Perioperative nutritional management in electively gastrointestinal surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHEN Hong , LI Fei

Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, P. R. China;

Corresponding author：

CHEN Hong, Email: chenhong@medmail.com.cn

Keywords：

gastrointestinal surgery; elective surgery; nutritional management

DOI：

10.7507/1007-9424.201611094

Video：

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Objective To summarize the nutritional management strategies of patients undergoing electively gastrointestinal surgery. Methods This article reviewed the recent researches on perioperative nutritional management in electively gastrointestinal surgery, including four major directions: preoperative nutritional evaluation, glucose level control, nutritional type, and immunonutrition. Results At present, preoperative nutritional evaluation methods included anthropometry, laboratory tests, subjective global assessment (SGA), nutritional risk screening (NRS) 2002, Reilly nutritional risk screening, nutritional risk indicator (NRI), and so on. For preoperative nutritional assessment system, however, current data could not single out superiority for any nutritional assessment methods in the ability to predict surgery-related complications. The usage of enhanced recovery after surgery (ERAS) protocol to reduce surgical stress and preclude postoperative insulin resistance had recently been clearly linked to reductions in postoperative morbidity and adverse outcomes. There were specific criterias for perioperative parenteral and enteral nutrition in undernourished patients, who were defined in clinical guidelines recently, such as the Guidelines for Adult Perioperative Nutrition Support issued by Chinese Society of Parenteral and Enteral Nutrition (CSPEN). Several systematic reviews showed that immunonutrition could reduce both morbidity and length of stay after major electively gastrointestinal surgery. Conclusion Perioperative nutritional management can ensure patients benefit from nutritional support by nutritional assessment, can reduce the nutritional risk and metabolic disorder caused by operation, can achieve the goal of optimal nutrition support in surgical patients, and can ultimately reduce postoperative complications.

Citation： CHEN Hong, LI Fei. Perioperative nutritional management in electively gastrointestinal surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(9): 1150-1155. doi: 10.7507/1007-9424.201611094 Copy

