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



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.


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).


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 identifier: NCT03877588.



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


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.


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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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