Log in to MyKarger to check if you already have access to this content.
Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more
CHF 38.00 *
EUR 35.00 *
USD 39.00 *
Buy a Karger Article Bundle (KAB) and profit from a discount!
If you would like to redeem your KAB credit, please log in.
Save over 20% compared to the individual article price. Access via DeepDyve Unlimited fulltext viewing Of this article Organize, annotate And mark up articles Printing And downloading restrictions apply Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more Select* The final prices may differ from the prices shown due to specifics of VAT rules.
Article / Publication DetailsFirst-Page Preview
Received: April 04, 2022
Accepted: August 17, 2022
Published online: October 03, 2022
Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 3
ISSN: 2297-4725 (Print)
eISSN: 2297-475X (Online)
For additional information: https://www.karger.com/VIS
AbstractBackground: Early oral feeding after major abdominal surgery has been clearly shown to be safe and not a risk factor for anastomotic dehiscence. Within the Enhanced Recovery after Surgery protocol, it is the nutritional plan A. Nonetheless, one must consider that postoperative protein and energy requirements will often be not covered by oral food intake alone. Because nutritional status has been shown to be a prognostic factor in patients undergoing major abdominal surgery, the preoperative identification of patients at risk may be mandatory. Malnutrition may be underestimated in an overweight society. With special regard to patients with cancer and those with preexisting malnutrition, an accumulating caloric gap may be harmful in the early and late postoperative periods. Furthermore, complications requiring reoperation and intensive care treatment may occur. Summary: Therefore, a plan B for postoperative nutrition therapy is needed, using preferentially the enteral route. The European Society for Clinical Nutrition and Metabolism recently addressed perioperative nutritional management and the indications for enteral and even parenteral supplementation to achieve caloric requirements in the postoperative course. In the first months after surgery, persisting weight loss is common in patients with upper gastrointestinal resections, even in those with an uncomplicated course. This may delay the initiation of adjuvant chemotherapy, increase toxicity, and worsen long-term outcomes.
© 2022 S. Karger AG, Basel
References Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745–61. Koterazawa Y, Oshikiri T, Takiguchi G, Urakawa N, Hasegawa H, Yamamoto M, et al. Severe weight loss after minimally invasive oesophagectomy is associated with poor survival in patients with oesophageal cancer at 5 years. BMC Gastroenterol. 2020;20(1):407. Mayanagi S, Tsubosa Y, Omae K, Niihara M, Uchida T, Tsushima T, et al. Negative impact of skeletal muscle wasting after neoadjuvant chemotherapy followed by surgery on survival for patients with thoracic esophageal cancer. Ann Surg Oncol. 2017;24(12):3741–7. Ford KL, Prado CM, Weimann A, Schuetz P, Lobo DN. Unresolved issues in perioperative nutrition: a narrative review. Clin Nutr. 2022;41(7):1578–90. Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesth Analg. 2018;126(6):1883–95. Constansia RDN, Hentzen JEKR, Hogenbirk RNM, van der Plas WY, Campmans-Kuijpers MJE, Buis CI, et al. Actual postoperative protein and calorie intake in patients undergoing major open abdominal cancer surgery: a prospective, observational cohort study. Nutr Clin Pract. 2022;37(1):183–91. Aoyama T, Yoshikawa T, Maezawa Y, Kano K, Numata M, Hara K, et al. The postoperative lean body mass loss at one month leads to a poor survival in patients with locally advanced gastric cancer. J Cancer. 2019;10(11):2450–6. Bozzetti F. Forcing the vicious circle: sarcopenia increases toxicity, decreases response to chemotherapy and worsens with chemotherapy. Ann Oncol. 2017;28(9):2107–18. Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, et al. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Obes Facts. 2022;15(3):321–35. Olotu C, Weimann A, Bahrs C, Schwenk W, Scherer M, Kiefmann R. The perioperative care of older patients. Dtsch Arztebl Int. 2019;116(5):63–9. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition ESPEN. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21. Jensen GL, Cederholm T, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition: a consensus report from the Global Clinical Nutrition Community. JPEN J Parenter Enteral Nutr. 2019;43(1):32–40. Tamandl D, Paireder M, Asari R, Baltzer PA, Schoppmann SF, Ba-Ssalamah A. Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer. Eur Radiol. 2016;26(5):1359–67. Martin L, Gioulbasanis I, Senesse P, Baracos VE. Cancer-associated malnutrition and CT-defined sarcopenia and myosteatosis are endemic in overweight and obese patients. JPEN J Parenter Enteral Nutr. 2020;44(2):227–38. Pecorelli N, Capretti G, Sandini M, Damascelli A, Cristel G, De Cobelli F, et al. Impact of sarcopenic obesity on failure to rescue from major complications following pancreaticoduodenectomy for cancer: results from a multicenter study. Ann Surg Oncol. 2018;25(1):308–17. Wobith M, Herbst C, Lurz M, Haberzettl D, Fischer M, Weimann A. Evaluation of malnutrition in patients undergoing major abdominal surgery using GLIM criteria and comparing CT and BIA for muscle mass measurement. Clin Nutr ESPEN. 2022;50:148–54. López-Rodríguez-Arias F, Sánchez-Guillén L, Lillo-García C, Aranaz-Ostáriz V, Alcaide MJ, Soler-Silva Á, et al. Assessment of body composition as an indicator of early peripheral parenteral nutrition therapy in patients undergoing colorectal cancer surgery in an enhanced recovery program. Nutrients. 2021;13(9):3245. Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol. 2015;22(Suppl 3):778–85. Gillis C, Buhler K, Bresee L, Carli F, Gramlich L, Culos-Reed N, et al. Effects of nutritional prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: a systematic review and meta-analysis. Gastroenterology. 2018;155(2):391–410.e4. Hughes MJ, Hackney RJ, Lamb PJ, Wigmore SJ, Christopher Deans DA, Skipworth RJE. Prehabilitation before major abdominal surgery: a systematic review and meta-analysis. World J Surg. 2019;43(7):1661–8. Waterland JL, McCourt O, Edbrooke L, Granger CL, Ismail H, Riedel B, et al. Efficacy of prehabilitation including exercise on postoperative outcomes following abdominal cancer surgery: a systematic review and meta-analysis. Front Surg. 2021;8:628848. McIsaac DI, Gill M, Boland L, Hutton B, Branje K, Shaw J, et al. Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. Br J Anaesth. 2022;128(2):244–57. Braga M, Ljungqvist O, Soeters P, Fearon K, Weimann A, Bozzetti F, et al. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr. 2009;28(4):378–86. Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for peri- operative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) society recommendations: 2018. World J Surg. 2019;43(3):659–95. Ma BQ, Chen SY, Jiang ZB, Wu B, He Y, Wang XX, et al. Effect of postoperative early enteral nutrition on clinical outcomes and immune function of cholangiocarcinoma patients with malignant obstructive jaundice. World J Gastroenterol. 2020;26(46):7405–15. Hogan S, Reece L, Solomon M, Rangan A, Carey S. Early enteral feeding is beneficial for patients after pelvic exenteration surgery: a randomized controlled trial. JPEN J Parenter Enteral Nutr. 2022;46(2):411–21. Shu XL, Kang K, Gu LJ, Zhang YS. Effect of early enteral nutrition on patients with digestive tract surgery: a meta-analysis of randomized controlled trials. Exp Ther Med. 2016;12(4):2136–44. Yan X, Zhou FX, Lan T, Xu H, Yang XX, Xie CH, et al. Optimal postoperative nutrition support for patients with gastrointestinal malignancy: a systematic review and meta-analysis. Clin Nutr. 2017;36(3):710–21. Yeung SE, Hilkewich L, Gillis C, Heine JA, Fenton TR. Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery after Surgery (ERAS) and conventional care after elective colorectal surgery. Am J Clin Nutr. 2017;106(1):44–51. Berkelmans GHK, Fransen LFC, Dolmans-Zwartjes ACP, Kouwenhoven EA, van Det MJ, Nilsson M, et al. Direct oral feeding following minimally invasive esophagectomy (NUTRIENT II trial): an international, multicenter, open-label randomized controlled trial. Ann Surg. 2020;271(1):41–7. Li X, Yan S, Ma Y, Li S, Wang Y, Wang X, et al. Impact of early oral feeding on anastomotic leakage rate after esophagectomy: a systematic review and meta-analysis. World J Surg. 2020;44(8):2709–18. Burcharth J, Falkenberg A, Schack A, Ekeloef S, Gögenur I. The effects of early enteral nutrition on mortality after major emergency abdominal surgery: a systematic review and meta-analysis with trial sequential analysis. Clin Nutr. 2021;40(4):1604–12. Slim K, Badon F, Vacheron CH, Occean BV, Dziri C, Chambrier C. Umbrella review of the efficacy of perioperative immunonutrition in visceral surgery. Clin Nutr ESPEN. 2022;48:99–108. Moya P, Soriano-Irigaray L, Ramirez JM, Garcea A, Blasco O, Blanco FJ, et al. Perioperative standard oral nutrition supplements versus immunonutrition in patients undergoing colorectal resection in an Enhanced Recovery (ERAS) protocol: a multicenter randomized clinical trial (SONVI study). Medicine. 