Sagar Ramesh C, Kumar K V Veerendra, Ramachandra C, Arjunan Ravi, Althaf Syed, Srinivas C
Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India.
Indian J Surg Oncol. 2019 Sep;10(3):460-464. doi: 10.1007/s13193-019-00930-9. Epub 2019 May 11.
Cancer is responsible for approximately 13% of all causes of death worldwide, and 20% of cancer patients die because of malnutrition and its complications. Malnutrition is common in cancer of stomach and esophagus. Although it is widely accepted that malnutrition adversely affects the postoperative outcome of patients, there is little evidence that perioperative nutrition support can reduce surgical risk in malnourished cancer patients. This prospective study was carried out from December 2016 to July 2017 at the Kidwai Memorial Institute of Oncology, Bengaluru. After stratified for age, sex, and tumor localization, patients were selected non-randomly and assigned to study ( = 30, 14 women, 16 men) and control group ( = 30, 14 women, 16 men) as alternate patients. Within 48 h of admission, patients underwent nutritional assessment by the subjective global assessment. Perioperative nutrition was administered in the study group by enteral route only. Patients had a functioning gastrointestinal tract, and they received enteral nutrition (EN). Target intake of non-protein (25 kcal/kg per day) and protein (0.25 g nitrogen/kg per day) was provided using available enteral formulas. This was supplementary to standard hospital diet. Nutritional re-assessment after 15 days of intervention showed significant change in nutritional status, which was measured as gain in weight for each patient. There were significant differences in the mortality and complications between the two groups. The total length of hospitalization and postoperative stay of the control patients were significantly longer than those of the study patients. In conclusion, perioperative nutrition support can decrease the incidence of postoperative complications in moderately and severely malnourished gastric and esophageal cancer patients. In addition, it is effective in reducing mortality. Enteral nutrition support alone can be used in the management of malnourished patients undergoing gastric and esophageal surgery.
癌症是全球约13%的死亡原因，20%的癌症患者死于营养不良及其并发症。营养不良在胃癌和食管癌患者中很常见。尽管人们普遍认为营养不良会对患者的术后结局产生不利影响，但几乎没有证据表明围手术期营养支持可以降低营养不良癌症患者的手术风险。这项前瞻性研究于2016年12月至2017年7月在班加罗尔的基德瓦伊纪念肿瘤研究所进行。在对年龄、性别和肿瘤定位进行分层后，非随机选择患者并将其作为交替患者分配到研究组（n = 30，14名女性，16名男性）和对照组（n = 30，14名女性，16名男性）。入院后48小时内，通过主观全面评定法对患者进行营养评估。研究组仅通过肠内途径给予围手术期营养。患者胃肠道功能正常，接受肠内营养（EN）。使用现有的肠内配方提供非蛋白质（每天25千卡/千克）和蛋白质（每天0.25克氮/千克）的目标摄入量。这是对标准医院饮食的补充。干预15天后的营养重新评估显示营养状况有显著变化，以每位患者的体重增加来衡量。两组在死亡率和并发症方面存在显著差异。对照组患者的总住院时间和术后住院时间明显长于研究组患者。总之，围手术期营养支持可以降低中度和重度营养不良的胃癌和食管癌患者的术后并发症发生率。此外，它在降低死亡率方面是有效的。单独的肠内营养支持可用于管理接受胃癌和食管癌手术的营养不良患者。
