ESPEN guideline: Clinical nutrition in surgery

Effects of perioperative ω-3 fish oil fat emulsion on postoperative gastric emptying function following Roux-en-Y reconstruction for gastric cancer

PURPOSE

Despite standardized surgical techniques, delayed gastric emptying (DGE) remains a major complication after Roux-en-Y reconstruction in patients with gastric cancer. This study aimed to evaluate the efficacy of ω-3 fish oil fat emulsion in reducing DGE incidence and improving postoperative outcomes.

METHODS

In this retrospective cohort study, 210 patients undergoing radical gastrectomy with Roux-en-Y reconstruction (Nanjing Drum Tower Hospital, 2018-2020) were stratified into 2 groups: the intervention group (n = 139) received parenteral nutrition (PN) with ω-3 fish oil emulsion (0.2 g/kg/d), whereas controls (n = 71) received standard PN. DGE diagnosis required persistent symptoms (>72 h postoperatively) and objective evidence of impaired motility (computed tomography contrast retention ≥ 50% at 4 h or scintigraphic T½ > 90 min), excluding mechanical obstructions (luminal stenosis < 8 mm).

RESULTS

The ω-3 group exhibited significantly lower DGE incidence (4.3% vs 15.5%; P =.005) and shorter median postoperative hospital stay (10 vs 13 days; P <.001). Multivariate analysis identified ω-3 supplementation as an independent protective factor against DGE (odds ratio, 0.32; 95% CI, 0.11-0.96; P =.042). Symptom severity (Gastroparesis Cardinal Symptom Index) showed progressive improvement in the ω-3 cohort, with significant reductions in nausea and vomiting scores by week 4 (P <.05).

CONCLUSION

Perioperative ω-3 fish oil fat emulsion supplementation reduces DGE risk by 71%, accelerates recovery, and improves surgical outcomes in patients with gastric cancer undergoing Roux-en-Y reconstruction. These findings support its integration into enhanced recovery protocols, particularly in high-risk populations.

Application of enhanced recovery after surgery in perioperative care of infants and children with Hirschsprung disease

BACKGROUND

Enhanced recovery after surgery (ERAS) represents an innovative, protocol-driven perioperative care program designed to optimize patient outcomes. However, its application and efficacy in infants and children with Hirschsprung disease (HD) remain underexplored.

AIM

To delve into the impact of ERAS on perioperative recovery and the overall medical experience in HD infants and children.

METHODS

Thirty-eight infants and children with HD who received the Soave surgical procedure were enrolled in this case-control study. According to age- and sex-stratified single-blind randomized tables, 20 cases received ERAS treatment (ERAS group) and 18 cases received conventional treatment (control group). The two treatments were then compared in terms of perioperative recovery and medical experience.

RESULTS

Significant differences were observed in pain scores at awakening (4.2 ± 1.3 vs5.2 ± 1.2, t = 2.516, P = 0.017) and pain duration (85.69 ± 7.46 hours vs 67.00 ± 8.56 hours, t = 7.139, P < 0.001) between the ERAS and control group. The recovery of bowel movement was earlier in the ERAS group than in the control group (borborygmus time: 33.63 ± 9.83 hours vs 44.69 ± 16.85 hours, t = 2.501, P = 0.017; feeding time: 36.63 ± 9.55 hours vs 49.36 ± 16.99 hours, t = 2.884, P = 0.007; anal catheter indwelling time: 75.83 ± 13.80 hours vs 93.36 ± 20.65 hours, t = 3.104, P = 0.004), and fever duration (40.73 ± 14.42 hours vs 52.63 ± 18.69 hours, t = 2.211, P = 0.034). In the ERAS group, hospital stay was shorter (7.5 ± 0.9 days vs 8.3 ± 1.2 days) and the cost was lower (14203 ± 2381 yuan vs 16847 ± 3558 yuan). During the 1-month follow-up period, of the multiple postoperative complications observed, the occurrence of perianal dermatitis (P_Fisher = 0.016) and defecation dysfunction (P_Fisher = 0.027) were lower in the ERAS group than in the control group.

CONCLUSION

The ERAS protocol has the potential to profoundly enhance postoperative recovery and significantly elevate the overall comfort and quality of the medical experience, making it an indispensable approach that warrants widespread adoption. Continuous refinement through evidence-based practices is anticipated to further optimize its efficacy.

Development and implementation of a stratified enhanced recovery after surgery pathway for ventral hernia repair

INTRODUCTION

Enhanced recovery after surgery (ERAS) pathways are widely adopted in both major and minimally invasive surgeries. However, ERAS pathway implementation in ventral hernia repair (VHR) surgery remains an area of ongoing research given the variability in hernia complexity and surgical approach. To address this, our institution proposed and developed a stratified ERAS pathway to deliver effective, tailored perioperative care.

AREAS COVERED

This narrative describes the development of the ERAS pathway stratified to address the varied perioperative needs of VHR procedures, outline the evidence-based interventions comprising the bundle, describe the implementation process, and discuss the potential economic impact of implementing this pathway. We conducted a systematic literature search, last updated on 15 February 2024.

EXPERT COMMENTARY

By leveraging the common elements of ventral hernia repair ERAS pathways, while addressing the perioperative needs of patients undergoing more complex procedures, a stratified pathway approach provides a practical and adaptable framework that balances intervention specificity with ease of implementation. While the introduction of conditional element modifications increases pathway complexity, it also facilitates patient-centered delivery of care. Operational expertise in organizing such pathways, as well as the implementation science behind it, is an opportunity to advance the frontiers of ERAS program developments.

Individual multimodal prehabilitation in high-risk patients undergoing major abdominal surgery following neoadjuvant treatment - a feasibility study

PURPOSE

Despite advancements in medicine, perioperative complications and functional decline remain challenges for patients undergoing major abdominal surgery, particularly in high-risk individuals with limited functional capacity and impaired nutritional status. Prehabilitation, which involves interventions before surgery, shows promise in addressing these issues, but the heterogeneity of studies limits specific recommendations. The integration of prehabilitation into clinical practice with special regard to the setting and modalities of treatment also remain unclear.

METHODS

As a feasibility study for home-based prehabilitation high-risk patients (age ≥ 70 years, ASA ≥ 3) undergoing neoadjuvant treatment for non-metastatic esophageal, gastric, or rectal cancer, followed by oncological resection were included. A six-week multimodal supervised home-based prehabilitation program, including nutritional therapy, exercise, and psychological support, was implemented after neoadjuvant treatment and before surgery. Functional, nutritional, and quality of life (QoL) assessments were conducted at multiple points. Feasibility and adherence were assessed. Secondary explorative outcome measures included complication rates, hospital stay, readmission, and mortality, which were compared to a matched cohort.

RESULTS

Of 24 enrolled patients, 20 completed the program, with high adherence to home-based workouts (91.8%), respiratory exercises (92.9%), and oral nutritional supplements (ONS) (88.7%). Functional and nutritional improvements were observed, including improved sit-to-stand performance (p = 0.025) and serum albumin levels (p = 0.001). QoL improved in the physical function domain (p = 0.009). Postoperative outcomes were similar between groups.

CONCLUSION

A supervised home-based prehabilitation program is feasible for high-risk patients, with high adherence to interventions and potential benefits in functional and nutritional status. Further research is needed to optimize program content, identify optimal patient populations, and assess long-term outcomes.

Nutritional characteristics and the potential impact of dietetic intervention on patients assessed for heart transplant

BACKGROUND & AIMS

Heart transplant (HT) is the gold standard treatment for people with end stage heart failure (HF). Up to 46 % of patients with chronic HF are malnourished and increasing rates of obesity have also been identified. Therefore, at time of HT assessment, patients are required to meet eligibility criteria, including nutrition targets. It is recommended that patients being considered for HT receive comprehensive assessment by a multidisciplinary team (MDT) to assist in meeting HT criteria. This study aimed to describe the baseline nutritional characteristics of patients undergoing HT assessment and to explore the impact of dietetic intervention on key nutritional parameters including BMI and malnutrition status pre-transplant.

METHODS

This study was a single-centre combined retrospective and prospective observational cohort study. Adults who underwent HT assessment and met inclusion criteria between January 1, 2015 and June 30, 2021 were included. Key nutrition-related parameters assessed were weight, Body Mass Index (BMI), and nutritional status using the Subjective Global Assessment (SGA): A well-nourished, B and C moderately and severely malnourished, collected at HT assessment, listing and HT. The impact of dietetic intervention on nutrition-related parameters was also assessed.

RESULTS

255 patients were included, with 2.7 % (n = 7) underweight, 32.2 % healthy weight, 38.8 % overweight and 26.3 % obese. Of 161 patients assessed using the SGA 22.4 % (n = 36) were moderately or severely malnourished. 26 patients had a relative nutrition contraindication for HT listing (BMI>35 kg/m2 and/or HbA1c >7.5 %) and n = 39 had suboptimal nutritional status including BMI <18.5 kg/m2 and/or presence of malnutrition.Dietetic intervention did not result in statistically significant changes in weight, BMI or nutritional status. 25.5 % of patients had relative nutritional contraindications to HT or suboptimal nutritional parameters and 9 had a decline in nutritional status, defined as developing malnutrition or worsened malnutrition.

CONCLUSIONS

This study showed a quarter of HT patients had suboptimal nutrition-related parameters including malnutrition, underweight, overweight or obesity at time of HT assessment, indicating opportunity for improved nutrition support prior to HT. The results also indicated that nutritional status can deteriorate in patients waiting for HT. Routine nutrition assessment and regular monitoring by a dietitian has the potential to support patients in their HT journey through optimising BMI and preventing nutritional decline.

