Postoperative complications in gastrointestinal cancer patients: The joint role of the nutritional status and the nutritional support

Perioperative nutrition is still a surgical orphan: results of a Swiss–Austrian survey

“…Despite some disparities exist, it is now generally accepted that perioperative nutrition is beneficial for patients undergoing major GI surgery by reducing overall complication rates, postoperative infectious complications and length of hospital stay (Waitzberg et al, 2006;Weimann et al, 2006;Stratton and Elia, 2007;Jones and Heyland, 2008;Sorensen et al, 2008). Immunonutrition, containing arginine, ribonucleic acid and n-3 fatty acids should be preferred as standard nutritional formula in patients undergoing GI cancer surgery (Waitzberg et al, 2006;Weimann et al, 2006;Xu et al, 2006;Bozzetti et al, 2007;Cerantola et al, 2011). Contents and importance of IN were respected by only about half of the responders in our study.…”

“…Contents and importance of IN were respected by only about half of the responders in our study. Nutritional support is most beneficial if given 5-7 days preoperatively with an optional prolongation in the post-operative course (Waitzberg et al, 2006;Weimann et al, 2006;Xu et al, 2006;Bozzetti et al, 2007). However, the recommended timing and duration of perioperative nutritional support were often not appropriate; therefore potential benefits of perioperative nutrition have the risk of getting lost.…”

“…Up to 30% of centres rarely or never assessed patients' nutritional status preoperatively, which has to be considered as an important shortcoming in modern GI surgery (ASPEN guidelines, 2002;Weimann et al, 2006;Bozzetti et al, 2007;Sorensen et al, 2008). Furthermore, 48% evaluated their patients' nutritional status only at admission or even postoperatively, which is too late for an effective nutritional intervention as outlined below.…”

“…Nutritional support mainly aims to decrease post-operative morbidity, that is, infectious complications, and must be therefore considered as a prophylactic intervention (Weimann et al, 2006;Bozzetti et al, 2007;Stratton and Elia, 2007;Cerantola et al, 2011). A typical feature of any prophylaxis is that a large number of patients must be treated to achieve a beneficial effect for the whole patient group, although it remains difficult or even impossible to predict a positive effect for the individual patient.…”

“…This is particularly related to the fact that even severe pre-existing comorbidities, like cardiovascular disease, pulmonary restrictions, impaired renal function and malnutrition, as well as age are no longer considered as contraindications for major GI surgery. There is increasing evidence that nutritional screening and therapy are important adjuncts in modern surgical care as 40% of surgical patients are malnourished (Bozzetti et al, 2007;Schiesser et al, 2008;Sorensen et al, 2008;Hiesmayr et al, 2009;Schindler et al, 2010).…”