NUTRITION PERIOPERATOIRE EN CHIRURGIE DIGESTIVE CARCINOLOGIQUE : PROTOCOLE D’ASSISTANCE NUTRITIONNELLE

Abstract

"Perioperative nutrition in digestive oncologic surgery: Nutritional assistance protocol". Introduction Digestive oncologic surgery exposes patients to complications, most often related to undernutrition. Those patients are subjected to a major inflammatory and endocrine response. The objective of perioperative nutritional care is to limit these consequences. In order to reduce perioperative morbidity, mortality and length of stay; a nutritional assistance protocol based on current international guidelines has been implemented. Material and methods In this prospective study conducted at General Surgery Department B-CHU Tlemcen, 87 patients, candidates for a digestive carcinological surgery, were enrolled during 4 years (from 2016 to 2020). All patients were managed with a perioperative nutritional protocol according to their nutritional stratifications: GN4 (undernourished) and GN2 (not undernourished). Results The age group [69-70 years] was the most represented (31%), with male predominance. The predominant pathology was colorectal cancer (70.1%). The rate of undernourished patients (GN4) represented 41.4%, correlating with the frequency of upper digestive tumors (29.9%). CNO was prescribed in 66.7% of patients. Preoperative artificial nutrition represented 33.3% of nutritional assistance (80.5% of the GN4 group), with a rate of 4.6% via the enteral route. Postoperatively, 31 patients (35.6%) received artificial feeding with a rate of 24.2% parenterally; 58.6% of patients received a sweet drink two hours before the operation and only 22.98% received early refeeding on D0. Morbidity and mortality rates were 18.4% and 3.4%, respectively, mainly in the GN4 group. Conclusion The results of our study have shown the beneficial effect of perioperative nutritional support and its impact on patient outcomes. This improvement requires the recognition of undernutrition as a treatable pathology. Thus, a global multimodal therapeutic strategy, adapted to the patients, will facilitate their early rehabilitation. Keywords: Digestive oncologic surgery, undernutrition, nutritional risk score, perioperative nutritional assistance.