Postoperative Nutritional Support Research Articles

Assessment of the Nutritional Status and Skeletal Muscle Condition in Patients With Resectable Gastric Cancer

Background: Patients with gastric cancer (GC) are at high risk of nutrient deficiencies (ND) that can negatively affect the postoperative period and long-term treatment outcomes.Objective: To assess the nutritional status (NS) and skeletal muscle condition in patients with resectable stage I-III GC.Materials and methods: Our study included 102 GC patients: 64 men (62.7%) and 38 women (37.3%) aged 31 to 77 years. During the assessment we used the NRS-2002 system, determined laboratory markers of the NS, calculated the Nutritional Risk Index (NRI), and evaluated the condition of adipose tissue and skeletal muscles using computed tomography.Results: We found that 70.6% of the patients had ND: NRS-2002 score < 3 points (52%) and NRS-2002 score ≥ 3 points (18.6%). Risk factors for ND were tumor localization in the cardia and stage III GC. Laboratory markers of ND were transferrin and NRI. Among the examined patients (n = 80) sarcopenia was detected in 10 (12.5%) patients: 1 patient (1/25; 4.0%) from the group without ND, 6 patients (6/42; 14.3%) from the group with NRS-2002 score < 3 points, and 3 patients (3/13; 23.1%) from the group with NRS2002 score ≥ 3 points, (P = .212). In multivariate logistic regression analysis, independent factors associated with sarcopenia were age, body mass index, and total protein.Conclusions: All GC patients selected for radical surgery should undergo nutritional assessment using special tools (NRS-2002, NRI) and evaluation of the skeletal muscle condition. Sarcopenia may occur in patients with no clinical or laboratory evidence of ND. In GC patients at nutritional risk, preand postoperative nutritional support should be considered to reduce the ND-related risks.

Short-term outcomes of pedicled jejunum reconstruction after esophagectomy for esophageal cancer.

369 Background: The number of patients with esophageal cancer after gastrectomy and patients accompanied with simultaneous gastric cancer has gradually increased because of the prevalence of gastric in Japan. Pedicled jejunum is one of the choices for esophageal reconstruction when the stomach is not available. However, surgical outcomes of jejunal reconstruction and the effect of the timing of gastrectomy remain to be elucidated. Methods: This study was a retrospective, cohort study that included 24 patients who underwent supercharged pedicled jejunal conduit for esophageal reconstruction in our institution between May 2007 and July 2023. The patients were divided into two groups: gastrectomy was performed before esophagectomy (A group) and gastrectomy was performed simultaneously for accompanied gastric cancer (S group). Surgical outcomes and postoperative complications were compared between the two groups. As a nutritional assessment, perioperative change in body composition such as visceral fat area (VFA) with computed tomography was analyzed. Results: In 24 patients, the median operative time was 769 minutes and the median blood loss was 543 g. Severe postoperative complications developed in 6 cases (25%). The A group included 15 cases and the S group did 9 cases. There was no statistical difference in postoperative complication between the two groups, however, postoperative hospital stay was statistically longer in the S group than in that of the A group (37 days vs. 21 days, p=0.02). Although weight loss at 1 year after operation was almost identical in the two groups, the loss of VFA was more severe in the S group than in the A group (23 % of preoperative VFA vs. 77% of preoperative VFA, p=0.03). Conclusions: The use of a pedicled jejunal conduit after esophagectomy could be performed safely. Postoperative nutritional support is needed for patients especially those who underwent simultaneous gastrectomy.

Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient.

For children with diminished quality of life and chronic pain caused by acute recurrent or chronic pancreatitis who are undergoing total pancreatectomy with islet autotransplantation, postoperative nutrition support has several unique characteristics. Surgical complications may lead to delays in nutrition support initiation or require modifications to the regimen. Early postoperative dysmotility requires the use of temporary enteral nutrition until this improves. The resultant complete exocrine pancreatic insufficiency necessitates lifelong pancreatic enzyme replacement therapy and fat-soluble vitamin supplementation. A low-oxalate diet is recommended to prevent kidney stones. Carbohydrate counting is needed for the provision of short-term insulin dosing and possibly long-term as well, depending on the transplanted islet yield. Children should have careful nutrition assessment and monitoring at several follow-up visits during the first year, then annually, and at any time with concerns.

