Irene Deftereos1, Nicole Kiss2, Elizabeth Isenring3, Vanessa M Carter4, Justin Mc Yeung5. 1. Department of Surgery, Western Health, The University of Melbourne, Melbourne, Australia; Department of Nutrition and Dietetics, Western Health, Footscray, Australia. Electronic address: irene.deftereos@unimelb.edu.au. 2. Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia; Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia. 3. Faculty of Health Sciences and Medicine, Bond University, Robina, Australia; Princess Alexandra Hospital, Brisbane, Australia. 4. Department of Nutrition and Dietetics, Western Health, Footscray, Australia. 5. Department of Surgery, Western Health, The University of Melbourne, Melbourne, Australia; Department of Colorectal Surgery, Western Health, Footscray, Australia; Western Health Chronic Disease Alliance, Western Health, Melbourne, Australia.
Abstract
BACKGROUND: Malnutrition is highly prevalent in patients with Upper Gastrointestinal (UGI) cancer and is associated with poor outcomes. However, there are no evidence-based guidelines for nutrition support specific to UGI cancer surgery. METHODS: Databases including MEDLINE, PUBMED, CINAHL, Web of Science, Cochrane Central and Clinicaltrials.gov were systematically searched. Abstracts of studies investigating the effect of preoperative nutrition support on nutritional status, functional status, body composition, quality of life and treatment outcomes in adult patients undergoing oesophageal, gastric or pancreatic cancer resection were identified. Screening of studies, quality assessment using the Downs and Black checklist, data extraction, and appraisal of evidence using GRADE were performed by two reviewers. Due to heterogeneity of the studies, results were synthesised narratively. The protocol was registered in PROSPERO (CRD42018111930). RESULTS: Nine studies with a total of 442 oesophageal and 418 gastric patients were included. Individualised dietary counselling, and enteral feeding in neoadjuvant therapy for oesophageal cancer demonstrated positive effects for weight maintenance and surgical complications, however the GRADE evidence quality was very low. Preoperative nutrition support in gastric cancer decreased the incidence of surgical site infections, length of stay and hospital costs, but GRADE assessment was unable to be completed due to only one study reporting on each outcome measure. CONCLUSIONS: This review demonstrates the lack of strong evidence to determine the most optimal methods of nutrition support prior to UGI cancer resection. Current surgical oncology guidelines should be utilised until further research from high quality trials enable the development of specific clinical practice guidelines.
BACKGROUND: Malnutrition is highly prevalent in patients with Upper Gastrointestinal (UGI) cancer and is associated with poor outcomes. However, there are no evidence-based guidelines for nutrition support specific to UGI cancer surgery. METHODS: Databases including MEDLINE, PUBMED, CINAHL, Web of Science, Cochrane Central and Clinicaltrials.gov were systematically searched. Abstracts of studies investigating the effect of preoperative nutrition support on nutritional status, functional status, body composition, quality of life and treatment outcomes in adult patients undergoing oesophageal, gastric or pancreatic cancer resection were identified. Screening of studies, quality assessment using the Downs and Black checklist, data extraction, and appraisal of evidence using GRADE were performed by two reviewers. Due to heterogeneity of the studies, results were synthesised narratively. The protocol was registered in PROSPERO (CRD42018111930). RESULTS: Nine studies with a total of 442 oesophageal and 418 gastric patients were included. Individualised dietary counselling, and enteral feeding in neoadjuvant therapy for oesophageal cancer demonstrated positive effects for weight maintenance and surgical complications, however the GRADE evidence quality was very low. Preoperative nutrition support in gastric cancer decreased the incidence of surgical site infections, length of stay and hospital costs, but GRADE assessment was unable to be completed due to only one study reporting on each outcome measure. CONCLUSIONS: This review demonstrates the lack of strong evidence to determine the most optimal methods of nutrition support prior to UGI cancer resection. Current surgical oncology guidelines should be utilised until further research from high quality trials enable the development of specific clinical practice guidelines.
Authors: Jeffrey B Velotta; Jennifer R Dusendang; Hyunjee Kwak; Michelle Huyser; Ashish Patel; Simon K Ashiku; Lisa J Herrinton Journal: J Thorac Dis Date: 2021-09 Impact factor: 2.895
Authors: Saad Muhammad Saeed; Sundus Bilal; Muhammad Zeeshan Siddique; Muhammad Saqib; Shahana Shahid; Azhar Noor Ghumman; Muhammed Aasim Yusuf Journal: Ther Adv Gastrointest Endosc Date: 2021-09-25
Authors: Catherine E Huggins; Lauren Hanna; Kate Furness; Mary Anne Silvers; June Savva; Helena Frawley; Daniel Croagh; Paul Cashin; Liang Low; Judy Bauer; Helen Truby; Terry P Haines Journal: Nutrients Date: 2022-08-07 Impact factor: 6.706