Zhou Jie, Huang Wentao, Hu Ya, Liu Fen, Xu Man, Chen Xiaoping, Xin Mingzhu, Lu Huiming, Zheng Xia
Department of Urinary Surgery, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Postanesthsia Care Unit, Department of Anesthesiology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Front Nutr. 2025 Jan 8;11:1478190. doi: 10.3389/fnut.2024.1478190. eCollection 2024.
Chyle leaks (CL) is a significant postoperative complication following lymph node dissection in cancer patients. Persistent CK is related to a series of adverse outcomes. Nutritional management is considered an effectively strategy that treat CL. However, the existing evidence on nutritional management for this patient cohort fails to provide actionable clinical guidance.
This study was aimed to establish an evidence-based framework for nutritional management, offering reliable basis for clinical nursing practice.
Utilizing the "6S" mode, we conducted a systematic search of UpToDate, BMJ, Best Practice, Cochrane Library, Joanna Briggs Institute (JBI) Center for Evidence-Based Health Care Database, National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Registered Nurses' Association of Ontario (RNAO), World Health Organization, Medlive, American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Clinical Nutrition and Metabolism (ESPEN), Web of Science, PubMed, Embase, CINAHL, China Biology Medicine (CBM), and China National Knowledge Infrastructure (CNKI) for all evidence on the nutritional management of postoperative coeliac leakage in cancer patients. This search included guidelines, evidence summaries, expert consensus, clinical decision-making, recommended practices, systematic evaluations or Meta-analyses, randomized controlled trials (RCTs), and class experiments. The search timeframe was from the library's establishment to June 2024. Quality assessment of the literature was completed independently by two researchers with professional evidence-based training and expert advice, and evidence was extracted and summarized for those that met the quality criteria.
A total of 13 articles were included in the analysis, comprising two expert consensus, one guideline, one class of experimental studies, seven systematic evaluations, and two clinical decisions. We summarized 22 pieces of evidence across five categories: nutritional screening, assessment, and monitoring, timing of nutritional therapy, methods and approaches to nutritional therapy, nutrient requirements, and dietary modification strategies.
This study presents key evidence for nutritional management in cancer patients with CL post-surgery, emphasizing nutritional screening, assessment, timing and methods of therapy, and dietary adjustment strategies. It emphasized the necessity of thorough screening tools for the assessment of nutritional condition, and the benefits of early enteral feeding. A multidisciplinary team approach is vital for conducting personalized dietary, while sustained nutritional support, dietary fat restrictions, and medium-chain triglycerides enhance nutrient absorption. Consistent monitoring of chylous fluid output and timely dietary adjustments are crucial for improving patient outcomes and recovery.
http://ebn.nursing.fudan.edu.cn/registerResources, identifier ES20244732.
乳糜漏（CL）是癌症患者淋巴结清扫术后的一种重要术后并发症。持续性乳糜漏与一系列不良结局相关。营养管理被认为是治疗乳糜漏的有效策略。然而，现有关于该患者群体营养管理的证据未能提供可操作的临床指导。
本研究旨在建立基于证据的营养管理框架，为临床护理实践提供可靠依据。
利用“6S”模式，我们系统检索了UpToDate、BMJ、最佳实践、Cochrane图书馆、乔安娜·布里格斯研究所（JBI）循证医疗保健数据库中心、国家指南库（NGC）、指南国际网络（GIN）、英国国家卫生与临床优化研究所（NICE）、苏格兰跨学院指南网络（SIGN）、安大略省注册护士协会（RNAO）、世界卫生组织、医脉通、美国肠外和肠内营养学会（ASPEN）、欧洲临床营养与代谢学会（ESPEN）、科学引文索引、PubMed、Embase、护理学与健康领域数据库（CINAHL）、中国生物医学文献数据库（CBM）和中国知网，以获取关于癌症患者术后乳糜漏营养管理的所有证据。该检索包括指南、证据总结、专家共识、临床决策、推荐实践、系统评价或Meta分析、随机对照试验（RCT）和类实验。检索时间范围为各数据库建库至2024年6月。由两名经过专业循证培训并接受专家建议的研究人员独立完成文献质量评估，对符合质量标准的文献进行证据提取和总结。
共纳入13篇文章进行分析，包括两篇专家共识、一篇指南、一类实验研究、七篇系统评价和两篇临床决策。我们从营养筛查、评估与监测、营养治疗时机、营养治疗方法与途径、营养需求和饮食调整策略五个类别中总结出22条证据。
本研究提供了癌症术后乳糜漏患者营养管理的关键证据，强调了营养筛查、评估、治疗时机和方法以及饮食调整策略。强调了使用全面筛查工具评估营养状况的必要性以及早期肠内喂养的益处。多学科团队方法对于实施个性化饮食至关重要，而持续的营养支持、饮食脂肪限制和中链甘油三酯可促进营养吸收。持续监测乳糜液输出量并及时调整饮食对于改善患者预后和康复至关重要。
http://ebn.nursing.fudan.edu.cn/registerResources，标识符ES20244732。
