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术前肠内营养对择期结直肠癌手术的营养不良患者临床结局的影响:一项前瞻性队列研究

Impact of Preoperative Enteral Nutrition on Clinical Outcomes in Malnourished Patients Undergoing Elective Colorectal Cancer Surgery: A Prospective Cohort Study.

作者信息

Pasic Fuad, Elezovic Haris

机构信息

University Clinical Center Tuzla, Department of Surgery, Bosnia and Herzegovina.

General hospital, Sanski Most, Bosnia and Herzegovina.

出版信息

Med Arch. 2025;79(3):227-232. doi: 10.5455/medarh.2025.79.227-232.

DOI:10.5455/medarh.2025.79.227-232
PMID:40657345
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12253596/
Abstract

BACKGROUND

Malnutrition is a frequent yet often overlooked comorbidity in patients undergoing surgery for colorectal cancer. It is associated with adverse postoperative outcomes, including increased complications, prolonged hospital stay, and elevated mortality.

OBJECTIVE

This study aimed to assess the clinical impact of short-term preoperative enteral nutrition in malnourished patients undergoing elective colorectal cancer surgery.

METHODS

A prospective cohort study was conducted involving 68 malnourished patients with histologically confirmed stage I-III colorectal cancer. Patients were divided into three groups: Group A (14-day enteral nutrition), Group B (7-day enteral nutrition), and Group C (no supplementation). Nutritional status, laboratory parameters, postoperative complications, transfusion needs, and hospitalization metrics were compared among groups.

RESULTS

Group A demonstrated the most favorable outcomes, including significantly fewer postoperative complications such as anastomotic leakage (5.0% vs. 17.9%, p = 0.030), reduced transfusion and albumin requirements, and shorter ICU and hospital stays (1.6 ± 0.7 and 7.1 ± 2.4 days, respectively). Group C showed the highest complication and mortality rates. Improvements in biochemical markers were observed in both intervention groups, supporting the efficacy of enteral supplementation.

CONCLUSION

Short-term preoperative enteral nutrition significantly improves clinical outcomes in malnourished colorectal cancer patients undergoing elective surgery. These findings support the integration of nutritional screening and intervention as standard components of perioperative care in oncologic surgery.

摘要

背景

营养不良是接受结直肠癌手术患者中常见但常被忽视的合并症。它与术后不良结局相关,包括并发症增加、住院时间延长和死亡率升高。

目的

本研究旨在评估术前短期肠内营养对接受择期结直肠癌手术的营养不良患者的临床影响。

方法

进行了一项前瞻性队列研究,纳入68例经组织学确诊为I-III期结直肠癌的营养不良患者。患者分为三组:A组(14天肠内营养)、B组(7天肠内营养)和C组(不补充营养)。比较各组之间的营养状况、实验室参数、术后并发症、输血需求和住院指标。

结果

A组显示出最有利的结局,包括术后并发症显著减少,如吻合口漏(5.0%对17.9%,p = 0.030),输血和白蛋白需求减少,以及ICU和住院时间缩短(分别为1.6±0.7天和7.1±2.4天)。C组的并发症和死亡率最高。两个干预组的生化指标均有改善,支持肠内营养补充的疗效。

结论

术前短期肠内营养可显著改善接受择期手术的营养不良结直肠癌患者的临床结局。这些发现支持将营养筛查和干预作为肿瘤手术围手术期护理的标准组成部分。

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Impact of Preoperative Enteral Nutrition on Clinical Outcomes in Malnourished Patients Undergoing Elective Colorectal Cancer Surgery: A Prospective Cohort Study.术前肠内营养对择期结直肠癌手术的营养不良患者临床结局的影响:一项前瞻性队列研究
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本文引用的文献

1
The Impact of Preoperative and Postoperative Nutritional Interventions on Treatment Outcomes and Quality of Life in Colorectal Cancer Patients-A Comprehensive Review.术前和术后营养干预对结直肠癌患者治疗结局和生活质量的影响——全面综述。
Medicina (Kaunas). 2024 Sep 27;60(10):1587. doi: 10.3390/medicina60101587.
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Compliance with oral nutritional supplements and its influencing factors in postoperative patients with digestive tract tumors: a cross-sectional study.消化道肿瘤术后患者口服营养补充剂的依从性及其影响因素:一项横断面研究
BMC Nurs. 2024 Jun 5;23(1):380. doi: 10.1186/s12912-024-02010-y.
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Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study.营养不良对癌症手术后早期结局的影响:一项国际多中心前瞻性队列研究
Lancet Glob Health. 2023 Mar;11(3):e341-e349. doi: 10.1016/S2214-109X(22)00550-2.
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Preoperative malnutrition in patients with colorectal cancer.结直肠癌患者术前营养不良。
Can J Surg. 2021 Nov 25;64(6):E621-E629. doi: 10.1503/cjs.016820. Print 2021 Nov-Dec.
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Colorectal cancer.结直肠癌。
Lancet. 2019 Oct 19;394(10207):1467-1480. doi: 10.1016/S0140-6736(19)32319-0.
6
GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community.GLIM 营养不良诊断标准 - 全球临床营养界的共识报告。
Clin Nutr. 2019 Feb;38(1):1-9. doi: 10.1016/j.clnu.2018.08.002. Epub 2018 Sep 3.
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Malnutrition is associated with adverse postoperative outcome in patients undergoing elective colorectal cancer resections.营养不良与择期结直肠癌切除术患者术后不良结局相关。
J BUON. 2018 Jan-Feb;23(1):36-41.
8
ESPEN guideline: Clinical nutrition in surgery.ESPEN 指南:外科手术中的临床营养。
Clin Nutr. 2017 Jun;36(3):623-650. doi: 10.1016/j.clnu.2017.02.013. Epub 2017 Mar 7.
9
Preoperative Prognostic Nutritional Index Correlates with Severe Complications and Poor Survival in Patients with Colorectal Cancer Undergoing Curative Laparoscopic Surgery: A Retrospective Study in a Single Chinese Institution.术前预后营养指数与接受根治性腹腔镜手术的结直肠癌患者的严重并发症及不良生存相关:一项单中心中国机构的回顾性研究
Nutr Cancer. 2017 Apr;69(3):454-463. doi: 10.1080/01635581.2017.1285038. Epub 2017 Feb 17.
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ESPEN guidelines on nutrition in cancer patients.ESPEN 肿瘤患者营养指南。
Clin Nutr. 2017 Feb;36(1):11-48. doi: 10.1016/j.clnu.2016.07.015. Epub 2016 Aug 6.