Preoperative nutritional support for patients undergoing elective colorectal cancer surgery - does it really work?

Abstract

Aims. This study aimed to evaluate the effect of preoperative administration of oral nutritional supplements (ONS) on the self-sufficiency, physical status, and nutritional status of patients undergoing elective colorectal resections. Methods. This prospective randomized clinical trial was conducted in a single institution. Patients scheduled to undergo colorectal cancer surgery were randomized to either ONS twice per day for 7 days before surgery or no ONS. Results. We enrolled 120 patients in the study. The two study groups had comparable hospital stay times and comparable numbers of postoperative complications. Laboratory parameter (albumin and prealbumin) values declined in the postoperative period, but differences between study groups were not significant. The groups had comparable arm circumference measurements, muscle mass and fat proportions, and water weights. Patient self-sufficiency in the postoperative period was comparable between groups (P=0.313). Lower limb force declined after surgery, but differences between the groups were not significant (P=0.579). Conclusion.Preoperative administration of ONS to patients undergoing elective colorectal surgery did not reduce postoperative morbidity or enhance recovery. Moreover, patient self-sufficiency, physical status, and nutritional status were not influenced by preoperative ONS. Patients should be properly selected for malnourishment before providing nutritional support to manage costs efficiently. Trial Registration: ClinicalTrials.gov (NCT03930888).

Surgical Prehabilitation in Patients with Gastrointestinal Cancers: Impact of Unimodal and Multimodal Programs on Postoperative Outcomes and Prospects for New Therapeutic Strategies—A Systematic Review

“…With such limited exposure, these interventions are less likely to demonstrate benefits on early postoperative outcomes. Our findings support that at least two weeks of surgical prehabilitation are necessary to expect an impact [ 28 , 29 , 30 , 32 , 38 ]. Unfortunately, in GI cancer resections, time is often considered of the essence to avoid disease progression, although this concept is challenged [ 59 , 60 ].…”

“…They did not find a significant difference in postoperative complications and 1-month hospital readmissions between groups. One study evaluated the effect of a 1-week high protein ONS supplementation on postoperative muscle mass and strength, complications, and LOS in patients with colorectal cancers [ 29 ]. They failed to demonstrate any difference between groups for all postoperative outcomes.…”

“…Despite a strong consensus among experts, there is currently a lack of scientific evidence. In this review, most negative studies had a nutritional intervention of only one week [ 28 , 29 , 30 , 32 , 38 ]. This suggests that such intervention may be too short to impact postoperative outcomes of GI cancers.…”

Nutrition as prevention for improved cancer health outcomes: a systematic literature review

“…Three studies examined preoperative use of immunonutrition, including use of oral immunonutrition in advanced pancreatic adenocarcinoma ( 31 ), enteral immunonutrition among patients with colorectal or gastric carcinoma ( 36 ), and immunonutrient-enriched supplementation in patients with colon cancer. Seven studies examined the use of more diverse oral nutrition support across gastrointestinal cancers, including use of preoperative Nutricia ( 35 ), hypercaloric supplementation (Nutridrink Protein) ( 28 ), peripheral intravenous nutrition for patients undergoing workup for biliopancreatic masses ( 29 ), oral nutrition combined with microbial preparations ( 33 ), preoperative oral supplementation for colorectal ( 34 ) and gastrointestinal cancers ( 27 ), and the use of Nutrison Fiber in patients with adenocarcinomas ( 37 ). The final 3 studies examined carbohydrate-rich beverages ( 26 , 32 ) as well as the use of 10% glucose solution before radical gastrectomy ( 25 ).…”

“…Among the 15 studies assessed for RoB ( Table 3 ), 8 were assessed as low or medium RoB and reported mixed results on development of complications, improvements in weight loss, and length of hospital stay ( Table 5 ) ( 23-25 , 27 , 30 , 32 , 34 , 36 ).…”