Recent advances in bariatric surgery: a narrative review of weight loss procedures

Bariatric surgery has emerged as a highly effective option for individuals with obesity, offering significant and sustainable weight loss outcomes. This surgical approach involves various procedures that alter the anatomy of the gastrointestinal tract, leading to reduced food intake and nutrient absorption. Established procedures such as sleeve gastrectomy, gastric bypass, adjustable gastric banding, and biliopancreatic diversion with duodenal switch have proven track records. In contrast, emerging options like intragastric balloons, AspireAssist devices, and endoscopic sleeve gastroplasty show promise but require further investigation. Numerous studies have highlighted the remarkable benefits of bariatric surgery, not only in weight loss but also in the resolution of obesity-related comorbidities and significant improvements in quality of life. However, successful outcomes rely on a multidisciplinary approach, encompassing preoperative evaluation, patient selection, comprehensive postoperative care, nutritional support, and psychological counseling. Regular follow-up and adherence to postsurgical recommendations are crucial for sustained weight loss and positive long-term results. As bariatric surgery continues to evolve, tailored procedures based on individual needs and ongoing research hold the potential for even more refined and effective approaches. Through this ongoing advancement, bariatric surgery is poised to offer improved patient outcomes, transforming lives for those grappling with the challenges of obesity.

OGC P67 Extended Use of Feeding Jejunostomy and Reduction of Weight Loss in Patients with Total Gastrectomy for Malignancy

Abstract Background Malnutrition and weight-loss are correlated with higher mortality and morbidity in patients undergoing total gastrectomy(TG) for gastric cancers. The role of feeding jejunostomy(FJ) in the event of leak and extended use for postoperative nutritional support is much debated. There is a variation of practice in insertion, duration and monitoring of FJ and the evidence is sparse.This study presents the experience of a tertiary referral centre where the use of FJ is extended after TG with intention of delivery of home enteral tube feeding(HETF); its effect in reduced percentage weight-loss during post-operative and adjuvant chemotherapy period were evaluated. Methods A retrospective cohort study of patients who underwent total gastrectomy for gastric adenocarcinoma between January 2017 to June 2022 at a tertiary referral centre were included. Length of stay, post operative complications and complications associated with feeding jejunostomy insertion were assessed along with adjuvant chemotherapy data and percentage weight loss 12 months following TG. SPSS software was used with frequencies analysed by chi squared test and continuous variables by T test. All p values were two tailed and values less than 0.05 were considered significant. Results 82 patients who underwent TG were included; 37 had FJ inserted and 45 patients did not. Of the 37 FJ patients, 34 were discharged with HETF. Median duration of HETF was 127 days(56-428). HETF patients had a significantly reduced percentage weight-loss at 1-, 3- and 6-months post-TG. At 12-months, although reduced percentage of weight-loss in FJ group was observed, this was not statistically significant. Adherence and completion rate of adjuvant chemotherapy was higher in FJ group.There was no difference in length of stay and post-operative complications.11 FJ-related minor complications were reported.1 case of small bowel obstruction was managed conservatively. Conclusions The use of FJ with HETF post TG was safe, posing minimal complications. There is a significant reduction in percentage of weight loss in the first 6 months in the FJ group. This may indicate improved nutritional status and therefore better adherence and completion of adjuvant chemotherapy observed. The role of FJ spans beyond nutritional support in the event of anastomotic leak; extended use during adjuvant therapy period should be considered. Large scale controlled studies are required to further evaluate the benefits and cost-effectiveness.

Concurrent Negative Impact of Undernutrition and Heart Failure on Functional and Cognitive Recovery in Hip Fracture Patients.

