Adherence to ESPEN guidelines and associations with postoperative outcomes in upper gastrointestinal cancer resection: results from the multi-centre NOURISH point prevalence study

Deftereos, Irene; Arslan, Janan; Carter, Vanessa; Isenring, Elisabeth; Kiss, Nicole; Cardamis, Anna; Dorey, Annika; Ottaway, Aurora; Maguire, B; Cleeve, Brydie; Davis, Caitlin; Zoanetti, Carmel; Gray, C. M.; Choong, Christine; Douglas, Claire A; Nixon, Claire; Platt, Daniel E.; Quinn, Eleanor; Simpson, Eliza; Hamdorf, Emma; McNamara, Emma; Whelan, Emma; Jegendran, Gayathri; Moore, Georgia; Lockwood, Georgina; McNamara, Jacqueline; Corrigan, Jemma; Haaksma, Karina; Fox, Kate; Furness, Kate; Cochrane, Kiah Witney; Huynh, Kieu; Lee, Kai Chyi; Hames, Nadia L.; Hendricks, Nadia; Page, Naomi; Brooks, Natalie; Nevin, Lauren; Parfrey, L.; Putrus, Emma; Pons, Rachel; Hoevenaars, Roy; Singh, Surjit; McCoy, Simone M.; Wallin, Siobhan; Mexias, Stella; Daniells, Suzie; Storr, Tayla; Robertson, Tom; Brown, Teresa M.

doi:10.1016/j.clnesp.2021.10.019

Cited by 11 publications

(6 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another set of possible discordant data lies in the relatively low rate of patients who received perioperative nutritional support (before and/or after surgery), in total less than one quarter, lower compared with previous experiences ( 38 ). For this reason and heterogeneous management (including oral immunonutrient supplementation, enteral feeding, and parenteral support/nutrition, often in combination) used in the setting of institutional protocols, or to correct malnutrition, or to support patients with complications, or even administered for all of these motivations, perioperative nutritional support was not included in the SEM analysis in relation to the outcomes of interest.…”

Section: Discussionmentioning

confidence: 93%

The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer

et al. 2023

View full text Add to dashboard Cite

BackgroundMini-invasive surgery (MIS), ERAS, and preoperative nutritional screening are currently used to reduce complications and the length of hospital stay (LOS); however, inter-variable correlations have seldom been explored. This research aimed to define inter-variable correlations in a large series of patients with gastrointestinal cancer and their impact on outcomes.MethodsPatients with consecutive cancer who underwent radical gastrointestinal surgery between 2019 and 2020 were analyzed. Age, BMI, comorbidities, ERAS, nutritional screening, and MIS were evaluated to determine their impact on 30-day complications and LOS. Inter-variable correlations were measured, and a latent variable was computed to define the patients' performance status using nutritional screening and comorbidity. Analyses were conducted using structural equation modeling (SEM).ResultsOf the 1,968 eligible patients, 1,648 were analyzed. Univariable analyses documented the benefit of nutritional screening for LOS and MIS and ERAS (≥7 items) for LOS and complications; conversely, being male and comorbidities correlated with complications, while increased age and BMI correlated with worse outcomes. SEM analysis revealed that (a) the latent variable is explained by the use of nutritional screening (p0·004); (b) the variables were correlated (age–comorbidity, ERAS–MIS, and ERAS–nutritional screening, p < 0·001); and (c) their impact on the outcomes was based on direct effects (complications: sex, p0·001), indirect effects (LOS: MIS-ERAS-nutritional screening, p < 0·001; complications: MIS-ERAS, p0·001), and regression-based effects (LOS: ERAS, MIS, p < 0·001, nutritional screening, p0·021; complications: ERAS, MIS, p < 0·001, sex, p0·001). Finally, LOS and complications were correlated (p < 0·001).ConclusionEnhanced recovery after surgery (ERAS), MIS, and nutritional screening are beneficial in surgical oncology; however, the inter-variable correlation is reliable, underlying the importance of the multidisciplinary approach.

