Postoperative patients, as a rule, benet from feeding the gut as soon as safely feasible and par­enteral nutrition used only when enteral nutrition is expected to be delayed for long periods. A recent trial randomized 87 patients with nasogas­tric tubes and continuous parenteral nutrition after pelvic exenteration to early trophic feeding versus standard of care suction. The results dem­onstrated that the incidence of postoperative ileus was signicantly lower in participants who were enterally fed. Furthermore, regression analysis showed that the longer patients were restricted from an oral diet after surgery, the greater the time was to rst bowel movement and the greater the postoperative complication rates [25]. In 2013, Roth etal. conducted a clinical trial with patients undergoing radical cystectomy/urinary detour procedures comparing two groups: rst group had parenteral nutrition and oral supple­ments during the rst ve postoperative days and the other had only oral nutritional supplements. The rst cohort was associated with more com­plications in general and infectious complica­tions, adding to the wealth of data that supports parenteral nutrition only being used in cases of expected prolonged inadequate enteral nutrition [48]. There are occasions when the timing of sur­gery cannot be delayed, however. In instances of surgery on patients with or at high risk for malnu­trition, consideration of early initiation of paren­teral nutritional is justied. In a recent study of patients undergoing abdominal surgery, initiation of TPN at day 3 reduced infectious complications compared to initiation on day 8 [57].