Evidence on the effects of frailty, undernutrition, and heart failure (HF) on patients with hip fractures is scarce. This retrospective cohort study aimed to examine the effects of undernutrition and HF on outcomes in patients who underwent convalescent rehabilitation after hip fracture. Undernutrition was defined as body mass index (BMI) < 20.0 (Low BMI). Heart failure (HF) was defined as a B-type natriuretic peptide (BNP) > 100 (High BNP). The study outcomes included the Functional Independence Measure motor domain (FIM-motor) and cognitive domain (FIM-cognition) at discharge. To consider the effects of low BMI, high BNP, and the simultaneous presence of both ("low BMI and high BNP"), we used multivariate linear regression analyses to examine whether these were associated with the outcomes. A total of 110 (mean age 87.4 years, 24.8% male) were analyzed. As a result, low BMI (β = -0.088, p = 0.027) and high BNP (β = -0.053, p = 0.015), each alone, were significantly associated with the FIM motor at discharge, whereas the simultaneous presence of "low BMI and high BNP" was significantly associated with the FIM motor at discharge, while the strength of the association was greater than each association alone (β = -0.152, p = 0.010). Further, the simultaneous presence of "low BMI and high BNP" was significantly associated with FIM cognition at discharge (β = -0.109, p = 0.014). Comprehensive multidisciplinary management is needed, including preoperative or early postoperative nutritional support and rehabilitation, followed by rehabilitation nutrition care management, in patients with hip fracture.

SP2.7 Is routine nasogastric tube placement following pancreatoduodenectomy really necessary?

Abstract Background Traditionally, pancreatoduodenectomy (PD) patients would leave theatre with a nasogastric tube (NGT) in situ. Recent evidence has suggested that the potential drawbacks of routine placement may outweigh the potential gains. This study aimed to compare the outcomes of PD patients who received a NGT intra-operatively to those did not. Methods Data taken from Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres from 8 countries, n=1484). The following outcome measures were used: median length of stay (LoS), incidence of delayed gastric emptying (DGE), incidence of grade B/C DGE, and the provision of postoperative nutritional support. Analyses were performed using Fisher’s exact test and the Mann-Whitney U test. Results Out of 1484 patients who underwent PD for malignancy, 1098 (74.0%) had data on their NGT status. 91.6% of patients received an intra-operative NGT. The median length of time until tube removal was four days (range: 1-64, interquartile range: 3). in comparison to the group with no NG tube, median length of stay (both 14 days, p=0.9), as well as incidence of DGE (14.3% vs 7.6%, p=0.08) grade B/C DGE (8.3% vs 4.3%, p=0.2) were similar. Patients who did not receive a tube less often received postoperative nutritional support (any form, 30.4% vs 49.8%, p=0.0004). Conclusion Most patients underwent PD had NG placed intraoperatively. Had no affect length of stay or incidence of DGE. Patients who received a NGT more often received postoperative nutritional support. NGTs should only be placed when they are clinically indicated.

FTP7.4 Variations in the type of nutritional support provided after pancreatoduodenectomy: results from an international multicentre retrospective cohort study

Abstract Aims An early oral diet is recommended after pancreatoduodenectomy (PD), however, the nutritional management of PD patients is known to be highly variable, and some centres still provide postoperative parenteral nutrition (PN) routinely. A proportion of patients who receive PN experience clinically significant complications underscoring its judicious use. Using a multicentre cohort, this study aimed to determine the proportion of PD patients that received postoperative nutritional support (NS), describe the variations in this support, and investigate whether receiving PN correlated with morbidity. Methods Data was extracted from the Recurrence After Whipple’s (RAW) study database, a retrospective study of patients undergoing PD for histologically confirmed pancreatic, ampullary or distal bile duct malignancy. Results 1323 patients (89.2%) had data on their postoperative NS status available. Of these, 45.4% received postoperative NS. This was “enteral only”, “parenteral only”, and “enteral and parenteral” in 44.3%, 35.2% and 20.5% of cases, respectively. Body mass index &amp;lt;18.5 kg/m2 (p=0.03), an absence of preoperative biliary stenting (p=0.009) and preoperative serum albumin &amp;lt;36 g/L (p=0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication (Clavien-Dindo grade ≥IIIa), one-fifth received PN. Conclusions Being underweight, not undergoing preoperative biliary stenting and having a low preoperative serum albumin all correlated with receiving postoperative NS. A considerable number of patients who had an uneventful recovery received PN; this should be reserved for those who are unable to take an oral diet or those in whom an oral diet is contraindicated.

