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. 2025 Jan 20:37:e1854.
doi: 10.1590/0102-6720202400060e1854. eCollection 2025.

EARLY REFEEDING AFTER COLORECTAL CANCER SURGERY REDUCES COMPLICATIONS AND LENGTH OF HOSPITAL STAY

Eliani Frizon  1   2 , José Eduardo de Aguilar-Nascimento  2   3 , Júlio Cesar Zanini  4 , Mariah Steinbach Roux  4 , Bruna Caroline de Lima Schemberg  4 , Pamela Luiza Tonello  1 , Diana Borges Dock-Nascimento  2
Affiliations

EARLY REFEEDING AFTER COLORECTAL CANCER SURGERY REDUCES COMPLICATIONS AND LENGTH OF HOSPITAL STAY

Eliani Frizon et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: Multimodal protocols such as Acceleration of Total Postoperative Recovery and Enhanced Recovery After Surgery propose a set of pre- and post-operative care to accelerate the recovery of surgical patients. However, in clinical practice, simple care such as early refeeding and use of drains are often neglected by multidisciplinary teams.

Aims: Investigate whether early postoperative refeeding determines benefits in colorectal oncological surgery; whether the patients' clinical conditions preoperatively and the use of a nasogastric tube and abdominal drain delay their recovery.

Methods: Retrospective cohort carried out at the Cascavel Uopeccan Cancer Hospital, including adult cancer patients (age ≥18 years), from the Unified Health System (SUS), who underwent colorectal surgeries from January 2018 to December 2021.

Results: 275 patients were evaluated. Of these, 199 (75.4%) were refed early. Late refeeding (odds ratio - OR=2.1; p=0.024), the use of nasogastric tube (OR=2.72; p=0.038) and intra-abdominal drain (OR=1.95; p=0.054) increased the chance of infectious complication. Multivariate analysis showed that receiving a late postoperative diet is an independent risk factor for infectious complications. Late refeeding (p=0.006) after the operation and the placement of an intra-abdominal drain (p=0.007) are independent risk factors for remaining hospitalized for more than five days postoperatively.

Conclusions: Refeeding early in the postoperative period reduces the risk of infectious complications. Using abdominal drains and refeeding late (>48h) for cancer patients undergoing colorectal surgery are risk factors for hospital stays longer than five days.

RACIONAL:: Protocolos multimodais como o de Aceleração da Recuperação Total Pós-operatório e o Enhanced Recovery After Surgery propõem um conjunto de cuidados pré e pós-operatório para acelerar a recuperação dos pacientes cirúrgicos, contudo, na prática clínica cuidados simples como realimentação precoce e uso racional de drenos são muitas vezes negligenciados pelas equipes multiprofissionais.

OBJETIVOS:: investigar se a realimentação precoce, no pós-operatório, determina benefícios em cirurgia oncológica colorretal; se as condições clínicas do paciente no pré-operatório e o uso de sonda nasogástrica e dreno abdominal atrasam a recuperação do paciente.

MÉTODOS:: Coorte retrospectiva realizada no Hospital do Câncer de Cascavel (Uopeccan), incluindo pacientes adultos (idade ≥18 anos), oncológicos, do Sistema Único de Saúde (SUS), submetidos a cirurgias colorretais de janeiro de 2018 a dezembro de 2021.

RESULTADOS:: Foram avaliados 275 pacientes. Destes 199 (75,4%) foram realimentados precocemente. A realimentação tardia (OR=2,1; p=0,024), o uso de sonda nasogástrica (OR=2,72; p=0,038) e dreno intra-abdominal (OR=1,95; p=0,054) aumentaram a chance de complicação infecciosa. A análise multivariada mostrou que receber dieta tardia no pós-operatório é fator de risco independente para complicação infecciosa. A realimentação tardia (p=0,006) após a operação e a colocação de dreno intra-abdominal (p=0,007) são fatores de risco independentes para permanecer mais que cinco dias internados no pós-operatório.

CONCLUSÕES:: realimentar precocemente no pós-operatório diminui o risco de complicações infecciosas, assim como usar drenos abdominais e realimentar tardiamente (>48 h) pacientes oncológicos submetidos a cirurgias colorretais são fatores de risco para permanência hospitalar superior a cinco dias.

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Conflict of interest statement

Conflict of interests: None

Figures

Figure 1
Figure 1. Flowchart of eligible patients who took part in the study.
Figure 2
Figure 2. Type of colorectal oncological surgery performed among the patients studied.
Figure 3
Figure 3. Early initiation of oral diet (hours) in the postoperative period of cancer patients undergoing colorectal surgery.
See this image and copyright information in PMC

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