A Meta-Analysis of the Effect of Combinations of Immune Modulating Nutrients on Outcome in Patients Undergoing Major Open Gastrointestinal Surgery

Marimuthu, Kanagaraj; Varadhan, Krishna K.; Ljungqvist, Olle; Lobo, Dileep N.

doi:10.1097/sla.0b013e318252edf8

Cited by 204 publications

(135 citation statements)

References 55 publications

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“…However, a recent meta-analysis suggested that preoperative only IMN did not improve outcomes when compared to preoperative isonitrogenous ONS. 70 Additional meta-analyses have demonstrated that postoperative IMN reduces infectious complications, 72,[74][75][76][77] including the recent analysis from Ljungqvist et al 72,[74][75][76][77] One meta-analysis of early enteral postoperative IMN also demonstrated a reduction in anastomotic leaks. 78 Limitations of these data include many early IMN studies informing that these meta-analyses were not balanced with an isocaloric, isonitrogenous controls.…”

Section: Role Of Perioperative Imnmentioning

confidence: 99%

“…63 Evidence suggests that patients undergoing high-risk GI surgery were the most likely to benefit, possibly due to the higher perioperative risk of complication. 72 Due to the large number of small to medium size trials, many conclusions have been drawn from meta-analyses. In their landmark meta-analysis in 2011, Drover et al 73 demonstrated a 40% reduction in perioperative infectious complications with IMN.…”

Section: Role Of Perioperative Imnmentioning

confidence: 99%

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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Wischmeyer

Carli

Evans

et al. 2018

Anesthesia &Amp; Analgesia

332

327

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Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.

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Section: Role Of Perioperative Imnmentioning

confidence: 99%

Section: Role Of Perioperative Imnmentioning

confidence: 99%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Wischmeyer

Carli

Evans

et al. 2018

Anesthesia &Amp; Analgesia

332

327

View full text Add to dashboard Cite

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“…Although there is an ongoing debate on the subject and opposing data in the literature, perioperative use of immune-modulating enteral products in patients undergoing major abdominal cancer surgery independent of the patient's nutritional status is recommended in the current ESPEN guidelines for enteral nutrition (16,25,26). These immunonutrition products are reimbursed by the state in Turkey and one would expect the use of such formulas for appropriate indications.…”

Section: Discussionmentioning

confidence: 99%

Surgeons’ approach toward clinical nutrition: A survey-based study

et al. 2017

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Surgeons' approach toward clinical nutrition: A survey-based study INTRODUCTIONIt is a well-known fact that surgical patients with a suboptimal nutritional status have impaired wound healing, impaired immune responses, increased organ dysfunction, delayed recovery, and increased morbidity and mortality (1, 2). However, even though the prevalence of malnutrition is high and may exceed 60% in patients undergoing gastrointestinal or major elective surgeries, many cases of malnutrition probably go unnoticed and untreated in surgical wards (3-6). As the attending specialist, the surgeon must organize nutritional screening and treatment of the patients in a surgical clinic. This necessitates surgeons to have sufficient knowledge of nutrition and to be very sensitive about the nutritional status of their patients. Unfortunately, limited data on the degree of attention paid to this important subject by surgeons suggests that the awareness of nutritional principles may be insufficient among this group of clinicians (5-7). This study displays the results of a survey designed to define the current attitudes of Turkish surgeons toward nutritional screening and support. MATERIAL AND METHODSA questionnaire consisting of 13 multiple choice questions was designed by the study authors to investigate the surgeons' approaches to perioperative nutritional screening and therapy of the general surgery patient (Appendix). This survey was e-mailed to 1500 general surgeons, all of whom had already finished the training program in surgery and were working in different hospitals in the Turkish Republic. A cover letter that stood for an informed consent was also attached to this e-mail explaining the purpose of this project and assuring the participants of anonymity.Since this study was based on a survey answered by doctors, no approval was obtained from any ethics committees; however, the study was conducted according to the Helsinki Declaration.Only the surgeons who stated that they screened the nutritional status of their patients were asked to answer the questions from 5 to 11 as it was essential to take part in nutritional screening in daily clinical practice to answer these questions.The answers of each surgeon were stored in a database and cross-queries were made over these responses. The surgeons who were working in state hospitals were compared with the surgeons working in teaching Objective: Although many surgical patients face postoperative problems due to a poor nutritional status, there is evidence that many cases of malnutrition still go unnoticed and untreated in surgical wards. This study aims to define the current attitudes of surgeons toward nutritional screening and support. Material and Methods:A questionnaire with 13 questions was e-mailed to 1500 surgeons. Cross-queries were made over the responses. Results:The response rate was 20.9%. Most of the respondents (89.5%) implemented nutritional screening. However, only 24.6% of these surgeons screened every patient for malnutrition. The time to initiate nutritional suppor...

