[Perioperative nutritional support in patients with colorectal neoplasms]

Abstract

Objectives: Malnutrition is clearly associated with increased morbidity and mortality after elective abdominal surgery. The purpose of this study was to compare perioperative nutritional support with traditional postoperative dietary management, evaluating its efficacy to reduce surgical complications, stances and mortality significantly in patients undergoing major colorectal procedures.

Method: A prospective, randomized trial was done among a sample of neoplasic patients undergoing intestinal resective surgery during a period of near 3 years. A perioperative immune-enhancing formula was randomly assigned to a group of patients who presented malnourished preoperatively (DS) while well-nourished and the rest of malnourished patients (DNS) received conventional postoperative intravenous fluids until the reintroduction of normal diet. The variables studied were: age, sex, tumor stage and length of hospital stay. Nutritional status at admission and discharge, mortality, outcome from surgery and gastrointestinal side effects (tolerability, diarrhoea, vomits or distension) were also collected. Statistical analyses were performed with the with the chi2, ANOVA and the Turkey post-hoc tests, with a significance of 95%.

Results: Sample conformed by 82 patients. The 3 groups were comparable for all baseline and surgical characteristics. Significant differences were observed in the incidence of gastrointestinal complications, length of hospital stay (DS: 13.15±5.26; DNS: 19.34±9.6; p=0.001) and mortality (DS: 13.8%, DNS:30%, p=0,004).

Conclusions: Significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. A statistically significant decrease in the incidence of postoperative gastrointestinal symptoms, a reduction in the length of hospital stay and less morbidity and mortality occurred on the group that received perioperative nutrition.