Nutritional depletion is commonly observed in patients undergoing surgical treatment for a gastrointestinal malignancy. An appropriate nutritional intervention could be associated with improved postoperative outcomes. The study was aimed to determine the effect of a program of gastrointestinal rehabilitation and early postoperative enteral nutrition upon complications and clinical outcomes in patients who experienced gastrointestinal surgery for cancer. This is a prospective study (2013 January–2015 December) of 465 consecutive patients submitted to gastrointestinal surgery for cancer and admitted to an Oncological Intensive Care Unit. The program of gastrointestinal rehabilitation and early postoperative enteral nutrition consisted on: (1) general rules: pain relive, early mobilization, antibiotic prophylaxis, deep vein thrombosis prophylaxis and respiratory physiotherapy; and (2) gastrointestinal rules: gastric protection, control of postoperative nausea and vomiting, early nasogastric tube remove and early enteral nutrition. The most frequent surgical sites were colorectal (44.9%), gynecological with intestinal suturing (15.7%) and esophagus/stomach (11.0%). Emergency surgery was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complications (19.2 vs. 10.2%; p = 0.030), respiratory complications (p = 0.040), delirium (p = 0.032), infectious complications (p = 0.047) and gastrointestinal complications (p < 0.001). Intensive care unit mortality (p = 0.018), length of intensive care unit stay (p < 0.001) and length of hospitalization (p < 0.001) were reduced as well. A program of gastrointestinal rehabilitation and early postoperative enteral nutrition is associated with reduced postoperative complications and improved clinical outcomes in patients undergoing gastrointestinal surgery for cancer.
Gastrointestinal cancer Postoperative nutrition Enhanced recovery after surgery Postoperative complication Outcome
This is a preview of subscription content, log in to check access.
The authors would like to thank Lucia Chang-Navarro for his help with the translation into English.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
This article does not involve any studies with animals.
This is a prospective study, and was therefore conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all patients.
PDQ Supportive and Palliative Care Editorial Board (2017) Nutrition in cancer care (PDQ): health professional version. PDQ cancer information summaries. Bethesda (MD): National Cancer Institute (US)Google Scholar
Ozorio GA, Barão K, Forones NM (2017) Cachexia stage, patient-generated subjective global assessment, phase angle, and handgrip strength in patients with gastrointestinal cancer. Nutr Cancer 19:1–8Google Scholar
Garth AK, Newsome CM, Simmance N, Crowe TC (2010) Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet 23:393–401CrossRefPubMedGoogle Scholar
Wanden-Berghe C, Sanz-Valero J, Arroyo-Sebastián A, Cheikh-Moussa K, Moya-Forcen P (2016) Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review. Nutr Hosp 33:402CrossRefPubMedGoogle Scholar
Li B, Liu HY, Guo SH, Sun P, Gong FM, Jia BQ (2015) Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer. Genet Mol Res 14:7136–7141CrossRefPubMedGoogle Scholar
Wang G, Chen H, Liu J, Ma Y, Jia H (2015) A comparison of postoperative early enteral nutrition with delayed enteral nutrition in patients with esophageal cancer. Nutrients 7:4308–4317CrossRefPubMedPubMedCentralGoogle Scholar
Martos-Benítez FD, Gutiérrez-Noyola A, Echevarría-Víctores A (2016) Postoperative complications and clinical outcomes among patients undergoing thoracic and gastrointestinal cancer surgery: a prospective cohort study. Rev Bras Ter Intensiva 28:40–48CrossRefPubMedPubMedCentralGoogle Scholar
Gero D, Gié O, Hübner M, Demartines N, Hahnloser D (2017) Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment. Langenbecks Arch Surg 402:149–158CrossRefPubMedGoogle Scholar