show abstract

Section: Discussionmentioning

confidence: 93%

The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Nutrition support is an essential component of management in upper gastrointestinal cancer resection and most data show worse surgical outcomes in malnourished patients [50]. In an Australian multicentre prevalence study, a poor adherence to the majority of assessed ESPEN guidelines was shown and poor nutritional adequacy was associated with increased LOS and complications [51].…”

Section: Focusing On Key Eras Componentsmentioning

confidence: 99%

State of the art of enhanced recovery after surgery (ERAS) protocols in esophagogastric cancer surgery: the Western experience

et al. 2022

View full text Add to dashboard Cite

Enhanced recovery after surgery programs provide a framework to standardize care processes and improve outcomes. The results of this multimodal and multidisciplinary approach have been beneficial across several surgical procedures in reducing morbidity and hospital stay without increasing readmissions.The implementation of these programs in esophagogastric cancer surgery has been challenging due to the complexity of both procedures and the high risk of complications, with most of the evidence coming from the East. Despite the limited evidence for ERAS in esophageal surgery in Western centers, systematic reviews and meta-analysis have confirmed that ERAS programs reduce pulmonary complications and hospital stay after esophagectomy without increasing readmissions. Single-center Western studies have shown that implementing gastrectomy ERAS protocols resulted in a reduction of the use of nasogastric tube and intrabdominal drains, accelerated advancement of diet and reduced length of stay, without increasing complications. Despite these beneficial outcomes, it has become clear that there has been wide heterogeneity and absence of standardization in the number and definition of the ERAS components. The development of ERAS consensus guidelines including procedure-specific components may reduce this variability.Regardless of growing evidence of effectiveness, adherence to ERAS protocols in esophagogastric surgery remains challenging and had great variability with a wide adherence rate (5.6-100%) for single item.As initial experiences have demonstrated to be so beneficial, an implementation of the protocols with multidisciplinary team engagement and feedback based on periodic audits is desirable. Pre-and posthabilitation are emerging concepts that are becoming relevant for the implementation of these protocols.

show abstract

“…Malnutrition negatively impacts quality of life, treatment adherence, and survival among pancreatic cancer patients and results in unnecessary hospitalizations [ 3 , 4 , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. Despite its devastating effects, malnutrition is underdiagnosed and undertreated among pancreatic cancer patients [ [14] , [15] , [16] ]. Clinical guidelines recommend malnutrition screening for all cancer patients and medical nutrition therapy (MNT) for cancer patients at-risk for malnutrition [ [17] , [18] , [19] , [20] ].…”

Section: Introductionmentioning

confidence: 99%

“…Clinical guidelines recommend malnutrition screening for all cancer patients and medical nutrition therapy (MNT) for cancer patients at-risk for malnutrition [ [17] , [18] , [19] , [20] ]. Currently, less than a quarter of pancreatic cancer patients identified as at-risk for malnutrition receive MNT [ 15 , 16 ]. Therefore, interventions are needed to increase access to malnutrition screening and MNT among pancreatic cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Support Through Remote Observation and Nutrition Guidance (STRONG), a digital health intervention to reduce malnutrition among pancreatic cancer patients: A study protocol for a pilot randomized controlled trial

Turner,

Kim,

Gonzalez

et al. 2024

Contemporary Clinical Trials Communications

View full text Add to dashboard Cite

Adherence to ESPEN guidelines and associations with postoperative outcomes in upper gastrointestinal cancer resection: results from the multi-centre NOURISH point prevalence study

Cited by 11 publications

References 32 publications

The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer

The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer

State of the art of enhanced recovery after surgery (ERAS) protocols in esophagogastric cancer surgery: the Western experience

Support Through Remote Observation and Nutrition Guidance (STRONG), a digital health intervention to reduce malnutrition among pancreatic cancer patients: A study protocol for a pilot randomized controlled trial

Contact Info

Product

Resources

About