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3 . 2021

Assessment of nutritive status and its correction in oncological patients after operations in the hepatopancreatoduodenal zone

Abstract

Surgical interventions in the hepatopancreatoduodenal zone in cancer patients are associated with high risk of nutritional deficiency in the postoperative period. This feature is due to both the volume of the operation itself (pancreatoduodenectomy), and the predominance of catabolic processes in the early postoperative period. In this regard, the monitoring of the main indicators of carbohydrate, protein and fat metabolism in the early postoperative period becomes fundamental for choosing the correct tactics of nutritional support for this patients.

Aim. Improvement of the nutritional status of cancer patients after operations carried out in the hepatopancreatoduodenal zone in connection with malignant neoplasms by means of a comprehensive comparative analysis of the effectiveness of isolated enteral, iso - latedparenteral and mixed types of nutritional support in the early postoperative period.

Material and methods. The examination included 40 patients with an average age of 44.5±6.8 years (15 men, 25 women). All patients for analysis were divided into two groups: the first, the main - patients receiving strictly enteral and/or probe nutrition (n=21), the second, control - isolated parenteral nutrition (n=19). The dynamic of the main predictors of nutritional status in the early postoperative period was assessed: the level of total blood protein, including albumin, lymphocyte count, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity, their ratio - the de Ritis coefficient (as indirect criterion of cytolytic syndrome), total bilirubin. The analysis included the time interval of the enteral and parenteral nutrition in the early postoperative period, together with the number of bed-days required to correct the nutritional status in these patients in an intensive care unit. To objectify and clarify the dynamics of the nutritional status of patients in the pre- and postoperative period, we used the generally accepted scales for assessing nutritional status - Subjective Global Assessment (SGA) Nutritional Risk Index (NRI).

Results. According to the SGA and NRI rating scales, the overwhelming majority of patients in the main and control groups (85.7% and 94.7%, respectively) had a normal nutritional status before the operation. In the postoperative period, 4 (21%) patients in the control group showed signs of moderate malnutrition by day 12, which regressed after the enteral nutritional support was connected. There were no statistically significant changes in nutritional status in patients of the main group. The basal metabolic rate in patients of both groups had no statistical differences before surgery (2296±279 kcal/day). On the 15th day of the postoperative period, its increase by 394 kcal/day was recorded in the main group, in the control group an increase in the basal metabolic rate was observed only with the addition of the enteral component of nutritional support, on average, by 321 kcal/day. There was no statistically significant decrease in the level of blood lymphocytes in patients of the main group (p=0.289) in comparison with the traced tendency to lymphopenia (p=0.019) in patients of the control group. The patients of the main group showed a slower regression of the ALT activity, and, accordingly, less increase in the de Ritis coefficient.

Conclusion. In patients operated in the hepatopancreatoduodenal zone due to malignant neoplasms, in the early postoperative period, the enteral administration of nutritional mixtures may be preferable, both as an isolated method of nutritional support and as a supplement to parenteral nutrition, given its positive effect on the gastrointestinal tract passage, the level of basal metabolism, the state of the protein-synthetic function of the liver and, indirectly, the degree of cytolytic syndrome.

Keywords:nutritional status, nutritional deficiency, nutritional support, siping, oncology, nutrition, malignant neoplasms of the hepatopancreatoduodenal zone

Funding. The study was not sponsored.

Conflict of interest. The authors declare no conflicts of interest.

For citation: Davanov Sh.K., Vasilev D.V., Kabildina N.A., Plyаssovskayа S.V. Assessment of nutritive status and its correction in oncological patients after operations in the hepatopancreatoduodenal zone. Voprosy pitaniia [Problems of Nutrition]. 2021; 90 (3): 77-83. DOI: https://doi.org/10.33029/0042-8833-2021-90-3-77-83 (in Russian)

References

1. Khomyakov V.M., Yermoshina A.D. Correction of nutritional deficiency in cancer patients using ready-made mixtures for oral nutrition (siping). Issledovaniya i praktika v medicine [Research and Practice in Medicine]. 2015; 2 (3): 82–8. DOI: https://doi.org/10.17709/2409-2231-2015-2-3-82-88 (in Russian)

2. Galushko O.A. Nutritional support for patients in the intensive care unit: old rules and new opportunities. Meditsina neotlozhnykh sostoyaniy [Emergency Medicine]. 2015; (4): 58–62. URL: http://nbuv.gov.ua/UJRN/Medns_2015_4_12 (in Russian)

3. Prasad N., Sinha A., Gupta A., Bhadauria D., Manjunath R., Kaul A., et al. Validity of nutrition risk index as a malnutrition screening tool compared with subjective global assessment in end-stage renal disease patients on peritoneal dialysis. Indian J Nephrol. 2016; 26 (1): 27–32. DOI: https://doi.org/10.4103/0971-4065.158449

4. Na B.G., Han S.S., Cho Y.A., Wie G.A., Kim J.Y., Lee J.M., et al. Nutritional status of patients with cancer: a prospective cohort study of 1,588 hospitalized patients. Nutr Cancer. 2018; 70 (8): 1228–36. DOI: https://doi.org/10.1080/01635581.2019.1578392

5. Liu F.F., Wang L.M., Rong W.Q., Wu F., Wu J.X. Clinical effectiveness of postoperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. Zhonghua Zhong Liu Za Zhi. 2018; 40 (10): 787–92. DOI: https://doi.org/10.3760/cma.j.issn.0253-3766.2018.10.012 [Article in Chinese; Abstract available in Chinese from the publisher]

6. Yang F., Wei L., Huo X., Ding Y., Zhou X., Liu D. Effects of early postoperative enteral nutrition versus usual care on serum albumin, prealbumin, transferrin, time to first flatus and postoperative hospital stay for patients with colorectal cancer: A systematic review and meta-analysis. Contemp Nurse. 2018; 54 (6): 561–77. DOI: https://doi.org/10.1080/10376178.2018.1513809

7. Gianotti L., Besselink M.G., Sandini M., Hackert T., Conlon K., Gerritsen A., et al. Nutritional support and therapy in pancreatic surgery: a position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2018; 164 (5): 1035–48. DOI: https://doi.org/10.1016/j.surg.2018.05.040

8. Zhengyu Jiang, Cen Wen, Changli Wang, Zhenzhen Zhao, Lulong Bo, et al. Plasma metabolomics of early parenteral nutrition followed with enteral nutrition in pancreatic surgery patients. Sci Rep. 2019; 9 (1): 18846. DOI: https://doi.org/10.1038/s41598-019-55440-z

9. Takagi K., Domagala P., Hartog H., van Eijck C., Groot Koerkamp B. Current evidence of nutritional therapy in pancreatoduodenectomy: systematic review of randomized controlled trials. Ann Gastroenterol Surg. 2019; 3 (6): 620–9. DOI: https://doi.org/10.1002/ags3.12287

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CHIEF EDITOR
CHIEF EDITOR
Viktor A. Tutelyan
Full Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Scientific Director of the Federal Research Centre of Nutrition, Biotechnology and Food Safety (Moscow, Russia)

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