Adequacy of oral intakes after cardiac surgery within an ERAS pathway: A prospective observational study

BACKGROUND

The 2019 Enhanced Recovery After Cardiac Surgery (ERACS) guidelines presented perioperative recommendations to optimize treatment for patients undergoing cardiac surgery (CS). However, the guidelines have not established postoperative nutrition recommendations. Limited studies have analyzed oral intakes after CS, but to our knowledge, none have done so in an ERACS pathway. The main objective of this study was to evaluate the adequacy of postoperative oral intakes, including adherence to oral nutrition supplements (ONSs).

METHODS

This was an observational prospective study. Postoperative oral intakes were analyzed from postoperative day (POD) 1 to 4, using direct observation of meal plates provided by the hospital. ONSs consumption was evaluated from POD2 to POD4. Adherence to other ERACS recommendations, including nutrition optimization before surgery, was recorded.

RESULTS

Forty-three patients were included in this study. Nutrition optimization before CS was offered to three (7%) patients. Forty-one (95%) patients resumed oral intakes on POD1. Mean oral calorie and protein intakes from POD2 to POD4 were 1088 ± 437 kcal and 0.8 ± 0.3 g/kg, respectively; however, 17 (41%) patients had calorie and protein intakes ≥70% of their estimated requirements. On POD2, ONSs consumption contributed 35% ± 19% and 38% ± 20% of calorie and protein intake, respectively. There was a significant decrease in ONSs consumption starting on POD3.

CONCLUSION

Within an ERACS pathway and with the contribution of ONSs, 41% of patients achieved sufficient oral intakes within the first 4 days after CS. The optimization of ONSs adherence on postoperative oral intakes should be further studied.

[Prehabilitation and enhanced recovery after surgery protocols for head and neck cancer : Value and application of these concepts]

Prehabilitation is gaining traction in complex oncological interventions and treatments. This CME article is focused on the basic principles of prehabilitation. We discuss the objective evaluation of physical fitness and how to improve it by physio- and speech therapy. Thereafter, we explain how to judge nutritional status, especially in oncological patients, and discuss modes of nutritional supplementation. Finally, the enhanced recovery after surgery concept is briefly explained and its current value in head and neck cancer patients discussed.

Perioperative or combined preoperative and postoperative standard nutrition therapy for patients with head and neck or gastrointestinal cancer: A systematic review and meta-analysis

BACKGROUND & AIMS

Since malnutrition is a risk factor for postoperative complications, preoperative nutritional therapy is recommended to reduce postoperative complications. Few meta-analyses conducted exclusively in cancer patients have shown that perioperative standard nutritional therapy reduces postoperative complications. This study examined whether preoperative or combined preoperative and postoperative standard nutritional therapy reduced postoperative complications in patients with head and neck or gastrointestinal (GI) cancer.

METHODS

We conducted randomized controlled trials in 1979-2021. Patients who received standard nutritional interventions were classified as the intervention group and those who did not receive any nutritional intervention as controls. The primary outcome was the total number of postoperative complications and infectious complications.

RESULTS

In total, 19 studies were included (n = 2047). Of 19 studies, 5 were for upper GI cancer, 8 were for lower GI cancer, 5 were for upper and lower GI cancers, and 1 was for head and neck cancer. Total postoperative and infectious complications were reported in 15 (n = 1762) and 9 (n = 905) studies. The meta-analysis showed that standard nutritional interventions may reduce the total complication rates (RR: 0.78, 95 % CI: 0.65-0.94) and infectious complications (RR: 0.67, 95 % CI: 0.51-0.87). There were no significant differences in subgroup analyses, according to the nutritional therapy timing and nutritional status. The risk of bias was high for random sequence generation, allocation concealment, and participants' and data analysts' blinding. COE for total postoperative and infectious complications was weak and inconsistent due to the high risk of bias and substantial heterogeneity.

CONCLUSION

Although the present study was inconclusive due to the small number of studies in head and neck cancer, preoperative or combined preoperative and postoperative standard nutrition therapy in patients with GI cancer may significantly reduce the incidence of postoperative complications. Further studies are needed to confirm these findings and to reduce the risk of bias.

Effect of tailored, intensive prehabilitation for risky lifestyles before ventral hernia repair on postoperative outcomes, health, and costs - study protocol for a randomised controlled trial (STRONG-Hernia)

BACKGROUND

A substantial untapped potential for risk reduction may be fulfilled by applying intensive lifestyle interventions targeting the co-existing risky lifestyle factors Smoking, Nutrition (both malnutrition and obesity), risky Alcohol intake, and Physical inactivity (SNAP) before surgery. This trial will compare the effect of combined and individually tailored prehabilitation with standard care on postoperative outcomes, health, and cost-effectiveness in short and long term in participants undergoing ventral hernia repair. An interview study will be nested within the randomised trial.

METHODS

The study is a multicenter, parallel-group, superiority randomised clinical trial. A total of 400 adult participants undergoing ventral hernia repair with ≥1 SNAP factor will be allocated to the individually tailored STRONG programme or standard care. The STRONG programme is initiated at least four weeks prior to surgery and consists of six sessions. It is delivered as one session a week, approximately, and includes patient education, motivational, and pharmaceutical supports. The primary outcome is postoperative complications requiring treatment within 30 days. Secondary outcomes address other surgical outcomes, changes in lifestyle, health, and cost-effectiveness. Follow-up takes place after 6 weeks (the end of intervention), at surgery, and 30 days, 90 days, and 6 months after surgery, respectively. Long-term data on health and costs will be obtained from nationwide registries after two years. Eligible trial participants will be invited to a semi-structured interview study at baseline. Their reflections on the STRONG programme and the choice of participating in the trial or not will be explored.

DISCUSSION

Many patients have multiple SNAP factors adding to the risk of complications related to surgery. As these are modifiable, prehabilitation may be an area with great potential for risk reduction. Nevertheless, no well-acknowledged and evidence-based strategies exist in the preoperative period. The STRONG programme is tailored specifically to the individual patient's preidentified needs including up to all five common risky SNAP factors and may tap into the large unused potential for risk reduction. Overall, the study will add important new knowledge on the effect of individually tailored prehabilitation on complications and other important outcomes in elective surgery, and also clarify if this intervention will have long-lasting implications.

TRIAL REGISTRATION

www.clinicaltrials.gov (NCT06611462).

Impact of prognostic nutritional index on oncological outcomes and mortality among advanced gastric cancer patients: European GASTRODATA registry analysis

While Prognostic Nutritional Index (PNI) is an established predictor of outcomes in Asian gastric cancer (GC) patients, data among Western populations are limited. This study assessed the predictive value of PNI in European GC patients undergoing multimodal treatment. Data from GASTRODATA, the largest European repository of GC patients undergoing gastrectomy, were collected between 2017 and 2022. The primary outcome was textbook outcome (TO) achievement, and the secondary was 90-day mortality. PNI was calculated one day before surgery, with a cut-off of 45.5 based on ROC analysis. Among 721 patients included 60.7% were men. Most patients had advanced tumors (cT3-4 = 75.2%) and metastatic lymph nodes (57.7%). Neoadjuvant chemotherapy (NAC) was administered to 46.7% of patients, and 32.9% received adjuvant chemotherapy. Median PNI was 49.5 (IQR 45.0-56.4). Low PNI was present among 30% of patients and was associated with decreased odds of TO achievement (OR = 0.57, 95% CI 0.37-0.89), higher 90-day mortality (OR = 4.99, 95% CI 2.32-10.73). NAC administration was associated with lower morbidity risk (OR = 0.56, p = 0.0408), and low PNI was a predictor of receiving AC (p = 0.0005). PNI was a valuable predictor for oncological outcomes and morbidity among European GC patients undergoing multimodal. While low PNI was associated with decreased odds of TO achievement and increased risk of 90-day mortality, further prospective and nutritional intervention studies are warranted to standardize the PNI threshold and improve its clinical applicability.

Early prediction of postoperative infection using inflammatory markers after cytoreductive surgery for peritoneal carcinomatosis

BACKGROUND

Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC). C-reactive protein (CRP) is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications, as is the neutrophil-to-lymphocyte ratio (NLR). In patients with peritoneal carcinomatosis, postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC.

AIM

To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections (OPIs) after CRS +/- HIPEC.

METHODS

Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital, in whom complete or optimal cytoreduction was achieved, were analyzed retrospectively. A total of 111 patients were included in this study. CRP and NRL values prior to surgery and during the first four postoperative days (PODs) were recorded, along with immunonutrition intake. Their association with OPI and intra-abdominal infections during the first week after surgery was evaluated.

RESULTS

Of the 111 patients included, 19 presented OPI and 8 intra-abdominal infections. Patients with infections had a higher number of digestive anastomoses than those without (1 vs 0.5, P = 0.053 and 1.2 vs 0.6, P = 0.049) and longer length of stay (19 vs 14.9 days, P = 0.022 and 22.3 vs 15.1 days, P = 0.006). CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7% and a specificity of 74.2% to detect OPI. No differences in NLR values were observed. Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI. Subsequently, on POD3 and POD4, patients with OPI presented with higher levels of CRP than patients without infection, regardless of the immunonutrition intake.

CONCLUSION

CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS. A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.

