Early nasogastric tube removal combined with metoclopramide after postchemotherapy retroperitoneal lymph node dissection for metastatic testicular nonseminomatous germ cell tumor.

Abstract

OBJECTIVES:

To evaluate the efficacy of combining early nasogastric tube (NGT) removal and metoclopramide after postchemotherapy retroperitoneal lymph node dissection (RPLND) in decreasing complications, time to diet tolerance, and discharge.

METHODS:

We performed a retrospective study of 31 patients who underwent postchemotherapy RPLND at the University of Texas M. D. Anderson Cancer Center between 1994 and 1996, who were treated with a clinical care pathway that included NGT removal on postoperative day 1 and immediate use of promotility agents such as metoclopramide. A comparison was made with 42 historic controls treated from 1988 to 1994 who were managed with an NGT until the return of flatus and minimal promotility agents.

RESULTS:

Both groups had comparable age, chemotherapy, and surgical procedures. The study group had fewer complications, with an earlier tolerance of solid food (median 5 +/- 2.5 days compared with 7 +/- 5.1 days in controls, P = 0.000) and discharge (median 6 +/- 2.6 days compared with 9 +/- 6.9 days in controls, P = 0.000). NGT replacement was required in 3.2% of study patients versus 9% of controls. Multiple regression analyses demonstrated that the number of NGT days was an independent predictor of early return of bowel function and length of hospitalization (P = 0.000), and metoclopramide was not.

CONCLUSIONS:

Early NGT removal combined with metoclopramide after postchemotherapy RPLND allowed earlier diet tolerance and shortened hospital stays without increased complications. The role that promotility agents play as a necessary component of safe, early NGT removal is unclear.

• Authors: John W Davis, Louis L Pisters, Michael J Doviak, S Machele Donat
• Journal: Urology (Urology) Vol. 59 Issue 4 Pg. 579-83 (Apr 2002) ISSN: 1527-9995 [Electronic] United States
• PMID: 11927318 (Publication Type: Journal Article)

Chemical References

• Antiemetics
• Antineoplastic Agents
• Metoclopramide

Topics

• Adult
• Antiemetics (therapeutic use)
• Antineoplastic Agents (therapeutic use)
• Case-Control Studies
• Device Removal (methods)
• Diet
• Humans
• Intestinal Obstruction (prevention & control)
• Intubation, Gastrointestinal (instrumentation)
• Length of Stay
• Lymph Node Excision
• Metoclopramide (therapeutic use)
• Postoperative Complications (prevention & control)
• Regression Analysis
• Retroperitoneal Space
• Retrospective Studies