Could preoperative and postoperative optimal nutrition support modulate the inflammatory response and clinical outcome of severe malnourished surgical patients with gastrointestinal neoplasia?

Introduction

Our aim was to assess whether perioperative and postoperative optimal 7-day nutrition support could modulate the inflammatory status and clinical outcome of severe malnourished patients with surgery for gastrointestinal neoplasia.

Methods

A prospective randomized study of 64 patients with gastrointestinal neoplasia, severe malnourished BMI <18.5, albumin level <3 g/dl, BW loss >10%, NRS >3, scheduled for surgery, allocated into two groups. Group A: 32 patients, minimal enteral nutrition in the postoperative period according to tolerance, medium 500 kcal/day. Group B: 32 patients received optimal parenteral nutrition support (25 kcal/kg/day) 3 days before surgery and continued for at least 4 days postoperatively. We measured CRP, fibrinogen, IL-6, TNF, albumin level preoperative and at 96 hours, the incidence of complications, and the length of ICU stay.

Results

There was a significant decrease in the values of CRP, IL-6, TNF, albumin at 96 hours in group B. No difference in fibrinogen. A significantly lower rate of complications and a shorter time of ICU stay were observed in group B. See Figures 1 and 2.

Figure 1

Results 1.

Figure 2

Results 2.

Conclusion

Perioperative optimal nutrition support for at least 7 days could modulate the inflammatory status and clinical outcome of severe malnourished surgical neoplasic patients.