Relation of Malnutrition on Septic Older Adults in Emergency Gastrointestinal Surgery: A Modified Global Leadership Initiative on Malnutrition Analysis

INTRODUCTION

Malnutrition in older adults has significant ramifications for surgical outcomes. The incidence of malnutrition is up to 30% in emergent gastrointestinal surgery (EGS). This study aims to investigate malnutrition's correlation on outcomes of older adults with preoperative sepsis undergoing EGS.

METHODS

Adults aged ≥ 65 y who had preoperative sepsis were included. The Global Leadership Initiative on Malnutrition (GLIM) introduced criteria to diagnose malnutrition. We used a modified GLIM (mGLIM) using the National Surgical Quality Improvement Project database. The mGLIM includes (1) body mass index ≤ 20 kg/m2 for age ≤ 70 y and body mass index ≤ 22 kg/m2 for age ≥ 71 y, (2) weight loss >10% within the past 6 mo, (3) admission albumin ≤ 3.5 g/dL, and (4) EGS as an acute disease marker. Multivariate regression explored the relationship of malnutrition on mortality, length of stay, and complications.

RESULTS

A total of 26,801 patients were included. Demographically, female patients included 58% (n = 15,501). African American patients consisted of 8.0% (n = 2133), and Caucasian patients accounted for 75.7% (n = 20,295) of the study population. Small bowel cases were 32.1% (n = 8609), and colorectal cases represented 76.5% (n = 20,490) of all cases. Malnourished patients made up of 1.8% (n = 481) of all patients. Multivariate regression revealed malnourished patients have higher chance of mortality for small bowel (P = 0.001, confidence interval [CI] 1.31-2.69) and colorectal (P < 0.001, CI 1.47-2.39) procedures, and higher likelihood of complications for colorectal (P = 0.001, CI 1.31-2.65) cases.

CONCLUSIONS

Our analysis shows that malnutrition, as identified by mGLIM criteria, is associated with higher mortality and complication rates after EGS. The mGLIM criteria could be a prognostic tool for adverse outcomes in malnutrition-risk patients.

An observational study on feeding recommencement and morbidity in reconstructive surgery of the oral cavity

BACKGROUND

Reconstructive surgery for floor-of-mouth (FOM) resections presents unique challenges. Delaying oral feeding is hypothesised to reduce surgical complications. This study explores the relationships between surgical resection extent, free flap reconstruction, feeding practices, and nutritional outcomes.

STUDY DESIGN

An observational study was conducted on patients with oral cavity reconstruction after oncological resections at a tertiary Australian Hospital.

METHOD

Patients were grouped by extent of resection (EOR): non-FOM, close FOM, extended FOM, and segmental mandibulectomies. Univariate analyses compared complication rates, feeding regimens, and nutritional outcomes.

RESULTS

EOR significantly affected the timing of feeding commencement (p = 0.044). Morbidity increased with EOR (p = 0.001) and was associated with the type of reconstruction (p = 0.002). There was no significant correlation between EOR and changes in BMI (p = 0.40) or postoperative serum albumin (p = 0.60).

CONCLUSION

Feed commencement post-reconstructive surgery was influenced by surgical complexity. Complex surgeries were associated with increased complications but did not affect nutritional status.

Effects of immunoenteric nutrition versus general enteral nutrition on prognosis in patients with squamous cell carcinoma undergoing radical esophagectomy post neoadjuvant chemotherapy

Malnutrition is a common complication among patients with esophageal cancer, significantly increasing the risk of postoperative complications and mortality. Multiple studies have shown that immunoenteric nutrition (IEN) can reduce postoperative infectious complications in patients with esophageal cancer. However, its prognostic impact on patients undergoing radical surgery following neoadjuvant therapy remains unclear. This study aimed to compare the prognostic effects of IEN versus standard enteral nutrition (EN) in patients with esophageal squamous cell carcinoma (ESCC) following radical esophageal cancer surgery after neoadjuvant therapy. This retrospective study included 197 patients with ESCC who underwent radical esophagectomy following neoadjuvant therapy between 2016 and 2022. Of these, 133 patients received postoperative standard EN, while 64 patients received IEN. The primary endpoints were overall survival (OS) and progression-free survival (PFS). The secondary endpoints included the incidence of postoperative complications and changes in relevant blood markers before and after surgery. No significant differences were observed in postoperative hospitalization duration or complications between the two groups. Postoperative C-reactive protein and immunoglobulin M levels were significantly lower in the IEN group compared to the EN group (P = 0.018 and 0.042). Kaplan-Meier survival curves were plotted for 1, 2, 3, and 5 years to compare the effects of IEN and EN on OS and PFS. The log-rank test revealed the following survival rates: 90.6% versus 77.2% (1-year PFS, P = 0.023); 95.3% versus 82.7% (1-year OS, P = 0.015); 71.9% versus 56.7% (2-year PFS, P = 0.035); 76.6% versus 62.4% (2-year OS, P = 0.03); 54.6% versus 41.7% (3-year PFS, P = 0.064); 61.4% versus 49.3% (3-year OS, P = 0.08); 39.4% versus 30.7% (5-year PFS, P = 0.093); and 41.5% versus 32.6% (5-year OS, P = 0.104). Univariate and multivariate analyses identified several independent predictors of 2-year PFS and OS. For 2-year PFS, the independent predictors included body mass index (P = 0.005), ypTNM stage (Pathologic TNM-staging after neoadjuvant therapy) (P = 0.045), ypT stage (Pathologic T-staging after neoadjuvant therapy) (P = 0.030), ypN stage (Pathologic N-staging after neoadjuvant therapy) (P = 0.007), tumor differentiation (P = 0.031), and type of EN (P = 0.004). For 2-year OS, the independent predictors were age (P = 0.015), body mass index (P = 0.004), ypTNM stage (P = 0.013), ypT stage (P = 0.010), ypN stage (P = 0.009), tumor differentiation (P = 0.026), and type of EN (P = 0.001). In patients with ESCC undergoing esophagectomy after neoadjuvant therapy, postoperative IEN accelerates the resolution of the inflammatory state and improves short-term survival, though its long-term benefits remain uncertain. Furthermore, IEN does not significantly affect the postoperative hospitalization duration or the incidence of complications.

Fit4Surgery app: Home-based prehabilitation app for older patients undergoing elective colorectal cancer surgery

BACKGROUND

Supervised multimodal prehabilitation prior to colorectal cancer (CRC) surgery is associated with reduced complications and enhanced recovery. However, it is labor intensive and expensive. In an aging population with increasing demand and costs on healthcare and staff shortages, home-based prehabilitation (HBP) with an app could be of interest. This study assessed the effectiveness of a Fit4Surgery app in CRC surgery.

METHOD

The app was effectuated in a prospective cohort study of 100 CRC patients ≥60 years from October 2021-December 2022. The primary outcome was preservation or improvement of the 6-minute walking test (6MWT) six weeks postoperative, compared to baseline. Secondary outcomes were 90-day complication and mortality rate, 90-day readmission, length of stay, 6MWT and Short Performance Physical Battery (SPPB) at different timepoints and total costs.

RESULTS

Three patients needed urgent surgery, remaining 97 patients (mean age 72) using the app for at least three weeks. The 6MWT was preserved in 74.7 % with a 12.1 m higher mean six weeks postoperative, compared to baseline (p = 0.194). A significant higher 6MWT was observed after prehabilitation and one year postoperative, compared to baseline (p=<0.001). The SPPB was significant higher at all timepoints. Overall 90-day complication rate was 25.8 %, readmission rate 6.3 % and mortality occurred in 2.1 %. Total costs were €518.50 per patient.

CONCLUSION

This is the first study of multimodal HBP by an app for CRC surgery patients with high compliance. Results show promising results regarding functional capacity and a low occurrence of complications, in line with multimodal supervised prehabilitation. This by reducing costs by half.

Effectiveness of prehabilitation for patients undergoing complex abdominal wall surgery

INTRODUCTION

Prehabilitation in the context of abdominal wall repair has received increasing interest as a strategy to improve postoperative outcomes by focusing on optimizing preoperative risk factors. The main approach includes nutritional counseling, exercise, and psychological intervention. The aim of this project was to assess whether a multimodal prehabilitation program for patients scheduled to undergo large ventral incisional hernia repair could modify the risk factors and optimize them for surgery. In addition, the impact on postoperative outcomes was evaluated.

PATIENTS AND METHODS

This retrospective analysis included patients referred to a multimodal prehabilitation program preceding complex abdominal wall repair for incisional hernia between 2016 and 2020. The program comprised medical optimization, supervised and home-based exercise training, personalized nutrition plans, smoking cessation counseling, and psychological support. Patients were deemed optimized if they met one of the recommended criteria: weight loss ≥ 7% of total body weight, smoking cessation, or Hemoglobin A1c < 7%. Perioperative care adhered to an Enhanced Recovery After Surgery (ERAS) pathway. Primary outcome was the number of patients reaching optimization criteria preoperatively. Secondary outcomes included functional capacity changes from baseline (six-minute walk test), length of stay, and postoperative complications.

RESULTS

Seventy consecutive patients were analyzed, with 57.1% completing the program (prehabilitation group) and 42.9% not (dropout group). Groups were similar in baseline characteristics. In the prehabilitation group, 27.5% were fully optimized, 45% partially optimized, and 82.5% underwent surgery, while 30% partially met criteria and 33.3% underwent surgery in the control group. Patients showed functional improvement (mean + 61 m in 6MWT), with no significant differences in postoperative outcomes.

CONCLUSION

Prehabilitation positively impacted modifiable risk factors in hernia patients, aiding in their eligibility for complex abdominal wall surgery. Patients participating in the program experienced enhanced functional capacity, indicating the potential benefits of prehabilitation in optimizing surgical outcomes.