1.	Holst M, Rasmussen HH, Irtun O. Advances in clinical nutrition in GI surgery. Expert Rev Gastroenterol Hepatol, 2015, 9(4): 467-473.
2.	Braga M, Ljungqvist O, Soeters P, et al. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr, 2009, 28(4): 378-386.
3.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
4.	Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr, 2010, 29(4): 434-440.
5.	中国加速康复外科专家组. 中国加速康复外科围手术期管理专家共识(2016). 中华外科杂志, 2016, 54(6): 413-418.
6.	陈宏, 李非, 贾建国, 等. 择期腹部手术后胰岛素抵抗相关因素研究. 中国实用外科杂志, 2009, 29(5): 428-430.
7.	Awad S, Fearon KC, Macdonald IA, et al. A randomized cross-over study of the metabolic and hormonal responses following two preoperative conditioning drinks. Nutrition, 2011, 27(9): 938-942.
8.	Zhong JX, Kang K, Shu XL. Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis. Asia Pac J Clin Nutr, 2015, 24(3): 367-378.
9.	Benoist S, Brouquet A. Nutritional assessment and screening for malnutrition. J Visc Surg, 2015, 152 Suppl 1: S3-S7.
10.	Hébuterne X, Lemarié E, Michallet M, et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr, 2014, 38(2): 196-204.
11.	Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg, 2009, 144(10): 961-969.
12.	Chambrier C, Sztark F, Société Francophone de nutrition clinique et métabolisme (SFNEP), et al. French clinical guidelines on perioperative nutrition. Update of the 1994 consensus conference on perioperative artificial nutrition for elective surgery in adults. J Visc Surg, 2012, 149(5): e325-e336.
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14.	Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4): 415-421.
15.	Reilly HM, Martineau JK, Moran A, et al. Nutritional screening—evaluation and implementation of a simple Nutrition Risk Score. Clin Nutr, 1995, 14(5): 269-273.
16.	Wolinsky FD, Coe RM, McIntosh WA, et al. Progress in the development of a nutritional risk index. J Nutr, 1990, 120 Suppl 11: 1549-1553.
17.	Schiesser M, Kirchhoff P, Muller MK, et al. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery, 2009, 145(5): 519-526.
18.	Schwegler I, von Holzen A, Gutzwiller JP, et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg, 2010, 97(1): 92-97.
19.	Guo W, Ou G, Li X, et al. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results. J Gastroenterol Hepatol, 2010, 25(4): 800-803.
20.	Rosania R, Chiapponi C, Malfertheiner P, et al. Nutrition in Patients with Gastric Cancer: An Update. Gastrointest Tumors, 2016, 2(4): 178-187.
21.	Palermo NE, Gianchandani RY, McDonnell ME, et al. Stress Hyperglycemia During Surgery and Anesthesia: Pathogenesis and Clinical Implications. Curr Diab Rep, 2016, 16(3): 33.
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25.	van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med, 2001, 345(19): 1359-1367.
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39.	Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg, 2014, 101(10): 1209-1229.
40.	Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr, 2012, 31(6): 801-816.
41.	Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr, 2012, 31(6): 817-830.
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43.	Feldheiser A, Aziz O, Baldini G, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand, 2016, 60(3): 289-334.
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45.	Ljungqvist O. Modulating postoperative insulin resistance by preoperative carbohydrate loading. Best Pract Res Clin Anaesthesiol, 2009, 23(4): 401-409.
46.	Gustafsson UO, Hausel J, Thorell A, et al. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg, 2011, 146(5): 571-577.
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1. Holst M, Rasmussen HH, Irtun O. Advances in clinical nutrition in GI surgery. Expert Rev Gastroenterol Hepatol, 2015, 9(4): 467-473.
2. Braga M, Ljungqvist O, Soeters P, et al. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr, 2009, 28(4): 378-386.
3. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
4. Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr, 2010, 29(4): 434-440.
5. 中国加速康复外科专家组. 中国加速康复外科围手术期管理专家共识(2016). 中华外科杂志, 2016, 54(6): 413-418.
6. 陈宏, 李非, 贾建国, 等. 择期腹部手术后胰岛素抵抗相关因素研究. 中国实用外科杂志, 2009, 29(5): 428-430.
7. Awad S, Fearon KC, Macdonald IA, et al. A randomized cross-over study of the metabolic and hormonal responses following two preoperative conditioning drinks. Nutrition, 2011, 27(9): 938-942.
8. Zhong JX, Kang K, Shu XL. Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis. Asia Pac J Clin Nutr, 2015, 24(3): 367-378.
9. Benoist S, Brouquet A. Nutritional assessment and screening for malnutrition. J Visc Surg, 2015, 152 Suppl 1: S3-S7.
10. Hébuterne X, Lemarié E, Michallet M, et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr, 2014, 38(2): 196-204.
11. Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg, 2009, 144(10): 961-969.
12. Chambrier C, Sztark F, Société Francophone de nutrition clinique et métabolisme (SFNEP), et al. French clinical guidelines on perioperative nutrition. Update of the 1994 consensus conference on perioperative artificial nutrition for elective surgery in adults. J Visc Surg, 2012, 149(5): e325-e336.
13. Detsky AS, Baker JP, O’Rourke K, et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery. JPEN J Parenter Enteral Nutr, 1987, 11(5): 440-446.
14. Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4): 415-421.
15. Reilly HM, Martineau JK, Moran A, et al. Nutritional screening—evaluation and implementation of a simple Nutrition Risk Score. Clin Nutr, 1995, 14(5): 269-273.
16. Wolinsky FD, Coe RM, McIntosh WA, et al. Progress in the development of a nutritional risk index. J Nutr, 1990, 120 Suppl 11: 1549-1553.
