Peripheral Parenteral Nutrition and Personalized Nutritional Approach After Colorectal Resection Surgery: A Comprehensive Review of Current Evidence

Abstract

Major surgical operations of the gastrointestinal tract, such as colorectal resections, lead to significant burden on the human body, which is expressed during the first postoperative hours with an intense inflammatory reaction and consumption of a large amount of energy, increasing patients' nutritional requirements. Therefore, specific protocols have been implemented for the early initiation of oral feeding. However, not every patient could meet them due to old age and associated pathophysiological changes, the use of opioid drugs for the management of postoperative pain (which is associated with postoperative ileus or nausea), as well as open resections which might lead to gastrointestinal impairment during the first postoperative days. Therefore, a tailored nutritional approach after colorectal resections seems necessary under specific conditions. Parenteral nutrition could be part of this personalized treatment, as it might counterbalance the energy deficit occurring during the early postoperative period, which appears to be associated with adverse clinical outcomes. Nevertheless, the conventional way of administration through central venous lines is associated with significant complications. On the other hand, the alternative administration of parenteral nutrition through a peripheral venous catheter could avoid morbidity, maintaining patients' energy balance even during the first postoperative hours. However, the efficacy of peripheral parenteral nutrition on the postoperative outcomes of patients undergoing colorectal resections needs to be investigated in prospective randomized trials. The aim of the present review is to present the current trends regarding administration of peripheral parenteral nutrition (PPN) after colorectal resections and highlight any potential correlations between PPN and postoperative inflammatory reaction, as well as short-term nutritional status.

Keywords: colorectal surgery; inflammatory response; nutritional status; peripheral parenteral nutrition; postoperative nutrition; postoperative recovery; postoperative stress.

Figure 1

Flow diagram of the study from its setup until the outcome analysis.

Figure 2

Comparison between different approached regarding nutritional replacement after colorectal resection surgery. PPN, peripheral parenteral nutrition; TPN, total parenteral nutrition; ERAS, enhanced recovery after surgery.