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Prof. Arved Weimann
Presentation Roadmap/ Summary
Preoperative impairment of nutritional status, and sarcopenia have shown significant impact on surgical outcome in patients undergoing surgery for cancer (1, 2). Sarcopenia is also a predictor for long-term survival after gastrectomy for gastric cancer (3).
“Severe” nutritional risk for surgical patients has been defined according to the ESPEN working group as the presence of at least one of the following criteria (4):
The ESPEN guidelines from 2017 (4) state: “Patients with severe nutritional risk shall receive nutritional therapy prior to major surgery (A) even if operations including those for cancer have to be delayed (BM). A period of 7 to 14 days may be appropriate (0).”
In patients undergoing neoadjuvant (radio-)/chemotherapy for gastrointestinal cancer usually a time period of 4-6 weeks precedes surgery. With special regard to those patients the new “prehabilitation” program including physical exercise, psychological support and nutrition therapy in an outpatient setting for 4-6 weeks may be very beneficial and attenuate post-surgical loss in lean body mass (5, 6). In a recent randomized controlled study a significant decrease in the number of patients with complications and the number of complications per patient had been observed (7). Nutritional management 7-14 days before surgery includes immunonutrition (8) and even parenteral supplementation, the day and the morning before surgery carbohydrate drink (4).
After surgery early oral food intake is feasible, however, it should be kept in mind that many patients after major upper gastrointestinal surgery will not cover their energy requirements for a longer period. Therefore, it is recommended to consider jejunal tube placement e.g. needle catheter jejunostomy for postoperative enteral supplementation. In case it is anticipated that oral/enteral nutrition will be not more than 50% of the recommended intake for more than seven days parenteral supplementation should be started. In patients with perioperative nutritional therapy follow-up of nutritional status is recommended after discharge.
At the conclusion of the presentation, the participant will be able to learn:
Key Takeaways/ Fast Facts
The preoperative period should be used for appropriate conditioning of the patient in a multimodality approach – so called “prehabilitation”
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