD, Department of General Surgery, Medical Faculty, Gazi University, 06510 Besevler, Ankara, Turkey.
E-mail: mkerem@gazi.edu.tr (or) keremm1@yahoo.com


Objective  To investigate the effect of l-alanine-l-glutamine (Gln) on postoperative complication rate and duration of hospitalization in patients operated for colorectal cancer.

Method  A total of 109 patients operated with the diagnosis of colorectal cancer and given enteral nutrition between January 2001 and January 2005 were prospectively analysed. The patients were randomized and analysed in two groups; Gln group (n = 57): patients were given parenteral Gln (1 g/kg/day, Dipeptiven, Fresenuis Kabi, Germany) together with enteral nutrition (Ensure; Abbott, Zwolle, The Netherlands) and the control group (n = 52) only received enteral nutrition (Ensure; Abbott), which was a standard isonitrogenous and isocaloric formula. The supplemental enteral nutrition was provided for at least 5 days pre- and postoperatively according to the nutritional status of the patients. Age, gender, subjective global assessment (SGA), body mass index (BMI), serum albumin, protein, associated disorders, localization of pathology, techniques of anastomosis, postoperative complications and length of hospital stay were analysed for each patient.

Results  The duration of nutritional support in the Gln group was 6 ± 2 and 5 ± 1 days pre- and postoperatively; while it was 7 ± 1 and 6 ± 1 days for the control group, and there were no significant difference among the groups (P > 0.05). Age, gender, SGA, BMI, levels of serum albumin and protein, localization of pathology and techniques of anastomosis were also similar (P > 0.05). Wound infection (P = 0.038), intraabdominal abcess formation (P = 0.044) and wound dehiscence (P = 0.044) were significantly higher in the control group than in the Gln group. There was no significant difference in terms of anastomotic leakage and other complications between both groups (P > 0.05). Hospital stay was significantly shorter in the Gln group (P < 0.001).

Conclusion  Supplementation of parenteral Gln decreased the postoperative complications and hospital stay and in the patients undergoing the colorectal surgery for cancer.