Introduction Malnutrition and cachexia are highly prevalent in patients with upper GI cancers and may adversely affect treatment options.1A multi-modal approach to peri-operative care has been shown to improve patient outcomes.2The aim of this study was to audit nutritional practices, including enhanced recovery principles in patients undergoing oesophago-gastric resection in NHS Lanarkshire.
Method Of the 70 patients approached 31 were included in the study. Dietetic consultations were conducted on initial assessment following new diagnosis of oesophageal or gastric cancer. Prospective data was collected on patient characteristics including anthropometry and clinical symptoms. Methods of nutritional support (pre and post-operatively) were examined for their effectiveness, in relation to achieving weight stability. Patients who were given carbohydrate (CHO) pre-load and oral immunonutrition pre-operatively (n = 15) were compared to those who were not (n = 16) in terms of length of stay on ICU. All data sets were analysed using SPSS 16.0.
Results This cohort consisted of 31 patients (mean age: 66.2, range: 42–81, 84% men) who were undergoing oesophago-gastric resections with curative intent. Mean weight, BMI, and weight loss at diagnosis was 80 kg, 28 kg/m2, 8.3%, respectively. Pre-operatively, oral nutritional support and high protein/energy diets were shown to be the most effective methods of nutritional support in achieving weight maintenance. Post-operatively, the most common nutritional method used was parenteral nutrition (68%). Patients on exclusive enteral nutrition were observed not to meet 100% of their nutritional requirements for the initial 7 days post-op. In addition, use of CHO pre-load and immunonutrition prior to surgery was associated with a reduced length of stay on ICU (mean difference: 3.2 days). All results were deemed statistically non-significant.
Conclusion Our study shows that this patient cohort experienced significant weight loss on diagnosis and required ongoing nutritional support throughout treatment. In addition, we show that nutritional methods pre and post operatively in patients undergoing UGI cancer surgery varies, warranting the need for standardisation of nutritional interventions to enable comparisons within and between regions. Nutritional practices as part of enhanced recovery protocols have the potential to significantly impact outcomes in this patient group, which requires further development and evaluation.
Garth A, et al. Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. Journal of Human Nutrition and Dietetics. 2010;23:393–401
Fearon K, et al. Enhanced recovery after surgery: A consensus review of clinical care for patients undergoing colonic resection. Clinical Nutrition. 2005;24:466–477
Disclosure of interest None Declared.