Strong impact of sarcopenic state defined by skeletal muscle mass index on postoperative complication of Crohn's disease patients

BackgroundMalnutrition impacts the clinical course of Crohn's disease; however, there is little evidence of its influence on perioperative adverse events. We assessed whether nutritional indicators are associated with postoperative complications in surgical treatment of Crohn's disease. Methods137 patients with Crohn's disease who underwent surgical treatment between January 2011 and December 2020 were included. Skeletal muscle index was calculated by a single CT slice. We analyzed the risk factors for adverse events. Results37 % of patients had postoperative complications. Adverse events occurred more frequently in patients with high serum C-reactive protein, low serum albumin, prognostic nutritional index <38.3, skeletal muscle index <38.9 cm2/m2, abdominoperineal resection, long surgical duration, and mass hemorrhage. Among patients with skeletal muscle index <38.9 cm2/m2, patients who experienced adverse events had higher visceral fat index compared with those who did not (0.85 vs. 0.45, P = 0.04). Multivariate analysis revealed that skeletal muscle index <38.9 cm2/m2 and low serum albumin were the independent risk factors for postoperative complications (Odds ratio, 2.85; 95 % confidence interval, 1.13–7.16; P = 0.03, 2.62; 1.09–6.26; P = 0.03, respectively). Separated by sex, low serum albumin (<3.5 and <2.8 g/dL, male and female, respectively) and skeletal muscle index (<38.9 and <36.6 cm2/m2, male and female, respectively) were statistically related to postoperative complications. ConclusionsSkeletal muscle index is the most useful nutritional predictor of postoperative complications in Crohn's disease patients among other nutritional indices. We believe that these patients are at high risk of postoperative complications and need appropriate nutritional support in the perioperative period.

Retrospective comparison of outcomes in septic peritonitis with or without closed-suction abdominal drainage in 115 dogs (2009–2019)

Septic peritonitis is a serious medical condition affecting veterinary patients and post-operative care remains controversial. This study aimed to evaluate and compare post-operative outcomes of dogs treated for septic peritonitis with and without surgically placed closed-suction abdominal drains. Medical records were retrospectively searched from the years 2009 through 2019 and one hundred and fifteen dogs with confirmed septic peritonitis treated with exploratory laparotomy were included. Twenty-two dogs had closed suction drains placed and ninety-three dogs were managed without post-operative drainage. Overall survival to discharge rate of patients in this study was 72%. The survival rate of patients with an abdominal drain was 53% compared to 77% in patients without a drain (P < 0.0001). Dogs with a higher APPLEfast score were significantly more likely to have a drain placed at the time of surgery (P = 0.0277). Dogs that had a closed-suction drain were significantly more likely to be given colloidal support compared to dogs managed without drainage (P = 0.0342). Based on this data, closed-suction drainage post-operatively for treatment of septic peritonitis was not associated with a more favorable survival outcome. The use of a severity of illness score, APPLEfast, did not show a correlation between severity of illness and survival outcome but did demonstrate a correlation between illness severity and placement of a closed-suction drain. Closed-suction drainage post-operatively increased the likelihood of receiving colloidal support, but due to the retrospective nature of the study and the lack of standardized post-operative nutritional support, definitive conclusion that post-operative drainage alone led to increased colloidal support cannot be made in this study.

