Advertisement

Nutritives Risiko und Ernährungstherapie bei Magen- und Kardiakarzinom

  • A. Weimann
Chapter

Zusammenfassung

Bei Patienten mit Magenkarzinom ist ein nutritives, metabolisches Risiko für das Entstehen postoperativer Komplikationen prognostisch relevant. Die frühzeitige Erkennung und Beobachtung von Patienten mit Gewichtsverlust und eingeschränkter oraler Nahrungsaufnahme ist deswegen essenziell. Der Nutritional Risk Score ist hierfür gut validiert. Mit dem Ziel der raschen Rekonvaleszenz und Verminderung der postoperativen Morbidität bedarf es auch innerhalb eines ERAS-Konzepts („Enhanced Recovery after Surgery“) besonderer ernährungsmedizinischer Mitbetreuung. Hiermit sollte bereits in der Phase einer neoadjuvanten Therapie und im Intervall vor der Operation begonnen werden. Nach Gastrektomie ist eine längerfristig inadäquate orale Nahrungsaufnahme (>10 Tage) vorhersehbar und kann ein metabolisches Risiko für Komplikationen sowie eine verzögerte Rehabilitation im postoperativen Verlauf darstellen. Dies gilt besonders bei bereits präoperativ bestehendem ernährungsmedizinischem Defizit.