Association of perioperative immunonutrition with anastomotic leak among patients undergoing elective colorectal surgery within a robust enhanced recovery after surgery program

BACKGROUND

Immunonutrition supplementation has been shown to reduce the risk of surgical infectious complications; however, its effect on decreasing anastomotic leak rates, in the context of an otherwise robust Enhanced Recovery After Surgery (ERAS) program, remains unclear. This study aims to assess the association between perioperative immunonutrition supplementation and anastomotic leak in an elective Enhanced Recovery After Surgery colorectal surgical population.

METHODS

We performed a retrospective single-institution cohort study consisting of adult patients enrolled in an Enhanced Recovery After Surgery pathway and undergoing elective colorectal surgery from 2018 to 2023. Immunonutrition supplementation was defined as a 10-day perioperative supply of commercially available nutritional shakes. Relevant demographic covariates, preoperative characteristics, and operative methods were identified and analyzed. Multivariable logistic regression was performed to determine the association of immunonutrition with anastomotic leak.

RESULTS

A total of 708 patients were included in the study, of which n = 400 (56.5%) received perioperative immunonutrition. Patients who received immunonutrition were more likely to be older (median age 57.9 vs 55.7), male (52.7% vs 44.8%), have a higher body mass index (27.7 vs 26.3), and less likely to be current smokers (9.8% vs 16.2%). On adjusted analysis, there was no association between immunonutrition use and anastomotic leak (odds ratio = 0.96, 95% confidence interval = 0.45, 2.08), 30-day readmission (odds ratio = 0.97, 95% confidence interval = 0.60, 1.57), or length of stay (β = .40, 95% confidence interval = -0.06, 0.86) CONCLUSION: We did not observe an association between perioperative immunonutrition supplementation and postoperative anastomotic leak, suggesting that the role of immunonutrition within a comprehensive Enhanced Recovery After Surgery program for elective colorectal surgery may warrant further evaluation.

Multimodal prehabilitation program for patients undergoing elective surgery for colorectal cancer: a scoping review

Objectives

Multimodal prehabilitation has been widely used in patients undergoing surgery for colorectal cancer and has improved clinical outcomes. The aim of this scoping review is to review the content and current state of clinical practice of multimodal prehabilitation programs.

Methods

A systematic literature review of multimodal prehabilitation studies in patients undergoing colorectal cancer surgery was conducted according to the PRISMA extension framework for scoping reviews. The literature was searched via the PubMed, Web of Science, SCOPUS, EMBASE and Cochrane Library databases. The results of the study included the components of multimodal prehabilitation (exercise, nutritional, and psychological interventions) and related evaluation indicators, duration, and compliance-related components.

Results

This review included 12 studies with 9 randomized controlled trials, 1 pilot intervention study, 1 cohort study, and 1 mock-target trial design. Specific protocols for multimodal rehabilitation training vary widely, ranging in duration from 2-8 weeks, and were implemented in healthcare facilities, the community, and at home. Adherence rates ranged from 50% to almost 100%. Common outcome indicators include the 6-minute walk test, comorbidities, length of hospitalization, health-related quality of life, and several anxiety assessment scales.

Conclusion

Current evidence suggests that multimodal preconditioning has a positive effect on the clinical prognosis of patients undergoing elective colorectal cancer surgery. However, owing to the heterogeneity of multimodal rehabilitation in terms of implementation protocols and evaluation metrics, many high-quality studies are still needed to explore the optimal model of multimodal rehabilitation and promote its standardization.

Important issues on the prevention of surgical site infections and the management of prophylactic antibiotics

In this article, we have addressed the recent published article by Wang et al which examines risk factors associated with surgical site infections (SSIs) and evaluates the effectiveness of prophylactic antibiotics in their prevention. Wang et al identified several significant risk factors of SSIs, including age ≥ 60 years, diabetes mellitus, and surgical complications such as insufficient cystic duct stump closure, gallbladder perforation, empyema, and postoperative hematoma. Their findings suggest that prophylactic antibiotics can serve as a protective factor against SSIs. However, other reported risk factors and preventive strategies warrant consideration to further reduce the incidence of SSIs, lower healthcare costs, and enhance patient outcomes. Additionally, the judicious use of prophylactic antibiotics is crucial in light of the growing global challenge of antibiotic resistance caused by the misuse and overuse of antibiotics. Effective management strategies for prophylactic antibiotic use should be prioritized to balance infection control with the need to combat antimicrobial resistance.

Primary tumor location is a risk factor for postoperative development of sarcopenia as a predictive marker for unfavorable outcomes in patients with colorectal cancer

BACKGROUND

The impact of the skeletal muscle volume after colorectal cancer surgery is unclear. Thus, we investigated the change of skeletal muscle mass after surgery and its effects on long-term outcomes.

METHODS

This retrospective analysis included clinical stage I-IV colorectal cancer patients who underwent curative resection between April 2012 and March 2014 in our hospital. The psoas muscle area at the third lumbar vertebra level was evaluated by computed tomography and was divided by the square of height to obtain the psoas muscle mass index (PMI). Sarcopenia was defined using the PMI cut-off values for Asian adults of 6.36 cm2/m2 for males and 3.92 cm2/m2 for females.

RESULTS

Among eligible 354 patients, 166 and 145 had pre- and postoperative sarcopenia one year after surgery, respectively. Five-year disease-free survival (DFS) and overall survival (OS) rates were 81.7% and 94.5%, respectively. In multivariate analysis, postoperative sarcopenia was an independent risk factor for shorter DFS [hazard ratio (HR) 1.71, p = 0.0171] and OS (HR 2.42, p = 0.0455), respectively, but preoperative sarcopenia was not a prognosticactor for either. One year after colorectal resection, 24 patients (6.8%) were newly diagnosed with sarcopenia, while 45 (12.7%) recovered from sarcopenia. Rectal cancer was identified as an independent risk factor for the postoperative development of sarcopenia (odds ratio 3.12, p = 0.0440).

CONCLUSION

Postoperative sarcopenia one year after surgery was associated with poor DFS and OS. Thus, clinicians need to consider skeletal muscle loss during postoperative surveillance, particularly in rectal cancer patients without sarcopenia before surgery.

Nurses' nutritional care practice and associated factors for hospitalized surgical patients; the case of referral hospitals in Bahir Dar City, Ethiopia

BACKGROUND

The prevalence of malnutrition in hospitalized patients continues to be high across countries, including Ethiopia. Although Nurses have key role to provide nutritional care, their practice is unknown in Ethiopia.

OBJECTIVE

we aimed to assess nurses' nutritional care practice and associated factors for hospitalized surgical patients in Bahir Dar city.

METHODS

An institution based cross-sectional study was conducted among 422 nurses in Bahir Dar City referral hospitals from February 1 to March 1/ 2023. Participants were selected by trained data collectors using simple random sampling. Data was collected using structured, self-administered and pre-tested tool and entered into Epi-info 7 & exported to SPSS version 23 for analysis. Multiple binary logistic regression used to identify factors and p-value of < 0.05 used to determine significant association with 95% CI odds ratio.

RESULT

In this study, 410 of 422 nurses were participated. Overall, 143 (35%) 95% CI: 30.5, 39.8) of nurses had good practice on the nutritional care. Female nurses (AOR = 2.69, 95% CI, 1.62, 4.44), nutrition guidelines (AOR = 2.59, 95% CI, 1.52, 4.39), physician order (AOR = 1.82 95% CI, 1.11, 3.00), experience sharing with peers (AOR = 1.74, 95%CI 1.05, 2.87) nurse to patient ratio < 1:5 (AOR = 1.75, 95%CI, 1.01, 3.02), were positively associated with their practice. But, poor knowledge (AOR = 0.50, 95%CI, 0.30, 0.83), and unfavorable attitude (AOR = 0.51 95%CI, 0.30, 0.84) were negatively associated with their practice.

CONCLUSION

The practice of nurses in nutritional care was low. Gender, access to nutritional information sources, physician orders, nurses to patient ratio, knowledge, and attitude of nurses were factors associated with their practice. Therefore; training, guideline access, experience sharing, and increasing nursing staff is crucial to provide optimal nutritional care for hospitalized patients.

Prehabilitation Research: A Bibliometric Analysis of Past Trends and Future Directions

OBJECTIVE

This study investigates the global research landscape of prehabilitation, identifying current trends, dominant disciplines, collaborative networks, and prominent articles in the field.

DESIGN

For our analysis, we employed the published prehabilitation literature indexed in the Web of Science Core Collection database, spanning from 2002 to 2022. In addition, we utilized CiteSpace (version 6.2; Drexel University), a widely used information visualization software to perform bibliometric analysis.

RESULTS

Analyzing 553 research articles, we observe a consistent upward trend in prehabilitation publication and citation activity. Interdisciplinary co-occurrence analysis highlights strong connections with fields such as surgery, rehabilitation, oncology, sports sciences, orthopedics, gastroenterology, and hepatology. Initially centered around postoperative outcomes in major abdominal surgeries, particularly for colorectal, pancreatic, and prostate cancers, prehabilitation research expanded to include thoracic surgeries, focusing on conditions like lung cancer and aortic valve replacement. Preoperative exercise remains a core area, with increasing interest in multimodal prehabilitation and its effectiveness based on patient group characteristics. North America and Western Europe emerge as primary contributors to prehabilitation research.

CONCLUSIONS

Current research concentrates on tailoring prehabilitation programs for specific groups, and broadening their geographical scope would enhance the studies, contributing valuable insights for medical practitioners shaping future research efforts.

