The impact of personalized nutritional support on postoperative outcome within the enhanced recovery after surgery (ERAS) program for liver resections: results from the NutriCatt protocol

Ardito, Francesco; Lai, Quirino; Rinninella, Emanuele; Mimmo, Antonio; Vellone, Maria; Panettieri, Elena; Adducci, Enrica; Cintoni, Marco; Mele, Maria Cristina; Gasbarrini, Antonio; Giuliante, Felice

doi:10.1007/s13304-020-00787-6

Cited by 15 publications

(16 citation statements)

References 53 publications

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“…This study also found that personalized nutritional support significantly decreased the number of severe postoperative complications in elderly patients undergoing colorectal surgery. These results are in line with our previous findings in surgical patients [14,28], and could be shareable in several other surgical contexts. Indeed, our team have shown that the NutriCatt protocol in the ERAS program reduces LOS without increasing the risk of postoperative complications in patients undergoing liver resections [28].…”

Section: Discussionsupporting

confidence: 93%

“…These results are in line with our previous findings in surgical patients [14,28], and could be shareable in several other surgical contexts. Indeed, our team have shown that the NutriCatt protocol in the ERAS program reduces LOS without increasing the risk of postoperative complications in patients undergoing liver resections [28]. Another study [29] evaluated the impact of the ERAS program (including an early postoperative feeding) on clinical outcomes in elderly patients, reporting a reduction in LOS and an improvement in short-term postoperative complications.…”

Section: Discussionsupporting

confidence: 93%

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NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

Rinninella

Biondi

Cintoni³

et al. 2021

Nutrients

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Background: A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center adopting the ERAS program. Methods: 302 out of 332 elderly (>75 years) patients from 2015 to 2020 were identified. Patients were divided according to their adherence, into “NutriCatt + ERAS” (n = 166) or “standard ERAS” patients (n = 136). Anthropometric and bioelectrical impedance analysis data were evaluated for NutriCatt + ERAS patients. Complications, length of hospital stay (LOS), and other postoperative outcomes were compared between both groups. Results: In NutriCatt + ERAS patients, significant improvements of phase angle (pre-admission vs. admission 4.61 ± 0.79 vs. 4.84 ± 0.85; p = 0.001; pre-admission vs. discharge 4.61 ± 0.79 vs. 5.85 ± 0.73; p = 0.0002) and body cell mass (pre-admission vs. admission 22.4 ± 5.6 vs. 23.2 ± 5.7; p = 0.03; pre-admission vs. discharge 22.4 ± 5.6 vs. 23.1 ± 5.8; p = 0.02) were shown. NutriCatt + ERAS patients reported reduced LOS (p = 0.03) and severe complications (p = 0.03) compared to standard ERAS patients. A regression analysis confirmed the protective effect of the NutriCatt protocol on severe complications (OR 0.10, 95% CI 0.01–0.56; p = 0.009). Conclusions: The NutriCatt protocol improves clinical outcomes in elderly patients and should be recommended in ERAS colorectal surgery.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

Rinninella

Biondi

Cintoni³

et al. 2021

Nutrients

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“…Other works conducted in cancer patients confirm the crucial role of personalized nutritional support. Particularly, in colon and liver cancer patients, the NutriCatt protocol—a nutritional prehabilitation to cancer surgery based on the ESPEN guidelines—ameliorated postoperative complications, length of stay, and hospital costs [ 78 , 79 ].…”

Section: Nutritional Challengesmentioning

confidence: 99%

Skeletal Muscle Loss during Multikinase Inhibitors Therapy: Molecular Pathways, Clinical Implications, and Nutritional Challenges

Rinninella

Cintoni²,

Raoul

et al. 2020

Nutrients

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In cancer patients, loss of muscle mass is significantly associated with low tolerability of chemotherapy and poor survival. Despite the great strides in the treatment of cancer, targeted therapies such as tyrosine kinase inhibitors (TKIs) could exacerbate muscle wasting. Over recent years, the impact of skeletal muscle loss during TKI therapy on clinical outcomes has been in the spotlight. In this review, we focus on the different molecular pathways of TKIs potentially involved in muscle wasting. Then, we report the results of the studies assessing the effects of different TKI therapies—such as sorafenib, regorafenib, sunitinib, and lenvatinib—on muscle mass, and highlight their potential clinical implications. Finally, we discuss an integrative nutritional approach to be adopted during TKI treatment. The assessment of muscle mass from computerized tomography imaging could be helpful in predicting toxicity and prognosis in patients treated with TKI such as sorafenib. Early recognition of low muscle mass and effective personalized nutritional support could prevent or attenuate muscle mass wasting. However, the role of nutrition is still overlooked, and future clinical trials are needed to find the optimal nutritional support to countermeasure muscle mass depletion during TKI therapy.

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“…However, despite the rapid development of surgical techniques today, the 5-year OS rate of HCCA patients is only 10–44% ( 5 – 7 ). An estimated 17–46% of surgical patients are diagnosed with malnutrition at the time of admission ( 8 – 10 ), which can lead to delayed wound healing and dysfunction of immune cells such as neutrophils, macrophages and lymphocytes ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Controlling Nutritional Status (CONUT) Score as a New Indicator of Prognosis in Patients With Hilar Cholangiocarcinoma Is Superior to NLR and PNI: A Single-Center Retrospective Study

Wang

Peng

et al. 2021

Front. Oncol.

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BackgroundCurrently, many nutritional indicators, including controlling nutritional status score (CONUT), can be used to assess a patient’s nutritional status and have been reported as reliable predictors of multiple malignancies. However, the value of CONUT score in predicting postoperative outcomes in patients with hilar cholangiocarcinoma has not been explored. In this study, its predictive value will be discussed and compared with the known predictors the neutrophil lymphocyte ratio (NLR) and prognostic nutritional index (PNI).MethodsPreoperative CONUT scores, PNI and NLR levels of 94 Hilar cholangiocarcinoma (HCCA) patients who underwent radical-intent resection of hepatobiliary surgery in our hospital from March 2010 to April 2019 were retrospectively collected and analyzed. They were grouped according to their optimal cutoff value and the prognostic effects of patients in each group were compared respectively.ResultsCONUThigh was more frequent in patients with Clavien–Dindo classification of ≥IIIa (P = 0.008) and Bile leakage presence (P = 0.011). Kaplan-Meier curves analyzing the relationship between CONUT, PNI, and NLR values and HCCA patient survival (including total survival (OS) and recurrence-free survival (RFS) showed significant differences between groups (P <0.001). Meanwhile, multi-factor analysis found that Degree of cure, PNI, NLR, and preoperative CONUT score were independent prognostic factors for OS and RFS. The predictive power of CONUT score was higher than that of NLR and PNI based on time-dependent receiver operating Characteristic (ROC) analysis and the net reclassification index (NRI) and integrated discriminatory index (IDI) values (P < 0.05).ConclusionCONUT score may be of some clinical reference value in evaluating postoperative prognosis of HCCA patients.

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The impact of personalized nutritional support on postoperative outcome within the enhanced recovery after surgery (ERAS) program for liver resections: results from the NutriCatt protocol

Cited by 15 publications

References 53 publications

NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

Skeletal Muscle Loss during Multikinase Inhibitors Therapy: Molecular Pathways, Clinical Implications, and Nutritional Challenges

Controlling Nutritional Status (CONUT) Score as a New Indicator of Prognosis in Patients With Hilar Cholangiocarcinoma Is Superior to NLR and PNI: A Single-Center Retrospective Study

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