Postoperative Parenteral Nutrition Support and Neoadjuvant Chemotherapy Combined with Cytoreductive Surgery Improve the Quality of Life, but Not the Survival Rate or Incidence of Complications

We have explored the efficacy of neoadjuvant chemotherapy in association with cytoreductive surgery and postoperative parenteral nutrition support in advanced ovarian cancer patients. The control group received cytoreductive surgery combined with postoperative conventional chemotherapy and fasted after surgery, whereas the treatment group received neoadjuvant chemotherapy combined with cytoreductive surgery and parenteral nutrition. In contrast to the control group, the operation time, hospital stay, amount of intraoperative blood loss, and abdominal fluid accumulation of the treatment group were diminished, the total effectiveness rate was elevated, serum levels of albumin, transferrin, and prealbumin were increased, levels of human epididymal protein 4, vascular endothelial growth factor, and carbohydrate antigen 125 were declined, and the Karnofky Performance Status score was higher. While there was no difference observed in the 1-year survival rate or total incidence of complications between the two groups, the quality of life of patients in the treatment group improved.

A global analysis of nutrition support practices in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy

Perioperative nutritional care has been identified as an important factor in the management of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Nevertheless, there is no published consensus on best practice for nutritional management specific to this patient group. The purpose of this study was to identify the current nutrition care practices among international centres performing CRS and HIPEC for patients with peritoneal malignancy. An online survey was developed and sent to experienced CRS and HIPEC centres. The survey questions covered clinician and institution demographics, formal nutrition care pathways, pre-operative nutrition care, post-operative nutrition support and post-discharge nutritional follow-up. Eighty-two centres were contacted, and 42 responses were received. Respondents were from 20 different countries and were mostly dietitians (71%). Nutrition assessments were frequently completed (52% pre-operatively and 86% post-operatively) and most centres used a validated nutrition screening or assessment tool (79%). Perioperative nutrition support with respect to the use of enteral nutrition, parenteral nutrition and enhanced recovery after surgery varied widely between centres. The use of routine parenteral and enteral nutrition was significantly higher in Europe compared with other locations (p=0.028). Nutrition care is pivotal and has been positively integrated into the complex management of patients undergoing CRS and HIPEC globally, however variation in practice is evident. The findings highlight a unique opportunity to collaboratively investigate the role nutrition plays in determining outcomes and to identify the most appropriate nutrition support methods to achieve improved clinical outcomes for these high-risk patients.

Nutritional status efficacy of early nutritional support in gastrointestinal care: A systematic review and meta-analysis

Gastrointestinal surgery is a complicated process used to treat many gastrointestinal diseases, and it is associated with a large trauma: Most patients often have different degrees of malnutrition and immune dysfunction before surgery and are prone to various infectious complications during postoperative recovery, thus affecting the efficacy of surgical treatment. Therefore, early postoperative nutritional support can provide essential nutritional supply, restore the intestinal barrier and reduce complication occurrence. However, different studies have shown different conclusions.To assess whether early postoperative nutritional support can improve the nutritional status of patients based on literature search and meta-analysis.Articles comparing the effect of early nutritional support and delayed nutritional support were retrieved from PubMed, EMBASE, Springer Link, Ovid, China National Knowledge Infrastructure, China Biology Medicine databases. Notably, only randomized controlled trial articles were retrieved from the databases (from establishment date to October 2022). The risk of bias of the included articles was determined using Cochrane Risk of Bias V2.0. The outcome indicators, such as albumin, prealbumin, and total protein, after statistical intervention were combined.Fourteen literatures with 2145 adult patients undergoing gastrointestinal surgery (1138 patients (53.1%) receiving early postoperative nutritional support and 1007 patients (46.9%) receiving traditional nutritional support or delayed nutritional support) were included in this study. Seven of the 14 studies assessed early enteral nutrition while the other seven studies assessed early oral feeding. Furthermore, six literatures had "some risk of bias," and eight literatures had "low risk". The overall quality of the included studies was good. Meta-analysis showed that patients receiving early nutritional support had slightly higher serum albumin levels, than patients receiving delayed nutritional support [MD (mean difference) = 3.51, 95%CI: -0.05 to 7.07, Z = 1.93, P = 0.05]. Also, patients receiving early nutritional support had shorter hospital stay (MD = -2.29, 95%CI: -2.89 to -1.69), Z = -7.46, P < 0.0001) shorter first defecation time (MD = -1.00, 95%CI: -1.37 to -0.64), Z = -5.42, P < 0.0001), and fewer complications (Odd ratio = 0.61, 95%CI: 0.50 to 0.76, Z = -4.52, P < 0.0001) than patients receiving delayed nutritional support.Early enteral nutritional support can slightly shorten the defecation time and overall hospital stay, reduce complication incidence, and accelerate the rehabilitation process of patients undergoing gastrointestinal surgery.

