Download Periopperative nutritional support in GI surgery

Periopperative nutritional
support in GI surgery
: Past, Present, and future on
oncology perspective observation
and evidence base
Sirikan Yamada, MD
Division of Gastrointestinal Surgery and Endoscopy
Department of Surgery
Faculty of Medicine
Chiang Mai University, Chiang Mai, Thailand
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There is a high incidence of
malnutrition in hospitalized patients
undergoing gastrointestinal surgery.
Malnutrition is clearly associated with
increased morbidity and mortality after
major gastrointestinal surgery.
Cancer cachexia may be an
immunologic phenomenon. Routine
preoperative TPN may not proper for
all types of cancer.
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The efficacy of perioperative nutrition support to
reduce surgical complications and mortality
significantly has been an area of active clinical
investigation over the past three decades.
From multiple prospective, randomized trials,
significant benefit from perioperative nutritional
support has been demonstrated in severely
malnourished patients undergoing major surgery.
Results of the prospective, randomized trials
studying the effects of perioperative nutrition
support on patients undergoing gastrointestinal
surgery are reviewed and critically analyzed.
Why ?
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Disease causes starvation and defect
of immunity
Major stress on elective complex GI
Surgery; especially, on upper GI
cancer surgery
Underestimation for nutritional risk by
surgeon
WHO?
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Nutritional Risk Screening
SGA
BMI? In ASIAN
Which type of operation
Which type of formula, and
When?
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For Complex Surgery Preparation
Enteral or TPN ?
BOTH !
, and Early as soon as possible.
HOW?
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Need not to do over TPN calory or
over feeding.
Use the actual weight.
Normal energy base requirement.
Immuno-nutrition
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TPN + glutamine dipeptide in bone
marrow transplantation patients.
In Esophageal cancer patients,
preoperative TPN + amino acids+
certain fatty acids decrease
postoperative infections, and it was
improved postoperatively when given
enteral nutrition supplemented with
arginine and omega 3-fatty acids
Oncology 1996:10
The effects of perioperative oral enteral support with
glutamine-added elemental formulas in patients with
gastrointestinal cancers. A prospective, randomized,
clinical study
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32patients with gastrointestinal (GI)
system cancer 33% of the daily energy
requirements was covered with
polymeric enteral formulas (Ensure®) in
the control group (n =16), and with
glutamine enriched elemental formulas
(Alitraq®) in the study group (n = 16).
ERDEM Nihal Zekiye, 2002
at the4 th Surgical Department of the Ankara Numune Research and
Education Hospital. In addition to hospital diet
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Patients had these regimens 7 days
in the preoperative period and 10
days in the postoperative period.
The effects of additional enteral
feeding support on anthropometric
and plasma protein levels in the
preoperative (days 1 and 7) and
postoperative (days1 and 10)
periods were assessed In both
groups
no differences were observed among the
anthropometric assessments, except for the
Nutritional Risk Index. Total protein, albumin,
transferrin, prealbumin, NRI, and nutritional
prognostic index were affirmatively affected by both
enteral formulas.
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***** However, the increments of these
parameters were higher and more significant in
the study group. Energy, protein, carbohydrate and
lipid consumption of the patients were managed as
the referred amounts. Pre- and post-operative
nutritional support with glutamine enriched enteral
formulas had beneficial effects on the patients with
GI cancers.
PREVENTION
is better than
ONLY TREATMENT