Periopperative nutritional support in GI surgery

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Periopperative nutritional support in GI surgery

• Past, Present, and future on oncology
  perspective observation and evidence base

Sirikan Yamada, MD Division of Gastrointestinal
Surgery and Endoscopy Department of
Surgery Faculty of Medicine Chiang Mai
University, Chiang Mai, Thailand
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• There is a high incidence of malnutrition in
  hospitalized patients undergoing gastrointestinal
  surgery.
• Malnutrition is clearly associated with increased
  morbidity and mortality after major
  gastrointestinal surgery.
• Cancer cachexia may be an immunologic phenomenon.
  Routine preoperative TPN may not proper for all
  types of cancer.

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• The efficacy of perioperative nutrition support
  to reduce surgical complications and mortality
  significantly has been an area of active clinical
  investigation over the past three decades.
• From multiple prospective, randomized trials,
  significant benefit from perioperative
  nutritional support has been demonstrated in
  severely malnourished patients undergoing major
  surgery.
• Results of the prospective, randomized trials
  studying the effects of perioperative nutrition
  support on patients undergoing gastrointestinal
  surgery are reviewed and critically analyzed.

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Why ?

• Disease causes starvation and defect of immunity
• Major stress on elective complex GI Surgery
  especially, on upper GI cancer surgery
• Underestimation for nutritional risk by surgeon

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WHO?

• Nutritional Risk Screening
• SGA
• BMI? In ASIAN

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Which type of operationWhich type of formula,
and When?

• For Complex Surgery Preparation
• Enteral or TPN ?
• BOTH !
• , and Early as soon as possible.

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HOW?

• Need not to do over TPN calory or over feeding.
• Use the actual weight.
• Normal energy base requirement.

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Immuno-nutrition

• TPN glutamine dipeptide in bone marrow
  transplantation patients.
• In Esophageal cancer patients, preoperative TPN
  amino acids certain fatty acids decrease
  postoperative infections, and it was improved
  postoperatively when given enteral nutrition
  supplemented with arginine and omega 3-fatty
  acids

Oncology 199610
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The effects of perioperative oral enteral support
with glutamine-added elemental formulas in
patients with gastrointestinal cancers. A
prospective, randomized, clinical study

• 32patients with gastrointestinal (GI) system
  cancer 33 of the daily energy requirements was
  covered with
• polymeric enteral formulas (Ensure) in the
  control group (n 16), and with glutamine
  enriched elemental formulas (Alitraq) in the
  study group (n 16).

ERDEM Nihal Zekiye, 2002 at the4 th Surgical
Department of the Ankara Numune Research and
Education Hospital. In addition to hospital diet
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• Patients had these regimens 7 days in the
  preoperative period and 10 days in the
  postoperative period. The effects of additional
  enteral feeding support on anthropometric and
  plasma protein levels in the preoperative (days 1
  and 7) and postoperative (days1 and 10) periods
  were assessed In both groups

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• no differences were observed among the
• anthropometric assessments, except for the
• Nutritional Risk Index. Total protein, albumin,
• transferrin, prealbumin, NRI, and nutritional
• prognostic index were affirmatively affected by
  both enteral formulas.
• However, the increments of these
  parameters were higher and more significant in
• the study group. Energy, protein, carbohydrate
  and
• lipid consumption of the patients were managed as
  
• the referred amounts. Pre- and post-operative
• nutritional support with glutamine enriched
  enteral
• formulas had beneficial effects on the patients
  with
• GI cancers.

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• PREVENTION
• is better than
• ONLY TREATMENT