ERAS with or without supplemental artificial nutrition in open pancreatoduodenectomy for cancer. A multicenter, randomized, open labeled trial (RASTA study protocol)

The role of supplemental artificial nutrition in patients perioperatively treated according to enhanced recovery programs (ERAS) on surgery-related morbidity is not known. Therefore, there is a need of a clinical trials specifically designed to explore whether given a full nutritional requirement by parenteral feeding after surgery coupled with oral food "at will" compared to oral food "at will" alone, within an established ERAS program, could achieve a reduction of the morbidity burden. RASTA will be a multicenter, randomized, parallel-arm, open labeled, superiority trial. The trial will be conducted in five Italian Institutions with proven experience in pancreatic surgery and already applying an established ERAS program. Adult patients (age ≥ 18 and < 90 years of age) candidate to elective open pancreatoduodenectomy (PD) for any periampullary or pancreatic cancer will be randomized to receive a full ERAS protocol that establishes oral food "at will" plus parenteral nutrition (PN) from postoperative day 1 to day 5 (treatment arm), or to ERAS protocol without PN (control arm). The primary endpoint of the trial is the complication burden within 90 days after the day of surgery. The complication burden will be assessed by the Comprehensive Complication Index, that incorporates all complications and their severity as defined by the Clavien-Dindo classification, and summarizes postoperative morbidity with a numerical scale ranging from 0 to 100. The H0 hypothesis tested is that he administration of a parenteral nutrition added to the ERAS protocol will not affect the CCI as compared to standard of care (ERAS). The H1 hypothesis is that the administration of a parenteral nutrition added to the ERAS protocol will positively affect the CCI as compared to standard of care (ERAS). The trial has been registered at ClinicalTrials.gov (number: NCT04438447; date: 18/05/2020). This upcoming trial will permit to establish if early postoperative artificial nutritional support after PD may improve postoperative outcomes compared to oral nutrition alone within an established ERAS program.

Assessing the Effects of a Perioperative Nutritional Support and Counseling in Gastrointestinal Cancer Patients: A Retrospective Comparative Study with Historical Controls.

The aim of this study was to investigate the effects of perioperative nutritional therapy care in gastrointestinal (esophageal, gastric, gastroesophageal) cancer patients on nutritional status and disease progression (complications, hospitalization, mortality). We considered 62 gastrointestinal cancer patients treated at the Center for Integrated Oncology (CIO), University Hospital Bonn, Germany (August 2017-July 2019). Of these, 42 patients (as intervention group: IG) received pre- and postoperative nutritional support with counseling, while 20 patients (as historical control group CG) received only postoperative nutritional therapy. Several clinical parameters, such as Body Mass Index (BMI), nutritional risk screening (NRS), phase angle, postoperative complications, length of hospital stay, and mortality, were determined. There were significantly fewer patients with gastric cancer/CDH1 gene mutation and more with esophageal cancer in IG (p = 0.001). Significantly more patients received neoadjuvant therapy in IG (p = 0.036). No significant differences were found between the groups regarding BMI, NRS, complications, length of hospital stay, and mortality. However, the comparison of post- and preoperative parameters in IG showed a tendency to lose 1.74 kg of weight (p = 0.046), a decrease in phase angle by 0.59° (p = 0.004), and an increase in NRS of 1.34 points (p < 0.001). Contrary to prior reports, we found no significant effect of perioperative nutritional therapy care in gastrointestinal cancer patients; however, the small cohort size and infrequent standardization in nutritional status may possibly account for the variance. Considering that oncological pathways and metabolic nutritional pathways are interrelated, dividing patients into subgroups to provide a personalized nutritional approach may help in improving their treatment.