Literatur

  1. Aahlin EK, Tranø G, Johns N et al. (2015) Risk factors, complications and survival after upper abdominal surgery: a prospective cohort study. BMC Surg 15: 83 DOI 10.1186/s12893-015-0069-2CrossRefPubMedPubMedCentralGoogle Scholar
  2. August DA, Huhmann MB, American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors (2009) A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. J Parenter Enteral Nutr 33: 472–500CrossRefGoogle Scholar
  3. Awad S, Varadhan KK, Ljungqvist O, Lobo DN (2013) A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr 32: 34–44CrossRefPubMedGoogle Scholar
  4. Baldwin C, Spiro A, Ahern R, Emery PW (2012) Oral nutritional interventions in malnourished Patients with cancer: a systematic review and meta-analysis. J Natl Cancer Inst 104: 371–385CrossRefPubMedGoogle Scholar
  5. Bollhalder L, Pfeil AM, Tomonaga Y, Schwenkglenks M (2013) A systematic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation. Clin Nutr 32: 213–223CrossRefPubMedGoogle Scholar
  6. Bozzetti F, Gavazzi C, Miceli R et al. (2000) Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer Patients: a randomized, clinical trial. J Parenter Enteral Nutr 24: 7c14CrossRefGoogle Scholar
  7. Cederholm T, Bosaeus I, Barazzoni R et al. (2015) Diagnostic criteria for malnutrition − an ESPEN consensus statement. Clin Nutr 34: 335–340CrossRefPubMedGoogle Scholar
  8. Chen B, Zhou Y, Yang P et al. (2010) Safety and efficacy of fish oil-enriched parenteral nutrition regimen on postoperative Patients undergoing major abdominal surgery: a meta-analysis of randomized controlled trials. J Parenter Enteral Nutr 34: 387–394CrossRefGoogle Scholar
  9. Chevrou-Séverac H, Pinget C, Cerantola Y et al. (2014) Cost-effectiveness analysis of immune-modulating nutritional support for gastrointestinal cancer Patients. Clin Nutr 33: 649–654CrossRefPubMedGoogle Scholar
  10. Elia M, Normand C, Norman K, Laviano A (2015) A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr 35(2): 370–380CrossRefPubMedGoogle Scholar
  11. Farreras N, Artigas V, Cardona D et al. (2005) Effect of early postoperative enteral immunonutrition on wound healing in Patients undergoing surgery for gastric cancer. Clin Nutr 24: 55–65CrossRefPubMedGoogle Scholar
  12. Fukuda Y, Yamamoto K, Hirao N et al. (2015) Prevalence of malnutrition among gastric cancer Patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol 22 (Suppl 3): S778–S785CrossRefPubMedGoogle Scholar
  13. Grass FG, Benoit M, Coti Bertrand P et al. (2016) Nutritional status deteriorates postoperatively despite preoperative nutritional support. Ann Nutr Metab 68: 291–297CrossRefPubMedGoogle Scholar
  14. Greco M, Capretti G, Beretta L et al. (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38: 1531–1541CrossRefPubMedGoogle Scholar
  15. Gupta D, Vashi PG, Lammersfeld CA, Braun DP (2011) Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature. Ann Nutr Metab 59: 96–106CrossRefPubMedGoogle Scholar
  16. Hegazi RA, Hustead DS, Evans DC (2014) Preoperative standard oral nutrition supplements vs immunonutrition: results of a systematic review and meta-analysis. J Am Coll Surg 219: 1078–1087CrossRefPubMedGoogle Scholar
  17. Hiesmayr M, Schindler K, Pernicka E et al., NutritionDay Audit Team (2009) Decreased food intake is a risk factor for mortality in hospitalised Patients: the NutritionDay survey 2006. Clin Nutr 28: 484–491CrossRefPubMedGoogle Scholar
  18. Hur H, Kim SG, Shim JH et al. (2011) Effect of early oral feeding after gastric cancer surgery: a result of randomized clinical trial. Surgery 149: 561–568CrossRefPubMedGoogle Scholar
  19. Hubbard GP, Elia M, Holdoway, Stratton RJ (2012) A systematic review of compliance to oral nutritional supplements. Clin Nutr 31: 293–312CrossRefPubMedGoogle Scholar
  20. Klek S, Szybinski P, Szczepanek K (2014) Perioperative immunonutrition in surgical cancer Patients; a summary of a decade of research. World J Surg 38: 803−812CrossRefPubMedGoogle Scholar
  21. Kondrup J, Allison SP, Elia M et al., Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN) (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22: 415−421CrossRefPubMedGoogle Scholar
  22. Kuppinger D, Hartl WH, Bertok M et al. (2012) Nutritional screening for risk prediction in Patients scheduled for abdominal operations 99: 728-737Google Scholar
  23. Lidder P, Flanagan D, Fleming S et al. (2010) Combining enteral with parenteral nutrition to improve postoperative glucose control. Br J Nutr 103: 1635–1641CrossRefPubMedGoogle Scholar
  24. Ligthart-Melis GC, Weijs PJM, te Boveldt ND et al. (2013). Dietician-delivered intensive nutritional support is associated with a decrease in severe postoperative complications after surgery in Patients with esophageal cancer. Dis Esophagus 26: 587–593CrossRefPubMedGoogle Scholar
  25. Mabvuure NT, Roman I, Khan OA (2013) Enteral immunonutrition versus standard enteral nutrition for Patients undergoing oesophagogastric resection for cancer. Int J Surg 11: 122–127CrossRefPubMedGoogle Scholar
