Abstract
Malnutrition is common in surgical cancer patients and it is widely accepted that it can adversely affect their postoperative outcome. Assessing the nutritional status of every patient, in particular care of elderly and cancer patients, is a crucial feature of the therapeutic pathway in order to optimize every strategy. Evidence exists that the advantages of perioperative nutrition are more significant in malnourished patients submitted to major surgery. For patients recognized as malnourished, preoperative nutrition therapies are indicated; the choice between parenteral and enteral nutrition is still controversial in perioperative malnourished surgical cancer patients, although enteral nutrition seems to have the best risk–benefit ratio. Early oral nutrition after surgery is advisable, when feasible, and should be administered in all the patients undergoing elective major surgery, if compliant. In patients with high risk for postoperative infections, perioperative immunonutrition has been proved in some ways to be effective, even if operations including those for cancer have to be delayed.
Highlights
Surgery is currently the main therapeutic approach to many solid neoplasms; surgical techniques have considerably evolved in the last 20 years, leading to an increase in overall survival and quality of life [1]
To assess and optimize the nutritional status of patients undergoing surgery, it is essential to understand how the metabolism changes during injury, and why a poor nutritional status is a risk factor for postoperative complications (Figure 1)
The use of immunonutrition is recommended in the perioperative period for 5 to 7 days in major upper abdominal surgeries, head and neck cancer, and severe trauma [47]
Summary
Surgery is currently the main therapeutic approach to many solid neoplasms; surgical techniques have considerably evolved in the last 20 years, leading to an increase in overall survival and quality of life [1]. Screening tools and hystotipe can affect the incidence of malnutrition [6]; in any case, malnutrition has been associated with poor prognosis and quality of life in any cancer type. Stress and systemic inflammation in surgical oncology patients are all independently associated with a poor prognosis, increased postoperative morbidity resulting in interruptions of postoperative anticancer treatments, and reduced quality of life. Data from the National Surgical Quality Improvement Program (NSQIP) demonstrate that malnutrition is among the first 10 preoperative risk factors leading to a poor outcome or increased mortality [9]; among the main causes of postoperative mortality malnutrition is the only identifiable and modifiable factor. The HCUP project reveals that fewer than 7% of malnutrition-related hospital stays are submitted to specific and significant nutritional interventions
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