17. Schiesser M, Kirchhoff P, Muller MK, et al. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery, 2009, 145(5): 519-526.
18. Schwegler I, von Holzen A, Gutzwiller JP, et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg, 2010, 97(1): 92-97.
19. Guo W, Ou G, Li X, et al. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results. J Gastroenterol Hepatol, 2010, 25(4): 800-803.
20. Rosania R, Chiapponi C, Malfertheiner P, et al. Nutrition in Patients with Gastric Cancer: An Update. Gastrointest Tumors, 2016, 2(4): 178-187.
21. Palermo NE, Gianchandani RY, McDonnell ME, et al. Stress Hyperglycemia During Surgery and Anesthesia: Pathogenesis and Clinical Implications. Curr Diab Rep, 2016, 16(3): 33.
22. Schricker T, Lattermann R. Perioperative catabolism. Can J Anaesth, 2015, 62(2): 182-193.
23. Gustafsson UO, Thorell A, Soop M, et al. Haemoglobin A1c as a predictor of postoperative hyperglycaemia and complications after major colorectal surgery. Br J Surg, 2009, 96(11): 1358-1364.
24. Ljungqvist O. Insulin resistance and outcomes in surgery. J Clin Endocrinol Metab, 2010, 95(9): 4217-4219.
25. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med, 2001, 345(19): 1359-1367.
26. Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc, 2004, 79(8): 992-1000.
27. Carvalho G, Lattermann R, Codere-Maruyama T, et al. Glucose and insulin administration while maintaining normoglycemia: the GIN concept. Minerva Anestesiol, 2013, 79(1): 74-82.
28. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med, 2009, 360(13): 1283-1297.
29. Lipshutz AK, Gropper MA. Perioperative glycemic control: an evidence-based review. Anesthesiology, 2009, 110(2): 408-421.
30. Landoni G, Pisano A, Lomivorotov V, et al. Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process. J Cardiothorac Vasc Anesth, 2017, 31(2): 719-730.
31. Friedrich JO, Chant C, Adhikari NK. Does intensive insulin therapy really reduce mortality in critically ill surgical patients? A reanalysis of meta-analytic data. Crit Care, 2010, 14(5): 324.
32. NICE-SUGAR Study Investigators, Finfer S, Liu B, et al. Hypoglycemia and risk of death in critically ill patients. N Engl J Med, 2012, 367(12): 1108-1118.
33. Yamada T, Shojima N, Noma H, et al. Glycemic control, mortality, and hypoglycemia in critically ill patients: a systematic review and network meta-analysis of randomized controlled trials. Intensive Care Med, 2017, 43(1): 1-15.
34. Kalfon P, Giraudeau B, Ichai C, et al. Tight computerized versus conventional glucose control in the ICU: a randomized controlled trial. Intensive Care Med, 2014, 40(2): 171-181.
35. Cappi SB, Noritomi DT, Velasco IT, et al. Dyslipidemia: a prospective controlled randomized trial of intensive glycemic control in sepsis. Intensive Care Med, 2012, 38(4): 634-641.
36. Bagnall NM, Malietzis G, Kennedy RH, et al. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Colorectal Dis, 2014, 16(12): 947-956.
37. Ljungqvist O. ERAS—enhanced recovery after surgery: moving evidence-based perioperative care to practice. JPEN J Parenter Enteral Nutr, 2014, 38(5): 559-566.
38. Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr, 2012, 31(6): 783-800.
39. Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg, 2014, 101(10): 1209-1229.
40. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr, 2012, 31(6): 801-816.
41. Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr, 2012, 31(6): 817-830.
42. Cerantola Y, Valerio M, Persson B, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS(®)) society recommendations. Clin Nutr, 2013, 32(6): 879-887.
43. Feldheiser A, Aziz O, Baldini G, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand, 2016, 60(3): 289-334.
44. Lassen K, Dejong CH, Revhaug A, et al. Food at will after pancreaticoduodenectomies. Re. " Perioperative nutritional support of patients undergoing pancreatic surgery in the age of ERAS”. Nutrition, 2015, 31(7-8): 1057-1058.
45. Ljungqvist O. Modulating postoperative insulin resistance by preoperative carbohydrate loading. Best Pract Res Clin Anaesthesiol, 2009, 23(4): 401-409.
46. Gustafsson UO, Hausel J, Thorell A, et al. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg, 2011, 146(5): 571-577.
47. Wang ZG, Wang Q, Wang WJ, et al. Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg, 2010, 97(3): 317-327.
48. Pimenta GP, de Aguilar-Nascimento JE. Prolonged preoperative fasting in elective surgical patients: why should we reduce it? Nutr Clin Pract, 2014, 29(1): 22-28.
49. Awad S, Lobo DN. Metabolic conditioning to attenuate the adverse effects of perioperative fasting and improve patient outcomes. Curr Opin Clin Nutr Metab Care, 2012, 15(2): 194-200.
50. Lugli AK, Schricker T, Wykes L, et al. Glucose and protein kinetics in patients undergoing colorectal surgery: perioperative amino acid versus hypocaloric dextrose infusion. Metabolism, 2010, 59(11): 1649-1655.
51. Aarts MA, Okrainec A, Glicksman A, et al. Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay. Surg Endosc, 2012, 26(2): 442-450.
52. Lassen K, Kjaeve J, Fetveit T, et al. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial. Ann Surg, 2008, 247(5): 721-729.
53. Liu XX, Jiang ZW, Wang ZM, et al. Multimodal optimization of surgical care shows beneficial outcome in gastrectomy surgery. JPEN J Parenter Enteral Nutr, 2010, 34(3): 313-321.
54. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A. S. P. E. N.). JPEN J Parenter Enteral Nutr, 2009, 33(3): 277-316.
55. Weimann A, Braga M, Harsanyi L, et al. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr, 2006, 25(2): 224-244.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Perioperative nutritional management in electively gastrointestinal surgery

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