2016;95(21):e3704. Zhuang W, Wu H, Liu H, Huang S, Wu Y, Deng C, et al. Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage. J Gastrointest Oncol. 2021;12(2):433–45. Li HN, Chen Y, Dai L, Wang Y-Y, Chen M-W, Mei L-X. A meta-analysis of jejunostomy versus nasoenteral tube for enteral nutrition following esophagectomy. J Surg Res. 2021;264:553–61. Holmén A, Hayami M, Szabo E, Rouvelas I, Agustsson T, Klevebro F. Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival. Langenbecks Arch Surg. 2021;406(5):1415–23. Shen X, Zhuo Z-G, Li G, Alai G-H, Song T-N, Xu Z-J, et al. Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile? A systematic review and meta-analysis. Ann Palliat Med. 2021;10(4):4232–41. Grass F, Benoit M, Coti Bertrand P, Sola J, Schäfer M, Demartines N, et al. Nutritional status deteriorates postoperatively despite preoperative nutritional support. Ann Nutr Metab. 2016;68(4):291–7. Gao X, Liu Y, Zhang L, Zhou D, Tian F, Gao T, et al. Effect of early vs late supplemental parenteral nutrition in patients undergoing abdominal surgery: a randomized clinical trial. JAMA Surg. 2022 May 1;157(5):384–93. Elke G, Hartl WH, Kreymann KG, Adolph M, Felbinger TW, Graf T, et al. Clinical nutrition in critical care medicine: guideline of the German society for nutritional medicine (DGEM). Clin Nutr ESPEN. 2019;33:220–75. Pradelli L, Mayer K, Klek S, Omar Alsaleh AJ, Clark RAC, Rosenthal MD, et al. ω-3 Fatty-acid enriched parenteral nutrition in hospitalized patients: systematic review with meta-analysis and trial sequential analysis. JPEN J Parenter Enteral Nutr. 2020;44(1):44–57. Lu S, Yang Z, Tang H, Sun X, Wang B, Qu J, et al. Associations between omega-3 polyunsaturated fatty acids supplementation and surgical prognosis in patients with gastrointestinal cancer: a systematic review and meta-analysis. Food Chem. 2022;4:100099. Ziegler TR, May AK, Hebbar G, Easley KA, Griffith DP, Dave N, et al. Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical ICU patients: an American multicenter randomized controlled trial. Ann Surg. 2016;263(4):646–55. Ridley EJ, Parke RL, Davies AR, Bailey M, Hodgson C, Deane AM, et al. What happens to nutrition intake in the post-intensive care unit hospitalization period? An observational cohort study in critically ill adults. JPEN J Parenter Enteral Nutr. 2019;43(1):88–95. Baker M, Halliday V, Williams RN, Bowrey DJ. A systematic review of the nutritional consequences of esophagectomy. Clin Nutr. 2016;35(5):987–94. Wobith M, Wehle L, Haberzettl D, Acikgöz A, Weimann A. Needle catheter jejunostomy in patients undergoing surgery for upper gastrointestinal and pancreato-biliary cancer: impact on nutritional and clinical outcome in the early and late postoperative period. Nutrients. 2020;12(9):2564. Aoyama T, Kawabe T, Fujikawa H, Hayashi T, Yamada T, Tsuchida K, et al. Loss of lean body mass as an independent risk factor for continuation of s-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol. 2015;22(8):2560–6. Chen X, Zhao G, Zhu L. Home enteral nutrition for postoperative elderly patients with esophageal cancer. Ann Palliat Med. 2021;10(1):278–84. Xueting H, Li L, Meng Y, Yuqing C, Yutong H, Lihong Q, et al. Home enteral nutrition and oral nutritional supplements in postoperative patients with upper gastrointestinal malignancy: a systematic review and meta-analysis. Clin Nutr. 2021;40(5):3082–93. Hatao F, Chen K-Y, Wu J-M, Wang M-Y, Aikou S, Onoyama H, et al. Randomized controlled clinical trial assessing the effects of oral nutritional supplements in postoperative gastric cancer patients. Langenbecks Arch Surg. 2017;402(2):203–11. Meng Q, Tan S, Jiang Y, Han J, Xi Q, Zhuang Q, et al. Post-discharge oral nutritional supplements with dietary advice in patients at nutritional risk after surgery for gastric cancer: a randomized clinical trial. Clin Nutr. 2021;40(1):40–6. Miyazaki Y, Omori T, Fujitani K, Fujita J, Kawabata R, Imamura H, et al. Oral nutritional supplements versus a regular diet alone for body weight loss after gastrectomy: a phase 3, multicenter, open-label randomized controlled trial. Gastric Cancer. 2021;24(5):1150–9. Article / Publication DetailsFirst-Page Preview
Received: April 04, 2022
Accepted: August 17, 2022
Published online: October 03, 2022
Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 3
ISSN: 2297-4725 (Print)
eISSN: 2297-475X (Online)
For additional information: https://www.karger.com/VIS
Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Comments (0)