Nutritional care in patients undergoing laparoscopic/minimally invasive surgeries for gastrointestinal tumours.

The introduction of minimally invasive surgeries for gastrointestinal tumours has been associated with many favourable postoperative outcomes and a reduced impact on nutritional status. The literature review begins by discussing the impact of minimally invasive procedures on the nutritional status of patients with gastrointestinal tumours, followed by indications for enteral nutrition (EN) in this population, including preoperative nutritional support and postoperative nutritional support. The review then examines the evidence that favours the use of EN in this population, including studies demonstrating improved outcomes with preoperative EN and reduced postoperative complications with postoperative EN. It also discusses potential strategies for improving outcomes with EN, such as early initiation of feeding and individualized nutrition plans. Overall, current evidence shows that EN improves outcomes, reduces complications, and enhances the quality of life. However, the optimal timing, composition of EN, and long-term outcomes are still unclear, indicating the need for future investigations.

Serum metabolic effects of corn oligopeptides with 7-day supplementation on early post-surgery primary liver cancer patients: a double-blind randomized controlled trial.

Liver cancer as the main leading cancer has caused heavy burdens globally. The prognosis of liver cancer is closely related with postoperative nutrition support. Corn oligopeptides (COPs) are protein hydrolysates produced by enzymatic treatments, which have shown potential bioactivities, such as inhibiting angiotensin I-converting enzyme, resisting lipid peroxidation and anti-oxidant. However, the correlation between COPs and liver cancer patients is still unknown and the potential mechanism of COPs on liver cancer is unclear as well. The aim of this study was to assess effects of 7-day intervention of COPs after surgery on liver function and serum metabolic profiles of liver cancer patients. Patients were assigned into COPs intervention group (n=50) and control group (n=91) for 7 days. Investigations were scheduled at 1st day and 7th day after liver resection surgery respectively, mainly including anthropometric, biochemical indexes and liquid chromatography-mass spectrometry (LC/MS) analysis. Seven-day supplementation of COPs on early post-surgery liver cancer patients down-regulated levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin and up-regulated prothrombin time activity and prealbumin levels. LC/MS analysis revealed metabolic signatures including regulation of 16 metabolites, which was closely related with two metabolic pathways (nicotinate and nicotinamide metabolism, fatty acid metabolism). COPs supplementation has displayed the potentials on alleviating the injury of liver function and it may be due to regulation of fatty acid metabolism, nicotinate and nicotinamide metabolism, lipid peroxidation and anti-inflammatory action. More researches are warranted in future to confirm the exact mechanisms.

Digital surgery group versus traditional experience group in head and neck reconstruction: a retrospective controlled study to analyze clinical value and time-economic-social effect