  26. Marimuthu K, Varadhan KK, Ljungqvist O, Lobo DN (2012) A meta-analysis of the effect of combinations of immune modulating nutrients on outcome in Patients undergoing major open gastrointestinal surgery. Ann Surg 255: 1060–1068CrossRefPubMedGoogle Scholar
  27. Martindale RG, McClave SA, Taylor B, Lawson CM (2013) Perioperative nutrition: what is the current landscape? J Parenter Enteral Nutr 37 (Suppl 5): 5S–20SCrossRefGoogle Scholar
  28. Meyer L, Meyer F, Dralle H et al., East German Study Group for Quality Control in Operative Medicine and Regional Development in Surgery (2005) Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma. Langenbecks Arch Surg 390: 510–516CrossRefPubMedGoogle Scholar
  29. Möhler M, Al-Batran SE, Andus T et al. (2011) German S3-Guideline: Diagnosis and treatment of esophagogastric cancer. Z Gastroenterol 49: 461–531CrossRefGoogle Scholar
  30. Mortensen K, Nilsson M, Slim K et al. (2014) Consensus guidelines for enhanced recovery after surgery (ERAS) Society recommendations. Br J Surg 101: 1209–1229CrossRefPubMedGoogle Scholar
  31. Nothacker M, Rütters D (2012) Evidenzbericht 2012: Analyse von Metaanalysen zur perioperativen klinischen Ernährung. Ärztliches Zentrum für Qualität in der Medizin (ÄZQ) BerlinGoogle Scholar
  32. Osland E, Hossain MB, Khan S, Memon MA (2014) Effect of timing of pharmaconutrition (immunonutrition) administration on outcomes of elective surgery for gastrointestinal malignancies: a systematic review and meta-analysis. J Parenter Enteral Nutr 38: 53–69CrossRefGoogle Scholar
  33. Peterson SJ, Tsai AA, Scala CM et al. (2010) Adequacy of oral intake in critically ill Patients 1 week after extubation. J Am Diet Assoc 110: 427–433CrossRefPubMedGoogle Scholar
  34. Pradelli L, Mayer K, Muscaritoli M, Heller AR (2012) n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU Patients: a meta-analysis. Crit Care 16: R184.CrossRefGoogle Scholar
  35. Smith MD, McCall J, Plank L et al. (2014) Preoperative carbohydrate treatment for enhancing recovery after elective surgery.Cochrane Database Syst Rev. 2014 Aug 14; 8:CD009161. doi:  10.1002/14651858.CD009161.pub2. Google Scholar
  36. Song GM, Tan X, Liang H et al. (2015) Role of enteral immunonutrition in Patients undergoing surgery for gastric cancer: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 94(31): e1311CrossRefGoogle Scholar
  37. Sorensen J, Kondrup J, Prokopowicz J et al., EuroOOPS study group (2008) EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 27: 340−349CrossRefPubMedGoogle Scholar
  38. Van Stijn MF, Korkic-Halilovic I, Bakker MS et al. (2013) Preoperative nutrition status and postoperative outcome in elderly general surgery Patients: a systematic review. J Parenter Enteral Nutr 37: 37−43CrossRefGoogle Scholar
  39. Wang Y, Jiang ZM, Nolan MT et al. (2010) The impact of glutamine dipeptide-supplemented parenteral nutrition on outcomes of surgical Patients: a meta-analysis of randomized clinical trials. J Parenter Enteral Nutr 34: 521−529CrossRefGoogle Scholar
  40. Weimann A (2014) Perioperative enterale und parenterale Ernährung bei Tumorpatienten. Forum 29: 386−391CrossRefGoogle Scholar
  41. Weimann A, Braga M, Harsanyi L et al., DGEM (German Society for Nutritional Medicine), ESPEN (European Society for Parenteral and Enteral Nutrition) (2006) ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr 25: 224−244CrossRefPubMedGoogle Scholar
  42. Weimann A, Schütz T, Lipp T et al. (2012) Supportiver Einsatz von Trinknahrung in der ambulanten Versorgung von Erwachsenen Patienten – ein Algorithmus. Aktuel Ernährungsmed 37: 282−286CrossRefGoogle Scholar
  43. Weimann A, Singer P (2013) Avoiding underfeeding in severely ill Patients in the intensive care unit, Lancet 381(9880): 1811CrossRefPubMedGoogle Scholar
  44. Weimann A, Breitenstein S, Breuer JP et al., DGEM Steering Committee (2014) Klinische Ernährung in der Chirurgie, S3 Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin e.V. (DGEM) in Zusammenarbeit mit der Gesellschaft für klinische Ernährung der Schweiz (GESKES), der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE), der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), der Deutschen Gesellschaft für Anästhesie, Intensiv- und Notfallmedizin (DGAI) und der Deutschen Gesellschaft für Chirurgie (DGCH), Chirurg 85: 320−326CrossRefPubMedGoogle Scholar
  45. Wong CS, Aly EH (2016) The effects of enteral immunonutrition in upper gastrointestinal surgery: a systematic review and meta-analysis. Int J Surg 29: 137–150CrossRefPubMedGoogle Scholar
  46. Ziegler TR, May Ak, Hebbar G et al. (2016) Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical ICU Patients: an American multicenter randomized controlled trial. Ann Surg 263: 646–655CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland 2017

Authors and Affiliations

  • A. Weimann
    • 1
  1. 1.Klinik für Allgemein-Viszeral- und Onkologische ChirurgieKlinikum St. Georg gGmbHLeipzigDeutschland

Personalised recommendations