Compliance analysis of oral nutritional supplements in hospitalized postsurgical patients with colorectal cancer: A prospective study

PURPOSE

There are few reports on compliance with oral nutritional supplements (ONS) after surgery in hospitalized patients. This study aimed to investigate the compliance with ONS and its influencing factors after surgery in colorectal cancer patients.

METHODS

STROBE checklist was used during the preparation of this paper. A total of 103 postoperative colorectal cancer patients were selected from November 2020 to April 2021 from the Department of Anorectal Surgery in our institution, which is a tertiary hospital in Hangzhou, China. The compliance with ONS was recorded by a self-record sheet, and sociodemographic and disease-related information of these patients was gathered through a self-designed questionnaire.

RESULTS

The overall ONS compliance rate of patients with colorectal cancer was 57.6%. Results of univariate analysis revealed that ONS compliance rate was related to sex, admission body mass index, abdominal distension, attitude towards ONS, and satisfaction with ONS. Multi-factor analysis showed that age, sex, and perceived benefits of nutrition therapy independently influenced the ONS compliance rate.

CONCLUSIONS

The postoperative ONS compliance rate of colorectal cancer patients needs to be further improved. Healthcare professionals should pay more attention to the postoperative ONS compliance and acknowledging the influence of age, gender, and attitudes towards ONS on ONS compliance. Notably, patients' perspectives towards ONS play a crucial and modifiable role in determining ONS compliance. Nurses ought to assist patients in cultivating a positive attitude towards ONS.

RELEVANCE TO CLINICAL PRACTICE

Dosage form and delivery method are also influence factors that deserves further exploration in the future. Future research endeavours should endeavour to craft tailored, meticulous nutritional intervention strategies tailored to the diverse factors that influence ONS compliance, ultimately leading to enhanced ONS adherence. Our findings could serve as valuable evidence for the development of strategies aimed at enhancing ONS usage practices.

Perioperative Nutritional Optimization in Spine Surgery

Although spine surgery has been shown to be an effective treatment for many spinal disorders, perioperative complications can increase patient morbidity and lead to poorer surgical outcomes. Nutritional status is a modifiable factor that affects spine surgery results. Malnutrition can negatively influence inflammatory pathways and can change circulating stress hormones. Perioperative nutrition status can be evaluated by both clinical and laboratory parameters, with nutritional indices allowing for determination of perioperative risk. Perioperative nutritional optimization has been attempted and has been associated with improved outcomes, for patients undergoing spine surgery. Additional investigation is needed to determine effective perioperative nutritional protocols.

Clinical benefits and controversies of jejunostomy feeding in patients undergoing gastrectomy for gastric cancer

Globally, gastric cancer ranks as the fifth most common malignancy and the third leading cause of cancer-related mortality. Gastrectomy combined with perioperative chemotherapy is currently the standard of care in locally advanced stages, but the completion rate of multimodal approach is influenced also by patient related factors. Malnutrition is a well-known risk factor associated with poor oncological outcomes. Its perioperative supplementation could lead to an improvement of the nutritional status. This article reviews and comments the retrospective study conducted by Jaquet et al, which evaluates the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer. The authors included 172 patients, 35% of whom received jejunostomy. Patients with optimized biological nutritional parameters (body mass index, albumin, prealbumin) showed reduced major complications (> III), according to the Dindo-Clavien classification, 0 (0%) vs 8 (4.7%) (P = 0.05). In the era of multimodal treatment, optimization of nutritional and performance status is integral part of the therapeutic strategy.

Malnutrition and perioperative nutritional rehabilitation in major operations

Background

Malnutrition is a potentially preventable risk factor for surgery. This systematic review examines nutritional management strategies aiming to enhance surgical outcomes.

Methods

A systematic search was conducted in PubMed for English-language studies published between July 1, 2004, and July 1, 2024, involving adult surgical patients. Study selection focused on four key themes: (1) nutritional screening and assessment, (2) preoperative nutritional therapy, (3) nutritional support in critically ill surgical patients, and (4) postoperative nutritional rehabilitation. Studies in non-surgical cohorts, letters, and case reports were excluded. Reference lists of relevant studies were manually screened for additional sources.

Results

Of 2763 studies identified, 251 met the inclusion criteria and 85 were added after manual screening, contributing to a total of 341 papers for the review. The prevalence of malnutrition varied widely by procedure, with the highest rates observed in pancreatic and esophagogastric operations. Preoperative malnutrition was strongly associated with increased postoperative complications, infections, prolonged hospital stay, and higher mortality. The Malnutrition Universal Screening Tool (MUST) was effective in identifying at-risk patients. Preoperative nutritional interventions, including dietitian-led counseling, oral supplementation, and enteral or parenteral nutrition, may reduce complications and improve outcomes. Critically ill patients benefited from structured enteral and parenteral strategies. Early postoperative nutrition within enhanced recovery after surgery (ERAS) protocols are linked to less complications and shorter hospital stay.

Conclusion

Malnutrition significantly impacts surgical outcomes, necessitating early identification and intervention. Standardized management is key to improving recovery and reducing complications. Future research should focus on refining diagnostic tools, assessing nutritional requirements, optimizing perioperative nutritional strategies, and establishing long-term nutritional follow-up guidelines for surgical patients.

A nutrition-based nomogram for predicting intra-abdominal infection after D2 radical gastrectomy for gastric cancer

BACKGROUND

This study aims to construct a nutrition-based nomogram for predicting the risk of intra-abdominal infection (IAI) after D2 radical gastrectomy for gastric cancer (GC).

METHODS

We retrospectively analyzed the clinical data of 404 individuals who received D2 radical gastrectomy for GC. Four preoperative nutrition-related indicators, the nutritional risk screening (NRS) 2002 score, albumin (ALB), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score, were collected and calculated. Multivariate logistic regression analysis was utilized to screen the independent risk factors for IAI following D2 radical gastrectomy for GC. The area under the receiver operating characteristics (ROC) curve (AUROC) was computed. A nomogram was established to forecast postoperative IAI using the independent risk factors.

RESULTS

The NRS2002 score, ALB, PNI, CONUT score, fasting blood glucose (FBG), American Society of Anesthesiologists (ASA) score, type of resection, multi-visceral resection, perioperative blood transfusion, and the tumor, node, metastasis (TNM) stage were significantly associated with postoperative IAI. Considering the collinearity between these nutrition-related variables, four multivariate logistic regression analyses were separately performed, and four independent nutrition-based models were constructed. Of these, the best one was the model based on the three indicators of NRS2002 score, FBG, and multi-visceral resection, which had an AUROC of 0.744 (0.657-0.830), with a specificity of 75.6% and a sensitivity of 62.9%. Further, a nomogram was constructed to estimate the probability of IAI following D2 radical gastrectomy. The internal validation was carried out using the bootstrap method with self-help repeated sampling 1000 times, and the concordance index (c-index) was determined at 0.742 (95% CI = 0.739-0.745). The calibration curve revealed that the predictive results of the nomogram were in excellent concordance with the actual observations. The decision curve analysis (DCA) indicates that the nomogram has excellent clinical benefit.

CONCLUSION

The nomogram constructed based on NRS2002 score, FBG, and multi-visceral resection has good predictive capacity for the incidence of IAI following D2 radical gastrectomy and provides a reference value for clinicians to assess the risk of IAI occurrence.

Early Diet Liberalization After Anterior Lumbar Interbody Fusion Improves Postoperative Recovery

STUDY DESIGN

Retrospective Cohort Study.

OBJECTIVES

The objective of this study was to assess the impact of diet liberalization on short-term outcomes in patients undergoing anterior interbody lumbar fusion (ALIF).

METHODS

A retrospective review was performed for patients undergoing ALIF at our tertiary care center institution from 2010 to 2022. Electronic medical records were reviewed for demographics, surgical characteristics, and 90-day postoperative outcomes.

RESULTS

We included 515 patients in this study with 102 patients receiving a full diet on the same day as their operation. All other patients had a delay of at least 1 day (average 1.6 days) until a full diet was provided. This group was found to have a higher rate of postoperative ileus (10.2% vs 2.9%) and urinary retention (16.0% vs 3.9%). The readmission rate and percent of patients presenting to the emergency department within 90 days postoperatively were similar. On multivariate regression analysis, same-day, full-diet patients had decreased odds of developing urinary retention (OR = .17) and a shorter length of hospital stay (Estimate: -.99). Immediate full diet had no impact on the development of ileus (OR: .33).

CONCLUSIONS

An immediate postoperative full diet following an anterior approach to the lumbar spine was not found to be associated with an increased risk of postoperative ileus in patients deemed appropriate for early diet liberalization. Moreover, an early full diet was found to reduce length of hospitalization and risk of postoperative urinary retention. Reconsideration of postoperative diet protocols may help optimize patient outcomes and recovery.

Nursing staff adherence to guidelines on nutritional management for critically ill patients with cancer: A service evaluation

BACKGROUND

Critically ill patients with cancer are at high risk of developing malnutrition, negatively affecting their outcome.

AIM

To critically analyse nursing staff's adherence to nutrition management guidelines for critically unwell patients with cancer and identify barriers which prevent this. Two areas of nutrition management were evaluated: early initiation (<48 h from admission) of enteral nutrition (EN) and continuation of EN without interruption.

STUDY DESIGN

A retrospective data analysis was performed on mechanically ventilated adult patients admitted to a single cancer centre. Data from electronic patient records (EPR) were collected. Health care professionals' (HCP) documentation was analysed, and a nursing staff focus group (n = 5) was undertaken.

