Introduction There is good evidence that nutritional support is beneficial. The advent of minimal access surgery allied with enhanced recovery pathways allows us to successfully feed patients earlier than ever before. With data suggesting early feeding is preferential to “nil by mouth” in terms of morbidity and hospital length of stay, we set out to determine the most important periods in which to provide nutritional support by assessing the temporal relationship between nutrition provision and surgery. Furthermore, based on the extensive works of Lungqvist, we assessed impact of feeding against physiological endpoints such as glucose homeostasis as well as more conventional clinical endpoints.

Methods Prospective four-armed double-blind randomised control trial. Patients allocated to one of four nutritional interventions: control pre-op/control post-op, active pre-op/control post-op, active pre-op/active post-op and control pre-op/active post-op. Patients were either given pre-op® or placebo pre-operatively, or fortifresh® or placebo postoperatively according to allocation. Caloric intake was assessed pre-operatively and during the early postoperative period. Endpoints included, glucose homeostasis, insulin resistance, biochemical markers of inflammation and morbidity/mortality data.

Results 120 patients were recruited. Demographically, groups were well matched. 94% of patients reported weight loss in the 3 months prior to surgery, of which 55% reported weight loss >5% of their normal body weight. Glucose homeostasis was better in supplemented groups (p=0.004), and there were reductions in insulin resistance (p=0.001) compared with standard care (placebo/placebo). Muscle strength (p<0.001) and lung function (p=0.035) were similarly improved following surgery. There were no significant differences in immediate post-operative complications but at 30 days the group receiving pre- and post-operative supplements developed fewer complications than those receiving standard care (placebo/placebo) (p=0.003, χ²=8.695).

Conclusion Disease-related malnutrition is prevalent within patients suffering from colorectal cancer. Nutritional intake in the peri-operative period remains inadequate and poor nutritional intake should be corrected with oral nutritional supplements as even modest intake results in improved biochemical response to stress and reductions in morbidity.