Abstract
ABSTRACTBackground: Some factors can act on nutritional status of patients operated for a gastrointestinal cancer. A timely and appropriate nutritional intervention could have a positive effect on postoperative outcomes. Aim: To determine the effect of a program of intestinal rehabilitation and early postoperative enteral nutrition on complications and clinical outcomes of patients underwent gastrointestinal surgery for cancer. Methods: This is a prospective study of 465 patients underwent gastrointestinal surgery for cancer consecutively admitted in an oncological intensive care unit. The program of intestinal rehabilitation and early postoperative enteral nutrition consisted in: 1) general rules, and 2) gastrointestinal rules. Results: The mean age of analysed patients was 63.7±9.1 years. The most frequent operation sites were colon-rectum (44.9%), gynaecological with intestinal suture (15.7%) and oesophagus-gastric (11.0%). Emergency intervention was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complication (19.2% vs. 10.2%; p=0.030), respiratory complications (p=0.040), delirium (p=0.032), infectious complications (p=0.047) and gastrointestinal complications (p<0.001), mainly anastomotic leakage (p=0.033). The oncological intensive care unit mortality (p=0.018), length of oncological intensive care unit (p<0.001) and hospital (p<0.001) stay were reduced as well. Conclusions: Implementing a program of intestinal rehabilitation and early postoperative enteral nutrition is associated with reduction in postoperative complications and improvement of clinical outcomes in patients undergoing gastrointestinal surgery for cancer.
Highlights
Malnutrition is commonly observed in patients presenting for surgical treatment of gastrointestinal malignancies, with a prevalence of 40–80%24
An early enteral nutritional is recommended for postoperative gastrointestinal patients, as it is associated with an enhanced recovery and lower complication rates[1,13,14,15,27,31]
Compared with the year 2013, a progress in the implementation of the intestinal rehabilitation and early postoperative enteral nutrition (IREPEN) program was observed for the year 2014 and 2015, especially in respiratory physiotherapy, early mobilization, early nasogastric tube remove and early enteral nutrition
Summary
Malnutrition is commonly observed in patients presenting for surgical treatment of gastrointestinal malignancies, with a prevalence of 40–80%24. It is caused by a variety of factors, including cancer nature, local effect of tumour, clinical stage of cancer, as well as chemotherapy or radiotherapy. Nausea, vomiting, decreased appetite, early satiety, taste changes, diarrhoea, pain, mucositis, physical obstruction of gastrointestinal tract due to tumour and malabsorption could result in weight loss, which consecutively is a strong prognostic factor of poor outcome in terms of survival and response to treatment[26]. Some patients with gastrointestinal tract solid tumour can develop cancer cachexia, which is a complex syndrome characterized by a chronic, progressive, involuntary weight loss, and poorly or only partially responsive to standard nutritional support[25]. A timely and appropriate nutritional intervention has a positive effect on postoperative outcomes in this group of patients[29]
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