RESULTS

Sixty-four patient records were included. Early EN was not administered in 67% (n = 43) of cases. The reasons for the three longest interruptions to EN feed were as follows: delays in EN tube insertion, gastric residual volumes (GRVs) less than the recommended feed discontinuation threshold and endotracheal intubation. Four main themes relating to barriers to practice were identified from the focus group data analysis: HCPs' approach towards nutrition management, the patient's physiological condition and stability, multi-disciplinary team (MDT) communication and guidance on nutrition management, and practical issues with patient care.

CONCLUSIONS

Multi-disciplinary communication difficulties, lack of clear guidelines and inadequate awareness of the importance of nutrition for critically ill patients with cancer were barriers identified preventing optimal nutrition management.

RELEVANCE TO CLINICAL PRACTICE

Nursing education is fundamental to help break down the barriers to practice which prevent critically ill patients from receiving optimal nutrition management.

Sarcopenia and risk of postoperative pneumonia: a systematic review and meta-analysis

BACKGROUND

Identifying patients at risk for postoperative pneumonia and preventing it in advance is crucial for improving the prognoses of patients undergoing surgery. This review aimed to interpret the predictive value of sarcopenia on postoperative pneumonia.

METHODS

Science Citation Index Expanded (SCIE), Embase, Medline, and Cochrane Central Register of Controlled Trials were searched from inception to August 2nd, 2023 to retrieve eligible studies. The risk of bias was assessed by the Newcastle-Ottawa Scale (NOS). For each study, we computed the odds ratio (OR) and 95% confidence interval (CI) for postoperative pneumonia in patients with and without preoperative sarcopenia, and the I-squared (I2) test was employed to estimate heterogeneity.

RESULTS

The search identified 6530 studies, and 32 studies including 114,532 participants were analyzed in this review. In most of the studies included, the risk of bias was moderate. The most reported surgical site was the chest and abdomen, followed by the abdomen, chest, limbs and spine, and head and neck. Overall, patients with preoperative sarcopenia have a 2.62-fold increased risk of developing postoperative pneumonia compared to non-sarcopenic patients [OR 2.62 (I2 = 67.5%, 95%CI 2.04-3.37). Subgroup analysis focusing on different surgical sites revealed that sarcopenia has the strongest predictive effect on postoperative pneumonia following abdominal surgery (OR 4.69, I2 = 0, 95% CI 3.06-7.19). Subgroup analyses targeting different types of research revealed that sarcopenia has a stronger predictive effect on postoperative pneumonia in prospective studies (OR 5.84 vs. 2.22).

CONCLUSIONS

Our research findings indicate that preoperative sarcopenia significantly increases the risk of postoperative pneumonia. Future high-quality prospective studies and intervention studies are needed to validate the relationship between sarcopenia and postoperative pneumonia and improve patient outcomes.

Personalized nutritional care for immune function recovery in postoperative gastrointestinal surgery patients: An observational study

BACKGROUND

Gastrointestinal (GI) surgery can significantly affect the nutritional status and immune function of patients. This study aimed to investigate the effects of personalized nutritional care on the recovery of immune function in patients who underwent postoperative GI surgery.

AIM

To study examines personalized nutritional care’s impact on immune function recovery, nutritional status, and clinical outcomes after GI surgery.

METHODS

This observational study included 80 patients who underwent GI surgery between 2021 and 2023. Patients received personalized nutritional care based on their individual needs and surgical outcomes. Immune function markers including lymphocyte subsets, immunoglobulins, and cytokines were measured preoperatively and at regular intervals postoperatively. Nutritional status, clinical outcomes, and quality of life were assessed.

RESULTS

Patients receiving personalized nutritional care showed significant improvements in immune function markers compared to baseline. At 4 weeks postoperatively, CD4+ T-cell counts increased by 25% (P < 0.001), while interleukin-6 levels decreased by 40% (P < 0.001). Nutritional status, as measured by prealbumin and transferrin levels, improved by 30% (P < 0.01). Postoperative complications reduced by 35% compared to historical controls. The quality-of-life scores improved by 40% at 3 months postoperatively.

CONCLUSION

Personalized nutritional care enhances immune function recovery, improves nutritional status, and reduces complications in patients undergoing postoperative GI surgery, highlighting its crucial role in optimizing patient outcomes following such procedures.

Development and validation of the systemic nutrition/inflammation index for improving perioperative management of non-small cell lung cancer

BACKGROUND

Systemic nutrition and inflammation status is recognized for its influence on cancer survival, yet its role in perioperative outcomes remains poorly defined. This study aimed to refine the assessment of systemic nutrition and inflammation status in non-small cell lung cancer (NSCLC) patients and to elucidate its impact on perioperative outcomes.

METHODS

All patients underwent video-assisted thoracoscopic lobectomy, with their nutrition and inflammation status assessed based on preoperative blood tests. The development cohort, comprising 1497 NSCLC patients from two centers, evaluated the predictive value of systemic nutrition/inflammation indicators for perioperative endpoints and formulated the systemic nutrition-inflammation index (SNII). The tertiles of SNII were used to classify the nutrition/inflammation risk as high (< 15.6), moderate (15.6-23.1), and low (> 23.1). An external validation cohort of 505 NSCLC patients was utilized to confirm the effectiveness of SNII in guiding perioperative management.

RESULTS

In the development cohort, the SNII tool, calculated as the product of total cholesterol and total lymphocytes divided by total monocytes, demonstrated a stronger correlation with perioperative outcomes compared to 11 existing nutrition/inflammation indicators. A low SNII score, indicative of high nutrition/inflammation risk, was independently predictive of increased complication incidence and severity, as well as prolonged chest tube duration and hospital stay. These findings were corroborated in the validation cohort. Upon combining the development and validation cohorts, the superiority of the SNII in predicting perioperative outcomes was further confirmed over the existing nutrition/inflammation indicators. Additionally, comprehensive subgroup analyses revealed the moderately variable efficacy of SNII across different patient populations.

CONCLUSIONS

This study developed and validated the SNII as a tool for identifying systemic nutrition and inflammation risk, which can enhance perioperative managements in NSCLC patients. Patients identified with high risk may benefit from prehabilitation and intensive treatments, highlighting the need for further research.

Application of oral nutritional supplements to control body weight loss in postoperative patients suffering from solid tumors: a systematic review and meta-analysis

Objective

This study aims to summarize the impact of oral nutritional supplements (ONSs) on mitigating body weight loss (BWL) in patients following surgical treatment for solid tumors.

Methods

A systematic and comprehensive search of four major publicly available databases was conducted up to May 2024 to identify studies for inclusion in the analysis. Data from eligible studies were extracted, and pooled mean differences (MD) along with their 95% confidence intervals (CIs) for BWL were computed.

Results

A total of 12 randomized controlled trials (RCTs) with 2,268 participants were finally included. The group receiving oral nutritional supplements demonstrated a statistically significant reduction in weight loss compared to the control group, with a mean difference of 1.11 (95% CI: 0.52-1.70), an I 2 statistic of 97.0%, and a p-value less than 0.01.

Conclusion

The meta-analysis provide evidence that ONSs effectively reduce BWL in postoperative patients with solid tumors. Additionally, ONS with lower daily caloric intake demonstrated superior efficacy in reducing BWL.

Prevalence of Malnutrition in People Hospitalized for Surgery: Prospective Cross-Sectional Study

Background/Objectives: Malnutrition poses a significant challenge to public health, affecting millions worldwide, particularly among people in hospital, notably among surgical cases that require adequate nutritional support for effective recovery. Factors contributing to malnutrition include chronic illnesses that hinder nutritional intake and socioeconomic barriers limiting food access. This study aimed to assess malnutrition in surgical patients at admission to enhance recovery, minimize complications, and improve clinical outcomes. Methods: This prospective observational cross-sectional study involved 282 adults hospitalized for over 48 h for surgery. This study utilized the MUST and MNA-SF assessments to evaluate malnutrition risk, confirming diagnoses via the GLIM criteria. Statistical analysis, including the Pearson chi-square test and univariate and multivariate logistic regression, identified significant malnutrition risk factors. Results: This study found an 18.1% malnutrition prevalence among these patients, with Stage 1 malnutrition being the most common at 9.6%. Additionally, a notable proportion of patients were classified as obese (46.5%) or overweight (27.7%). Men had higher malnutrition rates (12.8%) than women (5.3%). Age disparities were also significant, with higher rates among older (7.4%) and younger adults (7.1%) compared to middle-aged individuals (2.5%). Patients undergoing elective surgeries (9.9%) and emergency surgeries (6.7%) had higher malnutrition rates than those admitted for surgical complications. Furthermore, malnutrition was observed in 12% of patients undergoing orthopedic or general surgeries. Conclusions: Among adult patients admitted to surgical wards, malnutrition prevalence during admission was 18%, underscoring the need for comprehensive preoperative nutritional assessments and targeted interventions for patients undergoing surgery.

