Knowledge, attitudes and practice of surgeons regarding nutritional support in CRS and HIPEC patients: Are we missing something?

Abstract

Nutrition’s impact on the surgical outcome has been established in various surgical specialties. However, data addressing the nutritional aspect following surgery for peritoneal surface malignancies are considered scarce. We aim to evaluate the knowledge, attitudes, and practice of surgeons regarding their nutritional support for patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) via a survey directed to self‐evaluate nutritional knowledge, screening, and practice toward patients. The survey was submitted to the attendees of the International Regional Cancer Therapies Symposium. The response rate was 37% (56/151). Most surgeons estimated their knowledge and malnutrition screening skills in CRS and HIPEC to be ‘adequate’ or better. Only 35.19% reported the availability of nutritional screening and assessment tools for CRS and HIPEC patients. 86.5% of participants stated that their CRS and HIPEC patients have access to a dietitian on inpatient and outpatient basis. However, only 32.69% reported to ‘always’ consult a dietitian. Otherwise, the involvement of a nutrition specialist is considered on variable basis. Despite the consensus on the importance of nutrition in HIPEC patients, there appears to be a profound underutilization of nutrition specialists in the patients’ management, which may have had in impact on their surgical outcome.

Nutrition practices with a focus on parenteral nutrition in the context of enhanced recovery programs: An exploratory survey of gastrointestinal surgeons

“…In contrast, ESPEN guidelines recommend nutritional status assessment before and after major surgery, and in every patient undergoing cancer-related surgery, the most frequent reason for GI surgery in this survey [6,24]. Underutilization of nutritional screening has been reported in other surgeon surveys [25,26]. For example, many general surgeons in Turkey only conducted nutritional screening in patients who looked malnourished (41.1%), with just 24.6% screening all individuals [27].…”

Recognising undernutrition in a community hospital: the nursing judgement is insufficient

“…Therefore, nutritional screening is strongly encouraged in hospitals and residential settings [ 19 ]. However, the attention given to managing nutritional problems in the elderly is considered poor [ 5 ], and data on undernutrition in intermediate care are scarce.…”

“…Nevertheless, screening for undernutrition is considered poor in older adults [ 5 ]. Previous studies have shown a lack of attentive healthcare around clinical nutrition by professionals [ 6 ].…”

Nutritional assessment in surgical oncology: An ESSO-EYSAC global survey

“…The positive trend reported for surgeons dedicated to PSM, is consistent with a previous study conducted among the attendees of the International Regional Cancer Therapies Symposium in 2017. Although only 35.19% reported the availability of screening tools, 86.5% of participants stated that their CRS/HIPEC patients have access to a dietician referral [15]. This is of striking importance, since the vast majority of patients undergoing HIPEC and CRC are treated with multiple abdominal organ resections and chemotherapy drugs; malnutrition in these patients is reported with a prevalence of 33% and correlated with hospitalization and postoperative infections [8].…”