Visceral Sarcoma Surgery Unit, Città della Salute e della Scienza, Turin, Italy.
The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, The Netherlands.
Eur J Surg Oncol. 2018 Apr;44(4):509-514. doi: 10.1016/j.ejso.2017.12.010. Epub 2018 Jan 12.
Malnutrition in cancer patients - in both prevalence and degree - depends primarily on tumor stage and site. Preoperative malnutrition in surgical patients is a frequent problem and is associated with prolonged hospital stay, a higher rate of postoperative complications, higher re-admission rates, and a higher incidence of postoperative death. Given the focus on the cancer and its cure, nutrition is often neglected or under-evaluated, and this despite the availability of international guidelines for nutritional care in cancer patients and the evidence that nutritional deterioration negatively affects survival. Inadequate nutritional support for cancer patients should be considered ethically unacceptable; prompt nutritional support must be guaranteed to all cancer patients, as it can have many clinical and economic advantages. Patients undergoing multimodal oncological care are at particular risk of progressive nutritional decline, and it is essential to minimize the nutritional/metabolic impact of oncological treatments and to manage each surgical episode within the context of an enhanced recovery pathway. In Europe, enhanced recovery after surgery (ERAS) and routine nutritional assessment are only partially implemented because of insufficient awareness among health professionals of nutritional problems, a lack of structured collaboration between surgeons and clinical nutrition specialists, old dogmas, and the absence of dedicated resources. Collaboration between opinion leaders dedicated to ERAS from both the European Society of Surgical Oncology (ESSO) and the ERAS Society was born with the aim of promoting nutritional assessment and perioperative nutrition with and without an enhanced recovery program. The goal will be to improve awareness in the surgical oncology community and at institutional level to modify current clinical practice and identify optimal treatment options.
癌症患者的营养不良（无论是在患病率还是严重程度上）主要取决于肿瘤的分期和部位。手术患者术前营养不良是一个常见问题，与住院时间延长、术后并发症发生率更高、再入院率更高以及术后死亡率更高有关。由于关注的重点是癌症及其治疗，营养往往被忽视或评估不足，尽管有针对癌症患者营养护理的国际指南，以及营养恶化会对生存产生负面影响的证据。未能为癌症患者提供足够的营养支持在伦理上是不可接受的；必须向所有癌症患者提供及时的营养支持，因为这可以带来许多临床和经济效益。接受多模式肿瘤治疗的患者面临着营养状况逐渐恶化的特殊风险，因此必须尽量减少肿瘤治疗对营养/代谢的影响，并在强化康复途径的背景下管理每个手术阶段。在欧洲，由于医护人员对营养问题的认识不足、外科医生和临床营养专家之间缺乏结构化合作、旧观念以及缺乏专用资源，术后强化恢复（ERAS）和常规营养评估仅部分实施。欧洲外科肿瘤学会（ESSO）和 ERAS 学会的 ERAS 意见领袖之间的合作旨在促进营养评估以及围手术期营养支持，无论是否有强化恢复方案。目标是提高外科肿瘤学领域以及机构层面的认识，以改变当前的临床实践并确定最佳治疗方案。
