P-OGC01 Prevalence and treatment of nutritional deficiencies following Upper Gastrointestinal Surgery for Oesophageal or Gastric Cancer

Abstract

Abstract Background Patients undergoing Upper Gastrointestinal (UGI) surgery for cancer are left nutritionally vulnerable due to alterations in digestion and absorption this is becoming increasingly evident as more patients are achieving five year survival. Patients are more likely to endure nutritional deficiencies in particular B12, Iron, Vitamin D, Calcium, Zinc and folic acid. Reduced absorption and inadequate dietary intake of calories, protein and micronutrients are the main contributing factors post operatively and longer term. At 2 years post UGI resection the following nutritional deficiencies have been observed: 48% Iron, 42% B12, 40% Folic Acid, 34% Calcium, 33% Zinc, 24% Vitamin D. Methods Data was collected retrospectively from various systems on our Trusts Network. The trusts reporting system was utilised for blood results. Digital systems were used to confirm if any action had been taken and if this was appropriate. Additional digital systems were used to obtain clinic lists for the last 6 months. The Data was collected and entered into an Excel spread sheet for comparison. Chi squared testing was utilised to compare deficiency rate between different Upper GI surgeries. Results Chi squared statistical analysis of the nutritional deficiencies in the three main Cancer surgery types (Ivor Lewis / Total OG / Sub-total OG) found there was no statistical difference in prevalence of nutritional deficiency. Comparison of deficiencies indicated that the main prevalence was or Zinc and Vitamin D pre and post operatively. Conclusions Nutritional deficiencies should be corrected pre operatively. Monitoring thereafter of nutritional vitamin and mineral status should be individually tailored to suit the patient. All UGI patients should be commenced on a nutritionally complete vitamin and mineral supplement at the point of initial assessment in the UGI surgical clinic pre operatively. The recommendation would be to commence Forceval vitamin and mineral supplement as this offers optimal trace element coverage. Vitamin D deficiency pre operatively should have supplementation to maintain 25(OH)D levels greater than 50nmol/L and rechecked after 3 months. Zinc replacement should be monitored routinely.