Effects of Perioperative Oral Nutrition Supplementation in Malaysian Patients Undergoing Elective Surgery for Breast and Colorectal Cancers-A Randomised Controlled Trial.

Ting Xuan Wong,Seong Ting Chen,Khairul Hazim Hamdan,Raflis Ruzairee Awang,Sangeetha Shyam,Mohd Razali Ibrahim,Kandasami Palayan,Nurzarina Ahmed,Wei Xiang Wong,Shu Hwa Ong,Winnie Siew Swee Chee

doi:10.3390/nu14030615

Ting Xuan Wong, Seong Ting Chen + Show 9 more

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https://doi.org/10.3390/nu14030615

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Abstract

This study aimed to investigate the effectiveness of preoperative and an extended 90-days postoperative use of ONS among patients undergoing elective surgery for breast and colorectal cancers. Ninety-one patients were randomised into (i) Group SS received ONS up to 14 days preoperatively and postoperatively up to discharge, (ii) Group SS-E received ONS up to 14 days preoperatively, postoperatively up to discharge and for an extended 90-days after discharge and (iii) Group DS received ONS postoperatively up to discharge. Preoperatively, SS had significantly higher body weight (66.1 ± 15.3 kg vs. 62.5 ± 12.0 kg, p = 0.010) and BMI (26.8 ± 6.8 kg/m2 vs. 26.1 ± 6.7 kg/m2, p = 0.022) than DS when adjusted for baseline values. Postoperatively, SS-E had significantly higher handgrip strength (26 ± 9 kgF vs. 24 ± 6 kgF, p = 0.044) than DS at 90-days post-discharge after adjusted for preoperative values. At 90-days post-discharge, the proportions of patients in SS with albumin < 35 g/d, CAR ≥ 0.1, mPINI ≥ 0.4, mGPS score 1 or 2 were significantly reduced while in SS-E, the reduction in proportions of patients with high hsCRP and mPINI ≥ 0.4 was significant compared to upon discharge. Preoperative ONS had modest benefits in attenuating weight loss whilst postoperative supplementation up to 90-days post-discharge improved handgrip strength and inflammatory prognostic markers.

Highlights

Colorectal and breast cancers are among the most common cancers reported worldwide, contributing up to 9.4% and 6.9% of total cancer deaths, respectively [1]
At 90-days post-discharge, Group SS-E had significantly lower proportion of patients with high-sensitivity C-reactive protein (hsCRP) > 10 mg/L as compared with upon discharge (71% to 25%, p = 0.008)
The current study demonstrated that among patients undergoing elective surgery for breast and colorectal cancer with mild-to-moderate malnutrition, a prolonged supplementation until 90 days post-discharge significantly improved handgrip strength

Summary

Introduction

Colorectal and breast cancers are among the most common cancers reported worldwide, contributing up to 9.4% and 6.9% of total cancer deaths, respectively [1]. Colorectal and breast cancers are among the less aggressive cancer types and patients often do not exhibit conventional criteria for malnutrition such as low serum albumin, BMI, or weight loss [5,6]. They are predominantly overweight or obese upon diagnosis [7,8], malnutrition can occur following the disease trajectory as the primary tumour itself could exert metabolic alterations in the body while the surgical stress further exacerbates the nutrition status of the patients [9,10,11]

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