Influence of nutritional status on postoperative outcome in patients with colorectal cancer – the emerging role of the microbiome

Weimann, Arved

doi:10.1515/iss-2017-0039

Cited by 9 publications

(9 citation statements)

References 65 publications

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“…An increased BMI during laparoscopic colorectal-cancer surgery [73] and preoperative obesity is associated with poorer outcomes. On the other hand, early oral nutrition and thereby a more physiological gastrointestinal microbiome are associated with better outcomes [74]. After gastrectomy, 41.5% of patients suffer from sarcopenia, which highlights the importance of a sufficient nutritional status [75].…”

Section: Discussionmentioning

confidence: 99%

The Association of Gut Microbiota and Complications in Gastrointestinal-Cancer Therapies

et al. 2021

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The therapy of gastrointestinal carcinomas includes surgery, chemo- or immunotherapy, and radiation with diverse complications such as surgical-site infection and enteritis. In recent years, the microbiome’s influence on different diseases and complications has been studied in more detail using methods such as next-generation sequencing. Due to the relatively simple collectivisation, the gut microbiome is the best-studied so far. While certain bacteria are sometimes associated with one particular complication, it is often just the loss of alpha diversity linked together. Among others, a strong influence of Fusobacterium nucleatum on the effectiveness of chemotherapies is demonstrated. External factors such as diet or specific medications can also predispose to dysbiosis and lead to complications. In addition, there are attempts to treat developed dysbiosis, such as faecal microbiota transplant or probiotics. In the future, the underlying microbiome should be investigated in more detail for a better understanding of the precipitating factors of a complication with specific therapeutic options.

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Section: Discussionmentioning

confidence: 99%

The Association of Gut Microbiota and Complications in Gastrointestinal-Cancer Therapies

et al. 2021

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“…Another strength of this study is that we attempt to identify the relationship between immunonutrition and fecal microbiome. In colorectal cancer, the role of microbiome in carcinogenesis and postoperative complications has been studied in various ways, and a recent review suggested that malnutrition may be associated with the deterioration of intestinal microbiome, resulting in a higher incidence of postoperative complications [21]. Through this study, we anticipate to arrive at a more definite conclusion regarding the effect of preoperative immunonutrition in patients undergoing surgery for colon cancer.…”

Section: Discussionmentioning

confidence: 88%

Effect of preoperative immunonutrition on outcomes of colon cancer surgery: study protocol for a randomized controlled trial

Lee

Yeom

Kim

et al. 2020

Trials

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Background: Current guidelines recommend the prescription of immune-enriched oral nutritional supplements for malnourished patients before major gastrointestinal surgery. However, the benefit of preoperative immunonutrition is still controversial. This randomized controlled trial aims to evaluate the effect of preoperative immunonutrition on the outcomes of surgery for colon cancer. Methods/design: Patients with primary colon cancer will be included as study participants after screening. They will be randomly assigned (in a ratio of 1:1) to receive preoperative immunonutrition added to the normal diet (experimental arm) or consume normal diet alone (control arm). Patients in the experimental arm will receive oral supplementation (400 mL/day) with arginine and ω-3 fatty acids for 7 days before elective surgery. The primary endpoint is the rate of infectious complications, while the secondary endpoints are postoperative complication rate, change in body weight, length of hospital stay, and nature of fecal microbiome. The authors hypothesize that the rate of infectious complications would be 13% in the experimental arm and 30% in the control arm. With a twosided alpha of 0.05 and a power of 0.8, the sample size is calculated as 176 patients (88 per arm). Discussion: Although there have been many studies demonstrating significant benefits of preoperative immunonutrition, these were limited by a small sample size and potential publication bias. Despite the recommendation of immunonutrition before surgery in nutritional guidelines, its role in reduction of rate of infectious complications is still controversial. This trial is expected to provide evidence for the benefits of administration of preoperative immunonutrition in patients with colon cancer.

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“…As will be discussed later, obesity itself does not predispose a patient from being malnourished. Indeed, the opposite can be quite true, and many patients with obesity demonstrate protein calorie malnutrition and sarcopenia, as demonstrated by low albumin and prealbumin levels as well as muscle wasting on cross-sectional imaging [59,60]. Methods to reduce visceral and systemic adiposity while improving protein stores preoperatively are imperative to improve operative and postoperative outcomes [61].…”

Section: Obesitymentioning

confidence: 99%

Preoperative Evaluation in Colorectal Patients

Landmann

Francone

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Patients undergoing elective abdominal colorectal operations are in the "intermediate" risk group for perioperative morbidity and mortality. • Recognition and optimization of concomitant patient pathophysiology are paramount in minimizing sepsis (anastomotic leak, surgical site infection), complications, and overall morbidity. • These include cardiopulmonary, renal, metabolic, and endocrine physiology and other pathophysiologic risk factors and derangements (such as frailty and immunosuppression). • Implementation of ACC/AHA guidelines and evidencebased medical management leads to improved efficiencies with minimization of extraneous testing and delays, while preserving low complication rates. • Corticosteroids and immunosuppression remain significant determinants of morbidity in patients undergoing intestinal colorectal surgery. • Prehabilitation of the frail and elderly patient is critical in optimizing patients for surgery while attempting to mitigate perioperative morbidity and mortality. Evaluation of the Routine Colorectal Patients In Office by SurgeonA detailed history and physical examination are paramount to the evaluation and optimal management of a preoperative patient. A thorough review of the patient's chief complaint as well as associated signs and symptoms and confounding issues or factors is necessary to synthesize an appropriate diagnosis and perioperative plan. Careful attention to the patient's medical comorbidities and past surgical history, as well as review and reconciliation of the patient's medications, is relevant to help coordinate perioperative management and operative planning. In patients who require multidisciplinary care such as inflammatory bowel disease and rectal cancer, it is imperative to ascertain the other specialists' contact information for optimal coordination of care. Similarly, specialist communication should be coordinated for patients who have significant cardiopulmonary disease or other major medical comorbidities. Personal review of source documentation for pertinent pathology, endoscopy, and radiological findings is critical in establishing a diagnosis and individualized plan of care. In many cases, the above may require coordination among more than one physician and more than one healthcare organization to achieve optimal perioperative care and outcomes, while minimizing morbidity.

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Influence of nutritional status on postoperative outcome in patients with colorectal cancer – the emerging role of the microbiome

Cited by 9 publications

References 65 publications

The Association of Gut Microbiota and Complications in Gastrointestinal-Cancer Therapies

The Association of Gut Microbiota and Complications in Gastrointestinal-Cancer Therapies

Effect of preoperative immunonutrition on outcomes of colon cancer surgery: study protocol for a randomized controlled trial

Preoperative Evaluation in Colorectal Patients

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