Intensive Perioperative Nutrition Therapy

Malnutrition is well reported and common in surgery patients. Surgery itself leads to inflammation corresponding with the extent of the surgical trauma, and leads to a metabolic stress response. The existing research suggests that patients undergoing surgery for upper gastrointestinal or colorectal cancer are particularly at risk of malnutrition. Recent research from Malaysia shows almost similar findings from previous studies which is about 29.1% of surgical patients were malnourished and shows increase length of hospital stay, higher rate of surgical site infection and mortality.

Nutrition requirement for surgery is higher if compared with normal requirement in order to support speedy recovery. However, most of the patients especially cancer patients do unable to achieve even 50% energy requirement before operation. This will cause further depletion of nutritional status of patient. In conjunction with this, patients with suboptimal nutritional status pre-operatively will have a higher risk of postoperative complications. Interestingly, one of Malaysian study shows significant number of post-surgery complications compared to pre-surgery which was associated to the poor level of nutrition. The success of surgery does not depend exclusively on technical surgical skills but also on metabolic intervention therapy, taking into account the ability of patient to carry a metabolic load and to provide appropriate nutrition support. In fact, in patient with cancer, management during perioperative period may be crucial for long term outcome.

Nutrition therapy is the provision of nutrition or nutrients either orally (regular diet, therapeutic diet, e.g. fortified food, oral nutritional supplements) or via enteral nutrition (EN) or parenteral nutrition (PN) to prevent or treat malnutrition. Dietary advice or nutrition counselling is part of a nutrition therapy. In the surgical patient, the indications for nutritional therapy are prevention and treatment of catabolism and malnutrition. This affects mainly the perioperative maintenance of nutritional state in order to prevent postoperative complications. It is strongly recommended not to wait until severe disease-related malnutrition has developed, but to start nutrition therapy early, as soon as a nutritional risk becomes apparent.

Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery e.g. for cancer. In addition, appropriate perioperative nutrition therapy has been shown on improvement of perioperative outcomes especially in gastrointestinal and oncologic surgical patients.

Early nutrition intervention or perioperative EN is optimising patient's nutritional status so that their bodies can receive optimal effects during surgical. The general indications for nutritional support therapy in patients undergoing surgery are the prevention and treatment of undernutrition, i.e. the correction of undernutrition before surgery and the maintenance of nutritional status after surgery, when periods of prolonged fasting and/or severe catabolism are expected. Morbidity, length of hospital stay, and mortality are considered principal outcome parameters when evaluating the benefits of nutritional support.