Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

Ho Chiou Yi,Norshariza Jamhuri,Nor Baizura Md Yusop,Zalina Abu Zaid,Mohd Norazam Mohd Abas,Zulfitri ‘Azuan Mat Daud,Zuriati Ibrahim,Jamil Omar,Zuwariah Abdul Rahman

doi:10.3390/nu12010264

Abstract

Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.

Highlights

The primary modalities of cancer treatment are surgery, chemotherapy, and radiotherapy; these may be used alone or in combination
This study aims to determine the impact of Enhanced Recovery after Surgery (ERAS) with a preoperative whey protein-infused CHO-loading drink and postoperative early oral feeding on postoperative outcomes and complications, as well as the nutritional status and function status among surgical gynecologic cancer (GC) patients
The compliance study protocol between the intervention group (CHO-P) complied to the ERAS protocol, while the control group (CO) was under conventional care

Summary

Introduction

The primary modalities of cancer treatment are surgery, chemotherapy, and radiotherapy; these may be used alone or in combination. For those cancers which are well margined and operable, surgery is the first treatment for gynecologic cancer (GC) [1]. Inadequate oral intake due to delayed oral feeding causes depletion of nutrient storage in a patient’s body [3]. This is because of the utilization of energy which is converted from protein. Patients experience weight loss and muscle mass loss postoperatively [4]

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