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Malnutrition and Perioperative Nutritional Support in Retroperitoneal Sarcoma Patients: Results from a Prospective Study

  • Paola PrevitaliEmail author
  • Marco Fiore
  • Jacopo Colombo
  • Irina Arendar
  • Luca Fumagalli
  • Marta Pizzocri
  • Chiara Colombo
  • Nicolò N. Rampello
  • Luigi Mariani
  • Alessandro Gronchi
  • Daniela Codazzi
Sarcoma

Abstract

Introduction

Retroperitoneal soft tissue sarcomas (RPSs) are mesenchymal neoplasms. The prevalence of protein energetic malnutrition (PEM) and its impact in RPS patients who were candidates for surgery is unknown.

Materials and Methods

A prospective feasibility study enrolled 35 patients with primary RPS who were candidates for extended multivisceral resection. PEM was screened at enrollment. Preoperative high protein β-hydroxy-β-methyl butyrate oral nutritional support (ONS) was provided according to the degree of PEM. After surgery, nutritional support followed standard practice, targeting at least 1 g/kg/day protein and 20 kcal/kg/day caloric intake within the third postoperative day (POD). PEM was re-evaluated before surgery on POD 10, and at 4 and 12 months after surgery. Primary outcomes were the patient’s compliance to preoperative ONS and the physician’s compliance to postoperative nutritional targets.

Results

PEM was documented in 46% of patients at baseline; ONS met a 91% adherence (overall well tolerated). After ONS, PEM reduced to 38% (p = 0.45). The postoperative caloric target was reached on day 4.1 (standard error ± 2.7), with a protocol adherence rate of 52%. On POD 10, 91% of patients experienced PEM, the worsening of which was greater after resection of four or more organs (p = 0.06). At 4 and 12 months after surgery, almost all patients had fully recovered. A significant correlation between PEM at surgery and postoperative complications was found (p = 0.04).

Conclusions

Relevant PEM prevalence in RPS is documented for the first time. PEM correlates with greater morbidity. In this setting, preoperative ONS was feasible and well-tolerated. Disease-related factors for PEM and the ideal perioperative caloric target in the context of extended multivisceral resection need to be further investigated. Nutritional support should be included in enhanced recovery after surgery programs for RPS.

Trial Registry

ClinicalTrials.gov identifier: NCT03877588.

Notes

Funding

The authors have no financial relationships relevant to this article to disclose.

Disclosures

Paola Previtali, Marco Fiore, Jacopo Colombo, Irina Arendar, Luca Fumagalli, Marta Pizzocri, Chiara Colombo, Nicolò N. Rampello, Luigi Mariani, Alessandro Gronchi, and Daniela Codazzi have no conflicts of interest relevant to this article to disclose.