ObjectiveDiscuss the application value of digital surgical technology in the reconstruction of head and neck defects after tumor resection and comprehensively evaluate time-economic-benefit cost.MethodsA retrospective analysis of head and neck cancer patients who underwent reconstructive operations in head and neck surgery at Sichuan Cancer Hospital from January 2015 to January 2021 was performed. According to the inclusion and exclusion criteria, a total of 52 cases were included, including 25 cases using digital surgery (DS) and 27 cases using the conventional surgery (CS). The clinical-pathological characteristics, postoperative complications, functional aesthetic evaluation indexes, and time-cost-satisfaction evaluation indexes between the two groups were compared and statistically analyzed. Typical cases using digital surgery were shared.ResultsOutcomes between the two groups were comparable, and there was no significant difference in survival outcome and follow-up time between the two groups (P > 0.05). There was no significant difference between the two groups in the defect size, pathological type, other major clinicopathological features, or operation-related indicators (P > 0.05). The incidence of titanium plate displacement, deformation or exposure, and facial scar deformity in the DS group was significantly lower than that in the CS group (P < 0.05). However, there was no significant difference in other short-term or long-term complications (P > 0.05). The incidence of dysphagia and eating disorders in the DS group was significantly reduced (P < 0.05). The speech and social functions were improved, but not significantly (P > 0.05). Meanwhile, there was no significant difference in the evaluation index of facial aesthetics in this study (P > 0.05). Furthermore, the total operation time, preparation time of bone flap from the donor site, osteotomy time, and reconstruction time in the DS group were significantly lower than those in the traditional operation group (P < 0.05), but the shaping time and vascular anastomosis time of recipient area could not be shortened (P > 0.05). In addition, there was no significant difference in total hospitalization days between the DS group and CS group (P > 0.05), but the time of ICU treatment and postoperative intravenous nutrition support in the DS group were shorter than those in the CS group (P < 0.05). In particular, the preoperative doctor-patient communication of the DS group was more effective, and the treatment satisfaction of patients including their families was higher after operation (P < 0.05).ConclusionComprehensive application of digital surgical technology (CAD, CAM, VR, MA, etc.) in the reconstruction of the head and neck after tumor resection is feasible in clinical practice, which can not only improve the accuracy of repair, decrease some surgical complications, better preserve and improve patient’s diet and speech function, and reduce the operation and hospitalization time, but also increase the treatment cost. Furthermore, it is conducive to doctor-patient communication and improves patient satisfaction.

Postoperative nutritional support after pancreaticoduodenectomy in adults

Postoperative nutritional support after pancreaticoduodenectomy in adults

The Effects of Early Postoperative Nutrition Support on Enhanced Recovery After Lung Transplantation

<h3>Purpose</h3> There is currently no established guideline for nutritional management after lung transplantation (LT). Therefore, we have developed and introduced a protocol on early post-transplant nutrition, and verified the effectiveness of the protocol in improving nutrition-related outcomes. <h3>Methods</h3> Among 50 consecutive patients ≥18 years undergoing LT (7 from living donors) from January 2019 to April 2021 in our institution, the protocol had been applied in 22 patients since March 2020. The goal of our protocol was to start enteral nutrition or central parenteral nutrition within 48 hours after LT and we set targets of energy and protein amount as 25 kcal and 1 g per kg of ideal body weight a day by day 7. Nutritional sufficiency on day 7 and postoperative changes in body weight and muscle mass for 3 months after LT were retrospectively compared between the pre- and the post-protocol groups. Muscle mass was assessed by cross-sectional areas of the erector spinae muscles, which was evaluated using computed tomography. <h3>Results</h3> Regarding perioperative factors, there were no significant differences between two groups, while intraoperative extracorporeal circulation was more frequently used in the post-group compared to the pre-group (95% vs 64%, <i>p</i>=0.014). The number of cases in which tube feeding and central parenteral nutrition were started within 3 days after LT was significantly larger in the post-group than that in the pre-group (45% vs 7%, <i>p</i>=0.002; and 82% vs 29%, <i>p</i><0.001, respectively). Only 5 patients of the pre-group, who were extubated on day 2, started oral intake within 3 days after LT. The sufficiency rates of energy and protein on day 7 were significantly better in the post-group, compared to the pre-group (84% vs 69%, <i>p</i>=0.011; and 87% vs 74%, <i>p</i>=0.017, respectively). Body weight loss at 3 months after LT was more suppressed in the post-group than that in the pre-group (-0.5 kg vs -4.4 kg, <i>p</i>=0.034). The muscle mass decreased 2 weeks after LT in both groups (-14% in the post-group vs -16% in the pre-group, <i>p</i> = 0.105), while the muscle loss at 3 months after LT was significantly suppressed in the post-group than that in the pre-group (-5% vs -12%, <i>p</i>=0.034). <h3>Conclusion</h3> Although the target sufficiency rates had been incompletely achieved yet after the protocol was introduced, early nutrition support after LT was positively associated with the suppression of weight loss and muscle loss.