Nutritional interventions in prehabilitation for cancer surgery

Abstract

Purpose of review Nutrition remains a key focus in the preoptimization of patients undergoing cancer surgery. Given the catabolic nature of cancer, coupled with the physiological insult of surgery, malnutrition (when assessed) is prevalent in a significant proportion of patients. Therefore, robust research on interventions to attenuate the detrimental impact of this is crucial. Recent findings As a unimodal prehabilitation intervention, assessment for malnutrition is the first step, as universal supplementation has not been shown to have a significant impact on outcomes. However, targeted nutritional therapy, whether that is enteral or parenteral, has been shown to improve the nutritional state of patients’ presurgery, potentially reducing the rate of postoperative complications such as nosocomial infections. As part of multimodal prehabilitation, the situation is more nuanced given the difficulty in attribution of effects to the differing components, and vast heterogeneity in intervention and patient profiles. Summary Multimodal prehabilitation is proven to improve length of hospital stay and postoperative outcomes, with nutrition forming a significant part of the therapy given. Further work is required to look at not only the interplay between the optimization of nutritional status and other prehabilitation interventions, but also how to best select which patients will achieve significant benefit.

Fat malabsorption in pancreatic cancer: Pathophysiology and management

“…39,52,61 In the hospitalized patient, supplemental PN should be considered when the patient is unable to meet >50% of nutrition needs through EN or during prehabilitation for those planning to undergo a surgical intervention for cancer treatment. 62…”

Perioperative Immunosuppressive Factors during Cancer Surgery: An Updated Review

“…Most published studies evaluated the effects of optimized nutrition and physical exercise in cancer patients. Nutritional therapy and supplementation may improve the nutritional status of patients in whom cancer disease induces hypercatabolism [4]. Immuno-nutrition is a pharmaco-nutriment associating arginine (to increase the synthesis of lymphocytes), polysaturated fatty acids (to decrease inflammatory response and surgical stress), nucleotides (to restore immune functions), and guar fibers (to stimulate the maturation of lymphocytes and macrophages) [5].…”

Editorial: harnessing nutritional and technological interventions for optimal health outcomes

“…Highlighting the essential role of nutrition, especially for patients with cancer, Wall et al [4] explore the importance of a nuanced approach to nutritional prehabilitation in the context of cancer surgery. They advocate for malnutrition screening, and the used of enteral nutrition when needed.…”