影响细胞减灭术后（CRS）和腹腔热灌注化疗（HIPEC）后饮食进展的因素。

Factors affecting dietary progression post cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

机构信息

St George Hospital, Department of Nutrition and Dietetics, Level 2, Pritchard Wing, Kogarah, NSW, 2217, Australia; School of Medicine, Smart Foods Centre, Illawarra Health and Medical Research Institute, University of Wollongong, Building 32, Northfields Ave, Keiraville, NSW, 2500, Australia.

St George Hospital, Department of Nutrition and Dietetics, Level 2, Pritchard Wing, Kogarah, NSW, 2217, Australia.

出版信息

Clin Nutr ESPEN. 2024 Oct;63:520-529. doi: 10.1016/j.clnesp.2024.06.057. Epub 2024 Jul 5.

DOI:10.1016/j.clnesp.2024.06.057

PMID:38972376

Abstract

BACKGROUND & AIMS: Peritoneal carcinomatosis (PC) is treated by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Timely postoperative nutrition is required to reduce the risk of malnutrition and other complications; thus the present study aims to evaluate factors that may impact dietary progression following CRS/HIPEC treatment.

METHODS

Forty-two patients undergoing CRS/HIPEC at a tertiary hospital were audited between April 2019 and August 2020. Patients were classified into two groups: fast dietary progression (FDP) and slow dietary progression (SDP), based on commencement of a full fluid diet (FF) within 7 days or after 7 days postoperatively. Between-group differences in patient characteristics, surgical factors and postoperative complications were evaluated statistically (significant at p < 0.05).

RESULTS

FDP and SDP groups comprised of 22 (52%) and 20 (40%) patients, respectively. A FF diet was established on a median of 7 (4.25-9.75) days, but not before day 2. Nineteen of the 31 (61.3%) patients receiving parenteral nutrition (PN) were in the SDP group (p = 0.009). The SDP group had longer surgery duration (p = 0.05), more gastrointestinal anastomoses (GIAs) (p = 0.02), more enterotomies (p = 0.008), higher rates of prolonged ileus (p = 0.007), longer duration to first bowel motion (p = 0.002), more returns to theatre (p = 0.03), higher Clavien Dindo scores ≥ IIIb (p = 0.01) and longer postoperative length-of-stay (p = 0.001), compared to the FDP group.

CONCLUSIONS

Postoperative complications were associated with SDP in PC patients undergoing CRS/HIPEC. Strategies that aim to limit SDP through timely commencement of nutrition, including PN, are important to improve postoperative outcomes in this patient group.

摘要

背景与目的

腹膜癌转移（PC）的治疗方法是细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）。术后及时给予营养支持，以降低营养不良和其他并发症的风险。因此，本研究旨在评估可能影响 CRS/HIPEC 治疗后饮食进展的因素。

方法

对 2019 年 4 月至 2020 年 8 月在一家三级医院接受 CRS/HIPEC 治疗的 42 名患者进行了审核。根据术后 7 天内或 7 天后开始全流食（FF），将患者分为快速饮食进展（FDP）和缓慢饮食进展（SDP）两组。统计分析组间患者特征、手术因素和术后并发症的差异（p<0.05 为差异有统计学意义）。

结果

FDP 和 SDP 组分别包括 22 名（52%）和 20 名（40%）患者。FF 饮食中位数在第 7 天（4.25-9.75 天）建立，但第 2 天前未建立。31 名接受肠外营养（PN）的患者中有 19 名（61.3%）在 SDP 组（p=0.009）。SDP 组手术时间更长（p=0.05），胃肠吻合术（GIAs）更多（p=0.02），肠切开术更多（p=0.008），肠麻痹时间延长的发生率更高（p=0.007），首次排便时间更长（p=0.002），返回手术室的次数更多（p=0.03），Clavien-Dindo 评分≥IIIb 的发生率更高（p=0.01），术后住院时间更长（p=0.001）。