Abstract
Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced recovery program. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Postoperative complications and length of hospital stay (LOS) were assessed. Results: Of the 156 patients analyzed, 88 patients (56.4%) were classified as having high-risk BC according to CT measurements. PPN led to a 15.4% reduction in postoperative complications in high-risk vs. 1.7% in low-risk BC patients. In the multivariate analysis, high-risk BC was related to an OR (95% CI) of 2 (p = 0.044) of presenting complications and of 1.9 (p = 0.066) for major complications, and was associated with an increase in LOS of 3.6 days (p = 0.039). Conclusions: The measurement of patients’ BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes.
Highlights
In the past, body mass index (BMI) has been traditionally used as an indicator of malnutrition and prognosis
The aim of this study was to evaluate whether early postoperative supplementation with periOlimel N4-E versus conventional fluid therapy (FT) improves postoperative outcomes and length of hospital stay (LOS) according to the body composition measured by the Skeletal Muscle Index in patients with colorectal cancer (CRC) within an Enhanced Recovery After Surgery (ERAS) program
Other exclusion criteria included the need for emergency surgery, an American Society of Anaesthesiologists (ASA) physical status IV, renal failure defined via hemodialysis, hepatic failure, allergy or sensitivity to egg or soy protein, severe bleeding disorder, congenital abnormality of amino acid metabolism hyperlipidemia, not accepting or not being able to comply with the ERAS protocol, or the absence of a computed tomography (CT) scan one month prior to surgery
Summary
Body mass index (BMI) has been traditionally used as an indicator of malnutrition and prognosis. Body composition, measured by computed tomography (CT), is identifiable next to the L3 vertebra level, and allows for calculation of the skeletal muscle index (SMI). It has been used in recent studies to evaluate the relationship between skeletal muscle mass and postoperative outcomes. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Conclusions: The measurement of patients’ BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes
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