Brajcich Brian C, Stigall Kyle, Walsh Danielle S, Varghese Thomas K, Barber Annabel E, Kralovich Kurt A, Wescott Annie B, Pockaj Barbara A, Ko Clifford Y, Laronga Christine
From the Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL (Brajcich, Ko).
Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern Medicine, Chicago, IL (Brajcich).
J Am Coll Surg. 2022 Mar 1;234(3):384-394. doi: 10.1097/XCS.0000000000000055.
Malnutrition is common among patients with cancer and is a known risk factor for poor postoperative outcomes; however, preoperative nutritional optimization guidelines are lacking in this high-risk population. The objective of this study was to review the evidence regarding preoperative nutritional optimization of patients undergoing general surgical operations for the treatment of cancer.
A literature search was performed across the Ovid (MEDLINE), Cochrane Library (Wiley), Embase (Elsevier), CINAHL (EBSCOhost), and Web of Science (Clarivate) databases. Eligible studies included randomized clinical trials, observational studies, reviews, and meta-analyses published between 2010 and 2020. Included studies evaluated clinical outcomes after preoperative nutritional interventions among adult patients undergoing surgery for gastrointestinal cancer. Data extraction was performed using a template developed and tested by the study team.
A total of 5,505 publications were identified, of which 69 studies were included for data synthesis after screening and full text review. These studies evaluated preoperative nutritional counseling, protein-calorie supplementation, immunonutrition supplementation, and probiotic or symbiotic supplementation.
Preoperative nutritional counseling and immunonutrition supplementation should be considered for patients undergoing surgical treatment of gastrointestinal malignancy. For malnourished patients, protein-calorie supplementation should be considered, and for patients undergoing colorectal cancer surgery, probiotics or symbiotic supplementation should be considered.
营养不良在癌症患者中很常见，并且是术后不良结局的已知风险因素；然而，这一高危人群缺乏术前营养优化指南。本研究的目的是回顾关于接受普外科手术治疗癌症的患者术前营养优化的证据。
在Ovid（MEDLINE）、Cochrane图书馆（Wiley）、Embase（Elsevier）、CINAHL（EBSCOhost）和Web of Science（Clarivate）数据库中进行文献检索。符合条件的研究包括2010年至2020年发表的随机临床试验、观察性研究、综述和荟萃分析。纳入的研究评估了接受胃肠道癌手术的成年患者术前营养干预后的临床结局。使用研究团队开发并测试的模板进行数据提取。
共识别出5505篇出版物，其中69项研究在筛选和全文审查后纳入数据合成。这些研究评估了术前营养咨询、蛋白质 - 热量补充、免疫营养补充以及益生菌或共生菌补充。
对于接受胃肠道恶性肿瘤手术治疗的患者，应考虑术前营养咨询和免疫营养补充。对于营养不良的患者，应考虑蛋白质 - 热量补充，对于接受结直肠癌手术的患者，应考虑益生菌或共生菌补充。
