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Palliative Surgery pp 59–70Cite as

Nutrition

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Abstract

Malnutrition and nutritional difficulties are very common in patients with advanced cancer receiving palliative care. These patients often have cancer cachexia, a multifactorial syndrome in which there is loss of skeletal muscle mass, negative protein and energy balance, alterations involving carbohydrate, lipid and protein metabolism, and neuroinflammation. The early assessment of malnutrition is particularly important in patients undergoing palliative surgery. Nutritional status can be assessed by an objective method or by validated nutritional screening tools. These tools are easy to administer even by nonexpert personnel or by the patient themselves and should be used in every surgery department. Malnutrition worsens and increases postoperative complications, surgical risk factors, and mortality. Nutritional support must be prescribed as soon as possible to malnourished patients and patients at risk of malnutrition. The main goals of perioperative nutritional support are to minimize negative protein balance by avoiding starvation; to maintain muscle, immune, and cognitive functions; and to enhance postoperative recovery. Enteral feeding is the first choice route of nutrient administration although parenteral nutrition must be recommended in cases of intestinal failure. Immunonutrition improves surgical outcomes by reducing both infectious and noninfectious complications, as well as the time spent in hospital. Nutritional support therapy is rarely indicated in terminally ill cancer patients.

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Abbreviations

ASPEN:

American Society for Parenteral and Enteral Nutrition

BMI:

Body mass index

BMR:

Basal metabolic rate

CCS:

Cancer cachexia syndrome

ESPEN:

European Society for Clinical Nutrition and Metabolism

MNA:

Mini Nutritional Assessment

MUST:

Malnutrition Universal Screening Tool

n-3 PUFAs:

Omega-3 polyunsaturated fatty acids

NRI:

Nutrition Risk Index

NRS-2002:

Nutritional Risk Screening 2002

PG-SGA:

Patient-Generated Subjective Global Assessment

SCRINIO:

Screening the nutritional status in oncology

SGA:

Subjective Global Assessment

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Authors and Affiliations

  1. Metabolic-Nutritional Unit and Palliative Care Unit, Fondazione Salvatore Maugeri, Via Severino Boezio 28, Pavia, 27100, Italy

    Giacomo Bovio MD

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  1. Giacomo Bovio MD
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Correspondence to Giacomo Bovio MD .

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Editors and Affiliations

  1. Department of General Surgery, Mount Gambier General Hospital, Flinders University—Rural Medical School, Mount Gambier, South Australia, Australia

    Matthias W. Wichmann

  2. Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia

    Guy Maddern

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Bovio, G. (2014). Nutrition. In: Wichmann, M., Maddern, G. (eds) Palliative Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-53709-7_6

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  • DOI: https://doi.org/10.1007/978-3-642-53709-7_6

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