Prospective Survey of Postoperative Pain in Japan: A Multicenter, Observational Study

Background/Objectives: Postoperative analgesia is important for reducing biologically invasive reactions to surgery. In Japan, postoperative analgesia, including indices of analgesia, has not been adequately addressed. This study aimed to determine the relationship between postoperative pain and postoperative course and the importance of analgesia for early recovery. Methods: Patients who underwent any of seven surgical procedures in gastrointestinal, thoracic, and cardiac surgery were enrolled. The primary endpoint was a median Prince Henry Pain Scale score from postoperative days 1 to 3. Secondary endpoints were the quality of recovery on postoperative day 7 (Quality of Recovery-15 [QoR-15]) and the length of postoperative hospital stay. Results: Median postoperative pain levels among surgeries were 3 on day 1, 2 on days 2 and 3, 1 on day 7, and 1 at discharge. In both univariate and multivariate analyses, the use of postoperative epidural analgesia and intravenous patient-controlled analgesia (IV-PCA) were significant predictors of early postoperative pain. Only early postoperative pain was a significant predictor of QoR-15 score. Regular use of acetaminophen, early postoperative pain, no appetite, and postoperative complications were significant in affecting the length of postoperative hospital stay. In the comparison of early postoperative pain according to whether epidural analgesia and IV-PCA were used, the group that used both methods had the least pain. Conclusions: In Japan, early postoperative pain persists after major surgical procedures and affects postoperative quality of recovery and length of hospital stay. The use of epidural analgesia, IV-PCA, or both appeared to be effective in overcoming early postoperative pain, thereby enhancing early postoperative recovery.

INDEPSO-ISPSM consensus on peritoneal malignancies - Enhanced recovery after surgery in cytoreductive surgery (CRS) with/without hyperthermic intraperitoneal chemotherapy (HIPEC)

Background

The role of enhanced recovery after surgery (ERAS) in cytoreductive surgery and/or Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is evolving, with promising results that improve patient outcomes. This consensus exercise was carried out to address and standardize components of the ERAS protocol pertinent to the Indian context.

Method

The modified Delphi method was employed with two rounds of voting. All fifty invited specialists agreed to vote. There were 30 questions addressing the key elements of ERAS protocols. They were broadly distributed across four sections: Prehabilitation, Preoperative, Intraoperative, and Postoperative elements. A consensus was achieved if any one option received > 70 % votes (strong consensus > 90 %). If consensus was not achieved in round 1, the question was moved to round 2.

Results

After rounds I and II, 48/50 (95.8%) of invited panelists voted for the questions. The highest rate of 'skipped question' was 6% in both rounds. A consensus was obtained for 28/30 (93.33%) questions, and strong consensus was obtained for 5/30 (16.6%) questions. No consensus was obtained for two questions. Some of the panelists' recommendations contradicted the standard ERAS guidelines, such as using intraperitoneal drains in all patients and mechanical bowel preparation for left-sided colonic or rectal resections.

Conclusion

Despite some limitations, this consensus exercise represents a significant step toward advancement and pioneering efforts to improve patient outcomes by implementing and standardizing ERAS protocols in CRS and/or HIPEC tailored for India.

Nutrition education: Optimising preparation and recovery for benign oesophageal surgery

BACKGROUND

Patients requiring upper gastrointestinal surgery for benign oesophageal conditions are at nutrition risk before and after surgery. There is a dearth of published evidence guiding clinicians on effective collaboration with patients to mitigate perioperative nutritional challenges. We conducted a qualitative study aiming to explore patients' perioperative food, nutrition, and educational experiences to guide future care.

METHODS

Adult patients who had undergone elective, benign oesophageal surgery were invited to participate in semi-structured interviews within 3 weeks of hospital discharge. Interviews were transcribed and analysed with a reflexive form of inductive thematic analysis in addition to synthesised member checking.

RESULTS

Interviews with 12 patients identified three major themes. First, nutrition education fosters a better surgical recovery experience: patients expressed a desire to be prepared for their upcoming surgery and engage in the recovery process with informed food choices. Most patients preferred preoperative education given limited capacity for learning during hospital admission. Second, patients have priorities for nutrition information: patients expressed that educational material should be printed, comprehensive, practical, include familiar foods and focus on managing postoperative physical symptoms. Third, food impacts social and emotional experiences of surgery: resumption of a normal diet was a sign of recovery that enabled social reintegration. Identified themes resonated with Knowles' six-core principles of andragogy.

CONCLUSIONS

Patients with benign oesophageal conditions perceived nutrition education to be a vital aspect of surgical preparation and recovery. Re-designing perioperative education with patient input has the potential to improve outcomes and experiences.

[ERAS Implementation in Thoracic Surgery]

This manuscript provides an overview of the principles and requirements for implementing the ERAS program in thoracic surgery.The ERAS program optimises perioperative management of elective lung resection procedures and is based on the ERAS Guidelines for Thoracic Surgery of the ERAS Society. The clinical measures are described as in the current literature, with a focus on postoperative outcome. There are currently 45 enhanced recovery items covering four perioperative phases: from the prehospital admission phase (patient education, screening and treatment of potential risk factors such as anaemia, malnutrition, cessation of nicotine or alcohol abuse, prehabilitation, carbohydrate loading) to the immediate preoperative phase (shortened fasting period, non-sedating premedication, prophylaxis of PONV and thromboembolic complications), the intraoperative measures (antibiotic prophylaxis, standardised anaesthesia, normothermia, targeted fluid therapy, minimally invasive surgery, avoidance of catheters and probes) through to the postoperative measures (early mobilisation, early nutrition, removal of a urinary catheter, hyperglycaemia control). Most of these measures are based on scientific studies, with a high level of evidence and aim to reduce general postoperative complications.The ERAS program is an optimised perioperative treatment approach aiming to improve the postoperative recovery in patients after elective lung resection by reducing the overall complication rates and overall morbidity.

Prognostic Nutritional Index (PNI) As a Preoperative Screening Tool in Predicting Clinical Outcomes of Postoperative Pediatric Cardiac Surgery Patients

OBJECTIVE

The authors sought to evaluate the role of nutritional indices such as Onodera's prognostic nutrition index (PNI), World Health Organization (WHO)-based anthropometric measurements such as weight for age (w/a), height for age, weight for height, and perioperative serum albumin levels in the determination of postoperative clinical outcomes in pediatric patients who undergo surgery for congenital cardiac defects and surgical complexity (risk-adjusted congenital heart surgery score) and its correlation with postoperative course.

MATERIAL AND METHODS

In this prospective observational study, 108 post-pediatric cardiac surgery patients under the age of 18 months were enrolled between January 2023 and August 2023. Through receiver operating characteristic curve analysis we have found the cutoff value for PNI is ≤66.5 and >66.5. The above mentioned parameters were analyzed for postoperative clinical outcomes such as length of intensive care unit (ICU) stay, length of hospital stay, and duration of mechanical ventilation.

RESULTS

Significant negative correlation was found between length of ICU stay and hospital stay with lower PNI (P = .019 and <.001, respectively.). Analysis of low versus high PNI groups was suggestive of a remarkable increase in mechanical ventilation time (P = .03), length of ICU stay (0.01), and hospital stay (P ≤ .001) in the low PNI group. Lower WHO-based w/a Z score was found to be significantly associated with low PNI (<66.5), after adjusting for preoperative albumin, postoperative albumin drop, and C-reactive protein (odds ratio = 1.411 per unit 0.28 increment in W/azs, P = .004).

CONCLUSION

Preoperative Onoderas PNI is an effective and efficient tool for predicting postoperative clinical morbidity in pediatric patients undergoing congenital heart surgery.

Development and implementation of a Sezer gastrostomy care bundle using the Knowledge to Action framework

BACKGROUND

This project aimed to develop an evidence-based nursing care bundle after gastrostomy feeding tube insertion and implement it into clinical practice using the Knowledge to Action (KTA) framework.

METHODS

This mixed-method design project was conducted in a university hospital between December 2021 and June 2022. The project was carried out in four phases: (1) development of an evidence-based care bundle, (2) education for care bundle training, (3) implementation of the care bundle, (4) evaluation of the care bundle. Nurses' compliance with bundles was measured using All-or-None measurement. The analysis of the qualitative interview conducted was performed using the content analysis method of Graneheim and Lundman.

RESULTS

The developed Sezer gastrostomy care bundle consists of three parameters (peristomal area care, tube feeding, and medication administration through the feeding tube) and a total of 14 elements to be applied by nurses under these parameters. Compliance rates for peristomal area care, tube feeding, and medication administration through feeding tube parameters were 100%, 98.66%, and 98.66%, respectively. Two themes and six subthemes emerged: (1) reflection of using the Sezer gastrostomy care bundle on nursing care and (2) adoption of Sezer gastrostomy care bundle.

CONCLUSION

The gastrostomy care bundle was developed in accordance with the Institute of Healthcare Improvement's recommendations. The KTA framework provided an appropriate structure to transform evidence into practice, meticulously address barriers, evaluate outcomes, and ensure sustainability. The project found that nurses complied with all its parameters. Studies evaluating the effect of the gastrostomy care bundle on patient outcomes are recommended.

Changes in nutritional management after gastrointestinal cancer surgery over a 12-year period: a cohort study using a nationwide medical claims database

BACKGROUND

Nutritional management in patients after gastrointestinal cancer surgery has changed throughout the 2000s. However, its evolution has not been formally studied. This study aimed to evaluate changes in nutritional management using real-world data.

METHODS

Patient data from 2011 to 2022 were extracted from a nationwide medical claims database. Patients were divided into four groups based on their year of hospital admission: period I, 2011-2013; II, 2014-2016; III, 2017-2019; IV, 2020-2022. For each period, feeding routes in all patients and prescribed doses of parenteral energy and amino acids in fasting patients during postoperative days (POD) 1-7 were determined. The results of the four different periods were compared using statistical trend tests.