Chadi SA, Fingerhut A, Berho M, DeMeester SR, Fleshman JW, Hyman NH et al (2016) Emerging trends in the etiology, prevention, and treatment of gastrointestinal anastomotic leakage. J Gastrointest Surg 20:2035–2051CrossRefPubMedGoogle Scholar
Martos Benítez FD, Guzmán Breff BI, Betancourt Plaza I, González Martínez I (2016) Postoperative complications in thoracic and abdominal surgery: definitions, epidemiology and severity. Rev Cub Cir 55:40–53Google Scholar
Bos MM, de Keizer NF, Meynaar IA, Bakhshi-Raiez F, de Jonge E (2012) Outcomes of cancer patients after unplanned admission to general intensive care units. Acta Oncol 51:897–905CrossRefPubMedGoogle Scholar
Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, De Hert S et al (2014) 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management. The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol 31:517–573CrossRefPubMedGoogle Scholar
Barnett S, Moonesinghe SR (2011) Clinical risk scores to guide perioperative management. Postgrad Med J 87:535–541CrossRefPubMedGoogle Scholar
Knott A, Pathak S, McGrath JS, Kennedy R, Horgan A, Mythen M et al (2012) Consensus views on implementation and measurement of enhanced recovery after surgery in England: Delphi study. BMJ Open 2:e001878CrossRefPubMedPubMedCentralGoogle Scholar
Bona S, Molteni M, Rosati R, Elmore U, Bagnoli P, Monzani R et al (2014) Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience. World J Gastroenterol 20:17578–17587CrossRefPubMedPubMedCentralGoogle Scholar
Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38:1531CrossRefPubMedGoogle Scholar
Varadhan KK (2010) Enhanced recovery after surgery: the future of improving surgical care. Crit Care Clin 26:527–547CrossRefPubMedGoogle Scholar
Ni TG, Yang HT, Zhang H, Meng HP, Li B (2015) Enhanced recovery after surgery programs in patients undergoing hepatectomy: a meta-analysis. World J Gastroenterol 21:9209–9216CrossRefPubMedPubMedCentralGoogle Scholar
Małczak P, Pisarska M, Piotr M, Wysocki M, Budzyński A, Pędziwiatr M (2017) Enhanced recovery after bariatric surgery: systematic review and meta-analysis. Obes Surg 27:226–235CrossRefPubMedGoogle Scholar
Fisher WE, Hodges SE, Cruz G, Artinyan A, Silberfein EJ, Ahern CH et al (2011) Routine nasogastric suction may be unnecessary after a pancreatic resection. HPB 13:792–796CrossRefPubMedPubMedCentralGoogle Scholar
Nelson R, Edwards S, Tse B (2007) Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 3:CD004929Google Scholar
Manba N, Koyama Y, Kosugi S, Ishikawa T, Ichikawa H, Minagawa M et al (2014) Is early enteral nutrition initiated within 24 hours better for the postoperative course in esophageal cancer surgery? J Clin Med Res 6:53–58PubMedGoogle Scholar
Wang F, Hou MX, Wu XL, Bao LD, Dong PD (2015) Impact of enteral nutrition on postoperative immune function and nutritional status. Genet Mol Res 14:6065–6072CrossRefPubMedGoogle Scholar
Ding D, Feng Y, Song B, Gao S, Zhao J (2015) Effects of preoperative and postoperative enteral nutrition on postoperative nutritional status and immune function of gastric cancer patients. Turk J Gastroenterol 26:181–185CrossRefPubMedGoogle Scholar
Boelens PG, Heesakkers FF, Luyer MD, van Barneveld KW, de Hingh IH, Nieuwenhuijzen GA et al (2014) Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: prospective, randomized, controlled trial. Ann Surg 259:649–655CrossRefPubMedGoogle Scholar
Gianotti L, Nespoli L, Torselli L, Panelli M, Nespoli A (2011) Safety, feasibility, and tolerance of early oral feeding after colorectal resection outside an enhanced recovery after surgery (ERAS) program. Int J Colorectal Dis 26:747–753CrossRefPubMedGoogle Scholar
Osland E, Yunus RM, Khan S, Memon MA (2011) Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis. JPEN 35:473–487CrossRefGoogle Scholar