UNDERESTIMATED PROTEIN ENERGETIC MALNUTRITION (PEM) IN PATIENTS AFFECTED BY RETROPERITONEAL SARCOMA (RPS)

Abstract

RPS are mesenchymal non-epithelial neoplasms. Prevalence of PEM in patients with RPS is unknown. A prospective feasibility study enrolled 35 patients affected by primary RPS candidate to surgery. Patients were screened for PEM (according to SINPE Guidelines 2002). Preoperative high protein-beta-hydroxy-beta-methyl butyrate oral nutritional support (ONS) was provided according to PEM degree (Figure1). After surgery, nutritional support followed standard practice targeting 20-25 Kcal/Kg/die within 3rd postoperative day (pod). PEM was re-evaluated before surgery, at 10th pod, at 4 and 12 months. Primary outcome was patient's compliance to preoperative ONS. PEM was documented in 46% patients; although only 8.6% had been clinically undernourished. ONS had a 91% adherence, overall well tolerated. After ONS, PEM lowered to 38% (P=.45). Postoperative caloric target was reached on day 4.1 (SE±2.7), with 51% of protocol adherence. In 34% patients a naso-jejunal tube was positioned; Delayed gastric emptying (DGE) occurred in 38% patients. On 10th pod the majority of patients experienced serious PEM, and worsening was greater after resection of ≥4 organs (P=.06). At 4 and 12 months, almost all fully recovered (Figure 2). Relevant PEM prevalence in RPS, at risk to be clinically underestimated, is documented for the first time. In this setting, preoperative ONS was feasible and safe, and partially recovered PEM. Disease-related factors for PEM and ideal perioperative caloric target need to be further investigated. A wider use of jejunal access should be evaluated, considered the incidence of DGE. Nutritional support should be included in ERAS programs for RPS.