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“…При наличии стойкой дисфагии у больных данной группы на первом этапе осуществляют эндоскопическое стентирование, про-ведение зонда либо гастростомию, поскольку на началь-ном этапе облучения дисфагия может нарастать вследствие отека. Своевременное и правильное назначение гиперни-трогенных смесей (смесей с повышенным содержанием белка) для энтерального питания способно остановить процесс потери массы тела, нормализовать питательный статус больных, а также способствовать профилактике осложнений противоопухолевой терапии, в частности ин-фекционных [12,13].…”

Section: показания к лечебному питанию и способы нутритивной поддержкиunclassified

Malnutrition and methods of its correction in patients with malignant tumors of the esophagus and stomach

Khomyakov¹,

Хороненко²,

Ermoshina³

2016

Onkol. Z. im. P.A. Gercena

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33Недостаточность питания является одной из актуаль-ных проблем современного здравоохранения. Эта одна из форм нарушения питания, которая может быть след-ствием неадекватного потребления питательных веществ, мальабсорбции, нарушения метаболизма или увеличения энергетических потребностей, что характерно и для он-кологических больных. Согласно данным различных ис-следований, почти 1 / 3 пациентов, госпитализированных в стационар, входят в группу риска недостаточности пи-тания. В особенности это касается онкологических боль-ных, у которых нутритивная недостаточность встречается в 40-80% случаев [1,2].Общеизвестно, что развитие опухолевого процесса часто сопровождается нутритивной недостаточностью.Особенно это касается пациентов с опухолями торакоаб-доминальной локализации, при которых, помимо общего метаболического воздействия опухоли на организм, часто развиваются явления дисфагии и стеноза, препятствую-щие адекватному поступлению нутриентов.Исследования, проведенные группой ECOG в 2003 г., включавшего 3047 онкологических больных, установили, что частота нутритивной недостаточности при опухоле-вом поражении органов желудочно-кишечного тракта варьирует от 70 до 83%. Наиболее часто нутритивная не-достаточность встречается при раке желудка и пищевода.У 4 из 20 больных недостаточность питания является непосредственной причиной смерти.Хомяков Владимир Михайлович -канд. мед. наук, рук. торакоабдоминального отд-ния отдела торакоабдоминальной онкохирургии; e-mail: vladimirkhom@mail.ru © Коллектив авторов, 2016 doi: 10.17116/onkolog20165533-37 Проблема нутритивной недостаточности и методы ее коррекции у больных со злокачественными опухолями пищевода и желудка в.М. ХоМяКов, в.Э. ХороненКо, а.Д. ерМошИна Московский научно-исследовательский онкологический институт им. П.а. герцена -филиал Фгбу «национальный медицинский исследовательский радиологический центр» (дир. -чл.-корр. ран а.Д. Каприн) Минздрава россии, Москва, россия частота нутритивной недостаточности среди онкологических больных достигает 40-80%. она является одним из ос-новных осложнений онкологического процесса. недостаточность питания приводит к ухудшению непосредственных и отдаленных результатов лечения, ухудшению качества жизни больных, невозможности реализации протоколов комби-нированного и комплексного лечения. нутритивную поддержку следует рассматривать в качестве обязательного компо-нента сопроводительной терапии у онкологических больных, что особенно актуально при локализации опухоли в верхних отделах желудочно-кишечного тракта. Приведены данные литературы по проблеме нутритивной недостаточности и ее последствий у больных со злокачественными опухолями пищевода и желудка. обсуждаются показания и способы нутри-тивной поддержки на различных этапах хирургического и комбинированного лечения, а также протоколы нутритивной терапии у больных раком желудка и пищевода, применяемые в МнИоИ им. П.а. герцена. The rate of malnutrition among cancer patients is as high as 40-80%. It is one of the main complications of the oncological process. Malnutrition leads to poorer ...

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A Meta-Analysis of the Effect of Combinations of Immune Modulating Nutrients on Outcome in Patients Undergoing Major Open Gastrointestinal Surgery

Abstract: IMN is beneficial in reducing postoperative infectious and noninfectious complications and shortening hospital stay in patients undergoing major open gastrointestinal surgery.

Cited by 204 publications

References 55 publications

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Surgeons’ approach toward clinical nutrition: A survey-based study

Malnutrition and methods of its correction in patients with malignant tumors of the esophagus and stomach

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