References

  1. 1.
    Weimann A, Braga M, Carli F et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–50.CrossRefGoogle Scholar
  2. 2.
    Correia MITD, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235–9.CrossRefGoogle Scholar
  3. 3.
    Kassin MT, Owen RM, Perez SD et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;215(3):322–30.CrossRefGoogle Scholar
  4. 4.
    Drover JW, Cahill NE, Kutsogiannis J et al. Nutrition therapy for the critically ill surgical patient: we need to do better! JPEN J Parenter Enteral Nutr. 2010;34(6):644–52.CrossRefGoogle Scholar
  5. 5.
    Awad S, Lobo DN. What’s new in perioperative nutritional support? Curr Opin Anaesthesiol. 2011;24(3):339–48.CrossRefGoogle Scholar
  6. 6.
    West M, Wischmeyer P, Grocott M. Prehabilitation and nutritional support to improve perioperative outcomes. Curr Anesthesiol Rep. 2017;7(4):340–49.CrossRefGoogle Scholar
  7. 7.
    Burden S, Todd C, Hill J et al. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev Engl. 2012;11:.Google Scholar
  8. 8.
    Fukuda Y, Yamamoto K, Hirao M et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol. 2015;22(Suppl 3):S778–85.CrossRefGoogle Scholar
  9. 9.
    Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. N Engl J Med. 1991;325(8):525–32.CrossRefGoogle Scholar
  10. 10.
    Bozzetti F, Gavazzi C, Miceli R et al. Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. JPEN J Parenter Enteral Nutr. 2000;24(1):7–14.CrossRefGoogle Scholar
  11. 11.
    Von Meyenfeldt MF, Meijerink WJ, Rouflart MM et al. Perioperative nutritional support: a randomized clinical trial. Clin Nutr. 1992;11(4):180–6.CrossRefGoogle Scholar
  12. 12.
    Klein S, Kinney J, Jeejeebhoy K et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Clin Nutr. 1997;16(4):193–218.CrossRefGoogle Scholar
  13. 13.
    Heyland DK, Montalvo M, MacDonald S et al. Total parenteral nutrition in the surgical patient: a meta-analysis. Can J Surg. 2001;44(2):102–11.PubMedGoogle Scholar
  14. 14.
    Cawood AL, Elia M, Stratton RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev. 2012;11(2):278–96.CrossRefGoogle Scholar
  15. 15.
    Kabata P, Jastrzębski T, Kąkol M et al. Preoperative nutritional support in cancer patients with no clinical signs of malnutrition—prospective randomized controlled trial. Support Care Cancer 2015;23:365–370.CrossRefGoogle Scholar
  16. 16.
    Filomena G, Schuetz P, Bounoure L et al. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr. 2018;37(1):336–53.CrossRefGoogle Scholar
  17. 17.
    Gibson GR, Hutkins R, Sanders ME et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol. 2017;14(8):491–502.CrossRefGoogle Scholar
  18. 18.
    Williams JD, Wischmeyer PE. Assessment of perioperative nutrition practices and attitudes—a national survey of colorectal and GI surgical oncology programs. Am J Surg. 2017;213(6):1010–8.CrossRefGoogle Scholar
  19. 19.
    Trans-Atlantic RPS Working Group. Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol 2015;22:256–63.CrossRefGoogle Scholar
  20. 20.
    Gronchi A, Strauss DC, Miceli R et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the Multi-Institutional Collaborative RPS Working Group. Ann Surg 2016;263:1002–9.CrossRefGoogle Scholar
  21. 21.
    Bonvalot S, Raut CP, Pollock RE et al. Technical consideration in surgery for retroperitoneal sarcomas: position paper from e-surge, a master class in sarcoma surgery, and EORTC-STBSG. Ann Surg Oncol. 2012;19(9):2981–91.CrossRefGoogle Scholar
  22. 22.
    Kirov KM, Xu HP, Crenn P et al. Role of nutritional status in the early postoperative prognosis of patients operated for retroperitoneal liposarcoma (RLS): a single center experience. Eur J Surg Oncol. 2019;45(2):261–7.CrossRefGoogle Scholar
  23. 23.
    Ardoino I, Miceli R, Berselli M et al. Subtype specific post-operative nomogram for patients affected by primary retroperitoneal soft tissue sarcoma. Cancer 2010;116(10):2429–36.PubMedGoogle Scholar
  24. 24.
    Linee guida SINPE per la Nutrizione Artificiale Ospedaliera 2002. Rivista Italiana di Nutrizione Parenterale ed Enterale. 2002;20(S5):S9–S11.Google Scholar
  25. 25.
    Schaap LA, Quirke T, Wijnhoven HAH et al. Changes in body mass index and mid-upper arm circumference in relation to all-cause mortality in older adults. Clin Nutr. 2018;37(6 Pt A):2252–2259.CrossRefGoogle Scholar
  26. 26.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2020

Authors and Affiliations

  • Paola Previtali
    • 1
    • 2
    Email author
  • Marco Fiore
    • 3
  • Jacopo Colombo
    • 4
  • Irina Arendar
    • 1
  • Luca Fumagalli
    • 1
  • Marta Pizzocri
    • 1
  • Chiara Colombo
    • 3
  • Nicolò N. Rampello
    • 3
  • Luigi Mariani
    • 5
  • Alessandro Gronchi
    • 3
  • Daniela Codazzi
    • 1
  1. 1.Department of Anesthesiology Intensive and Palliative CareFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  2. 2.Department of Anesthesiology and ResuscitationNiguarda HospitalMilanItaly
  3. 3.Sarcoma Service, Department of SurgeryFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  4. 4.Cardiothoracic Anesthesiology and Critical Care UnitNiguarda HospitalMilanItaly
  5. 5.Medical Statistics, Biometry and Bioinformatics, Unit of Clinical Epidemiology and Trial OrganizationFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly

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