RESULTS

The study cohort was comprised of 365,125 patients. During POD 1-3, the proportion of patients administered any oral intake increased over time (I, 40.3%; II, 47.1%; III, 49.4%; IV, 54.2%; P < 0.001), while that of patients receiving parenteral nutrition (PN) decreased (I, 60.1%; II, 55.0%; III, 50.3%; IV, 45.5%; P < 0.001). Of 19,661 patients with PN alone (i.e., neither oral intake nor enteral nutrition) during POD 1-7, the median (interquartile range) prescribed doses on POD 7 of energy (kcal/kg) [I, 15.3 (10.3-21.9); II, 13.9 (8.4-20.0); III, 13.2 (7.7-19.2); IV, 12.9 (7.0-18.7); P < 0.001] and amino acids (g/kg) [I, 0.65 (0.30-0.94); II, 0.58 (0.24-0.89); III, 0.56 (0.00-0.86); IV, 0.56 (0.00-0.87); P < 0.001] both decreased over time.

CONCLUSION

From 2011 to 2022, more patients who underwent gastrointestinal cancer surgery in Japan were administered early oral intake, while fewer patients were administered early PN. Overall, the energy and amino acid doses prescribed in PN were far below the guideline recommendations.

Erythrocyte modified controlling nutritional status as a biomarker for predicting poor prognosis in post-surgery breast cancer patients

Nutrition and inflammation are closely related to prognosis in breast cancer patients. However, current nutritional and inflammatory measures predict disease free survival (DFS) of breast cancer are still different, and the most predictive measures remain unknown. This study aimed to compare the predictive effects of commonly used nutritional and inflammatory measures on DFS and to improve existing nutritional or inflammatory measures in order to develop a new model that is more effective for predicting postoperative recurrence and metastasis in breast cancer patients. The clinical data of 536 female breast cancer patients with invasive ductal carcinoma who underwent surgery at Shaoxing People's Hospital from January 2012 to December 2018 were retrospectively evaluated. The predictive effects of nutritional and inflammatory indicators on DFS were evaluated. Machine learning was used to evaluate and rank laboratory indicators, select relatively important variables to modify nutritional or inflammatory indicators with the best predictive power, and evaluate their predictive role in patients' postoperative recurrence and metastasis. Among various metrics predicting DFS, the CONUT score emerged paramount with an area under the curve (AUC) of 0.667. Interestingly, the combination of the erythrocyte levels with the CONUT score (ECONUT) achieved the highest AUC (0.722). The Kaplan-Meier survival analysis showed that the group exhibiting high ECONUT scores experiencing a notably poorer DFS. ECONUT was identified as an independent risk factor for postoperative DFS (P < 0.001). The ECONUT model could provide an effective assessment tool for predicting DFS in breast cancer patients.

Nutritional Status and Nutritional Support in Patients with Gastrointestinal Diseases

Gastrointestinal diseases include a wide spectrum of functional and structural disorders of the alimentary system, involving hepatic, bile duct, and pancreatic diseases [...].

Increased consumption of ultra-processed foods and worse diet quality in colorectal cancer patients after colostomy: A prospective study

Colorectal cancer (CRC) is commonly treated with intestinal resections that lead to colostomy, which can influence changes in eating habits. This study aimed to analyze energy and nutrient intake, diet quality, and food consumption based on the processing level in CRC patients after colostomy. A prospective study was carried out at three time points (T0-recent colostomy, T1-3 months after colostomy, and T2-6 months after colostomy). Food intake was assessed by 24-hour dietary recall. Macro-micronutrient consumption, the Brazilian Healthy Eating Index-Revised (BHEI-R), and food consumption according to processing level by NOVA classification (raw or minimally processed, processed, and ultra-processed foods) were estimated. Generalized estimating equations were used to compare the food intake variables with time points. Of the 46 patients, 52.2% were women, and the mean age was 60.6±12.2 years old. There was a change in food consumption over time, with an increase in energy consumption (kcal and kcal/kg), lipids, and sodium, in addition to a reduction in some nutrients such as protein (g and g/kg), fiber, vitamin B1 and C and phosphorus. Regarding the key outcomes, BHEI-R and NOVA classification showed a poor diet quality with a reduction in total index (p = 0.022), raw food (p = 0.001), total fruits, and whole fruit consumption (p = 0.001), and an increase in sodium (p = 0.001) at 3 and/or 6 months after colostomy concomitant an increase in ultra-processed food (p = 0.015). Nutritional counseling is essential in care, effective eating changes habits improvement of symptoms and nutritional status, besides avoiding potential cancer recurrence.

Malnutrition in spondylodiscitis: an overlooked risk factor

OBJECTIVE

Spondylodiscitis presents a significant diagnostic and treatment challenge to healthcare providers, with various risk factors and treatment outcomes having been identified. Malnutrition, a multifactorial condition defined by imbalance or deficiency of nutrients, is a known risk factor for various adverse events such as postoperative infection and readmissions in spine surgery. However, its impact in SD has not yet been explored. The study aims to assess the prevalence of malnutrition and hypoalbuminemia in SD patients and their impact on the 90-day-all-cause readmission and in-hospital mortality rates.

METHODS

Using the 2020 Nationwide Readmission Database, adult patients were selected by primary ICD-10 diagnosis for SD (M46.2x, M46.3x and M46.4x). Demographic information and clinical data were extracted. Readmissions were identified by VisitLink. Patients were categorized into 2 groups: those with malnutrition and/or hypoalbuminemia and those without. Descriptive and comparative analysis, with multivariate regression models to assess for independent risk factors of mortality and readmission were performed.

METHODS

Using the 2020 Nationwide Readmission Database, adult patients were selected by primary ICD-10 diagnosis for SD (M46.2x, M46.3x and M46.4x). Demographic information and clinical data were extracted. Readmissions were identified by VisitLink. Patients were categorized into 2 groups: those with malnutrition and/or hypoalbuminemia and those without. Descriptive and comparative analysis, with multivariate regression models to assess for independent risk factors of mortality and readmission were performed.

CONCLUSION

Malnutrition and hypoalbuminemia are relatively common in SD patients and are significant risk factors for both in-hospital mortality and readmission. Early identification, including screening for hypoalbuminemia and management of malnutrition, may be beneficial in SD treatment.

Immunonutrition to improve the quality of life of upper gastrointestinal cancer patients undergoing neoadjuvant treatment prior to surgery (NEOIMMUNE): double-blind randomized controlled multicenter clinical trial

BACKGROUND

Malnutrition is common with esophagogastric cancers and is associated with negative outcomes. We aimed to evaluate if immunonutrition during neoadjuvant treatment improves patient's health-related quality of life (HRQOL) and reduces postoperative morbidity and toxicities during neoadjuvant treatment.

METHODS

A multicenter double-blind randomized controlled trial (RCT) was undertaken. Included patients had untreated nonmetastatic esophagogastric tumor, aged 18 ≥ years with a life expectancy of >3 months. The study was powered for 80% power to detect a clinically relevant difference in EORTC-QLQC30 with standard deviation of 15 between groups. Primary end point was the quality of life as measured by the global health status at 30 days after surgery. An intention-to-treat analysis was employed.

RESULTS

The study was terminated at the interim analysis stage. About 300 patients were randomized: 149 to the IMPACT group and 151 to the control-formula group. Patient groups were well-balanced in terms of age, sex, body mass index, WHO performance status, and clinical tumor stage. Analysis of the primary end point for the study of global health status at 30-day postoperatively failed to show any significant differences between the groups (55.4 ± 18.6 [IMPACT] vs. 55.9 ± 19.8 [control]; P = 0.345). No significant differences between the groups were detected in the majority of domains from EORTC QLQC30 and OG25 tools after neoadjuvant therapy and 30 days postoperatively. Finally, no significant differences were seen between groups in neoadjuvant therapy or postoperative complications, or tumor response.

CONCLUSION

The results of this multicenter double-blind RCT fail to demonstrate any HRQOL benefits to the utilization of immunonutrition during neoadjuvant therapy in patients with esophagogastric cancer.

Progress and Challenges in Integrating Nutritional Care into Oncology Practice: Results from a National Survey on Behalf of the NutriOnc Research Group

INTRODUCTION

Nutritional care is a cornerstone of cancer treatment, with the potential to significantly improve patient outcomes by addressing malnutrition and enhancing recovery. Despite growing awareness, the integration of evidence-based nutritional strategies into oncology remains inconsistent. Following a 2020 survey that highlighted critical gaps, the NutriOnc Research Group launched targeted initiatives to raise awareness and improve practices. This study reassesses progress in integrating nutritional care and identifies persistent challenges.

METHODS

A 29-question survey was conducted in 2024 among 73 early-career oncologists, surgeons, radiation oncologists, and nutrition specialists across Italy. Respondents provided insights into clinical nutrition program availability, multidisciplinary team composition, screening practices, and educational needs.

RESULTS

Encouraging advancements were noted, with 80.8% of respondents reporting the presence of clinical nutrition programs, compared to fewer structured efforts in 2020. However, only 26.0% included nutrition specialists in multidisciplinary teams, and barriers such as financial constraints, limited product availability, and the absence of trained professionals persisted. While 82.2% performed nutritional screening, variability in tools and practices highlighted the need for standardization. Strikingly, 98.6% expressed a strong demand for advanced education on clinical nutrition, emphasizing the need for innovative and accessible training programs.

CONCLUSIONS

This study reveals a landscape of progress tempered by persistent inequities. To close the gap, oncology must embrace standardized protocols, expand access to trained nutrition specialists, and invest in educational initiatives. The findings offer actionable insights for transforming cancer care through nutrition, underscoring its potential to improve survival, quality of life, and overall treatment success.