Is there a rationale for perioperative nutrition therapy in the times of ERAS?

Weimann, Arved

doi:10.1515/iss-2019-0012

Cited by 10 publications

(8 citation statements)

References 44 publications

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“…To receive sufficient adjuvant treatment, perioperative nutrition status of patients before and after the ERAS program is becoming increasingly important and warrants further in-depth investigation. 50,51 In conclusion, even though the shortening of LOS and the reduction of the total complication rate were achieved in this modified ERAS program for PD, postoperative oral energy and protein intakes were not recovered sufficiently in the first two postoperative weeks; this is especially true for patients with postoperative complications. The nutrition deficiency had to be compensated by early EN.…”

Section: Discussionmentioning

confidence: 87%

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Postoperative oral energy and protein intakes for an enhanced recovery after surgery program incorporating early enteral nutrition for pancreaticoduodenectomy: A retrospective study

et al. 2021

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Background Although postoperative early oral feeding in the enhanced recovery after surgery (ERAS) program for pancreaticoduodenectomy (PD) is deemed safe, the assessment of oral intakes has been insufficient. This study aimed to investigate postoperative oral intakes and the effectiveness of an ERAS program incorporating early enteral nutrition (EN). Methods In total, 203 patients with PD were enrolled retrospectively. The first group (group E1; n = 61) comprised 11 ERAS care elements, whereas the second group (group E2; n = 106) comprised 19 elements. The control group (group C; n = 36) was managed using traditional care before ERAS was implemented. Postoperative energy and protein requirements were estimated at 25–30 kcal per kilogram of ideal body weight and 1.2–1.5 g per kilogram of ideal body weight, respectively, and were investigated along with the length of hospital stay (LOS). Results The oral energy and protein intakes from the diets in the ERAS groups at postoperative day 7 significantly increased compared with those in group C. Intakes in groups E1 and E2 were not significantly different and provided <30% of the requirements. However, the total intakes, which were compensated by EN, were maintained at >80% of the requirements. LOS was significantly shorter in groups E1 (31 days) and E2 (19 days) than in group C (52 days). Conclusions Postoperative early oral energy and protein intakes of this modified ERAS program failed to meet the dietary requirements. However, early EN compensated for the shortages and contributed to the reduction of LOS.

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Section: Discussionmentioning

confidence: 87%

“…Many patients with pancreatic head cancer will be prescribed both neoadjuvant and postoperative adjuvant chemotherapy. To receive sufficient adjuvant treatment, perioperative nutrition status of patients before and after the ERAS program is becoming increasingly important and warrants further in‐depth investigation 50,51 …”

Section: Discussionmentioning

confidence: 99%

Postoperative oral energy and protein intakes for an enhanced recovery after surgery program incorporating early enteral nutrition for pancreaticoduodenectomy: A retrospective study

et al. 2021

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“…At the area of enhanced recovery after surgery (ERAS), bowel rest has limited place in the management of surgical patients: on the contrary, there is an encouragement to use the gut for feeding as early as possible [ 45 , 46 ▪ ]: using oral nutrition supplements for a few days may complete this strategy [ 47 ]. The same early start is recommended for any intubated medical or surgical patient [ 1 ▪▪ ].…”

Section: When To Rest and When To Feedmentioning

confidence: 99%

Management of gastrointestinal failure in the adult critical care setting

Berger

Hurni

2022

Current Opinion in Critical Care

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Purpose of reviewGastrointestinal failure is a polymorphic syndrome with multiple causes. Managing the different situations from a practical, metabolic, and nutritional point of view is challenging, which the present review will try to address. Recent findingsAcute gastrointestinal injury (AGI) has been defined and has evolved into a concept of gastrointestinal dysfunction score (GIDS) built on the model of Sequential Organ Failure Assessment (SOFA) score, and ranging from 0 (no risk) to 4 (life threatening). But there is yet no specific, reliable and reproducible, biomarker linked to it. Evaluating the risk with the Nutrition Risk Screening (NRS) score is the first step whenever addressing nutrition therapy. Depending on the severity of the gastrointestinal failure and its clinical manifestations, nutritional management needs to be individualized but always including prevention of undernutrition and dehydration, and administration of target essential micronutrients. The use of fibers in enteral feeding solutions has gained acceptance and is even recommended based on microbiome findings. Parenteral nutrition whether alone or combined to enteral feeding is indicated whenever the intestine is unable to process the needs.

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“…Improvement of patient nutritional status during NAT and prior to surgery may lead to better surgical outcomes and be an important part of oncological management[ 23 , 24 ]. The best nutritional strategy to manage PDAC patients is still under debate, even if an appropriate nutritional support represents an important therapeutic strategy in the preoperative period[ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant treatment: A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma

Trestini¹,

Cintoni²,

Rinninella³

et al. 2021

WJGS

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Patients affected by pancreatic ductal adenocarcinoma (PDAC) frequently present with advanced disease at the time of diagnosis, limiting an upfront surgical approach. Neoadjuvant treatment (NAT) has become the standard of care to downstage non-metastatic locally advanced PDAC. However, this treatment increases the risk of a nutritional status decline, which in turn, may impact therapeutic tolerance, postoperative outcomes, or even prevent the possibility of surgery. Literature on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications, length of hospital stay, and readmission rate, while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still missing. Particularly, appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical trauma. In this regard, NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program, aiming to increase the PDAC patient’s capacity to complete the planned therapy and potentially improve clinical and survival outcomes. Given these perspectives, this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.

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Is there a rationale for perioperative nutrition therapy in the times of ERAS?

Cited by 10 publications

References 44 publications

Postoperative oral energy and protein intakes for an enhanced recovery after surgery program incorporating early enteral nutrition for pancreaticoduodenectomy: A retrospective study

Postoperative oral energy and protein intakes for an enhanced recovery after surgery program incorporating early enteral nutrition for pancreaticoduodenectomy: A retrospective study

Management of gastrointestinal failure in the adult critical care setting

Neoadjuvant treatment: A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma

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