Abstract
The metabolic risk for patients undergoing abdominal cancer resection increases in the perioperative period and malnutrition may be observed. In order to prevent further weight loss, the guidelines recommend for high-risk patients the placement of a needle catheter jejunostomy (NCJ) for supplementing enteral feeding in the early and late postoperative period. Our aim was to evaluate the safety of NCJ placement and its potential benefits regarding the nutritional status in the postoperative course. We retrospectively analyzed patients undergoing surgery for upper gastrointestinal cancer, such as esophageal, gastric, and pancreato-biliary cancer, and NCJ placement during the operation. The nutritional parameters body mass index (BMI), perioperative weight loss, phase angle measured by bioelectrical impedance analysis (BIA) and the clinical outcome were assessed perioperatively and during follow-up visits 1 to 3 months and 4 to 6 months after surgery. In 102 patients a NCJ was placed between January 2006 and December 2016. Follow-up visits 1 to 3 months and 4 to 6 months after surgery were performed in 90 patients and 88 patients, respectively. No severe complications were seen after the NCJ placement. The supplementing enteral nutrition via NCJ did not improve the nutritional status of the patients postoperatively. There was a significant postoperative decline of weight and phase angle, especially in the first to third month after surgery, which could be stabilized until 4–6 months after surgery. Placement of NCJ is safe. In patients with upper gastrointestinal and pancreato-biliary cancer, supplementing enteral nutrition during the postoperative course and continued after discharge may attenuate unavoidable weight loss and a reduction of body cell mass within the first six months.
Highlights
In the time of Enhanced Recovery after Surgery programs (ERAS), perioperative nutrition therapy seems to be very “traditional” and even redundant [1]
In a prospective study of malabsorption and malnutrition after esophageal and gastric surgery, a weight loss of more than 15%
The nutritional status of the patients was assessed by the body mass index (BMI) and bioelectrical impedance analysis (BIA) preoperatively, 1 to 3 months postoperatively and 4 to 6 months postoperatively
Summary
In the time of Enhanced Recovery after Surgery programs (ERAS), perioperative nutrition therapy seems to be very “traditional” and even redundant [1]. Oral feeding is feasible even after esophagectomy and without impact on the incidence and severity of postoperative complications [2]. Abdominal cancer patients, with special regard to those with cancer in the upper gastrointestinal and hepatopancreatobiliary tract, bear a high metabolic risk for malnutrition. 32% and 87% of patients suffer from weight loss at the time of diagnosis [3]. The degree of malnutrition may be related to the type of cancer, stage and location [3]. In patients with advanced cancer the prevalence of malnutrition may be as high, with 80–85% in pancreatic cancer, 65–85% in Nutrients 2020, 12, 2564; doi:10.3390/nu12092564 www.mdpi.com/journal/nutrients
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