Update enterale und parenterale Ernährung

Hinsichtlich des Ziels einer raschen postoperativen Erholung nach dem Enhanced-Recovery-after-Surgery-(ERAS-)Konzept als Plan A erscheinen perioperative enterale und parenterale Ernährung sehr traditionell und redundant. Eine vorbestehende Mangelernährung und das Auftreten von Komplikationen mit notwendiger Intensivbehandlung trotz bestem perioperativen Management erfordern jedoch einen Plan B mit individuell angepasster Ernährungstherapie. In der Übersicht werden als Update die aktuelle Literatur und Leitlinienempfehlungen diskutiert.

Publication History

Article published online:
06 December 2021

• Literatur

• 1 Hübner J, Büntzel J, Weimann A. et al. Unterernährt gleich unterbehandelt – Ernährungsmedizin ist Teil der onkologischen Versorgung. Onkologe 2021; 27: 96-99
• 2 Williams DGA, Molinger J, Wischmeyer PE. The malnourished surgery patient: a silent epidemic in perioperative outcome?. Curr Opin Anesthesiol 2019; 32: 405-411
• 3 Simonsen C, de Heer P, Bjerre ED. et al. Sarcopenia and postoperative complication risk in gastrointestinal surgical oncology: a meta-analysis. Ann Surg 2018; 268: 58-69 DOI: 10.1097/SLA.0000000000002679. (PMID: 29373365)
• 4 Cao Y, Han D, Zhou X. et al. Effects of preoperative nutrition on postoperative outcomes in esophageal cancer: a systematic review and meta-analysis. Dis Esophagus 2021; DOI: 10.1093/dote/doab028. (PMID: 33969399)
• 5 Kenny E, Samavat H, Touger-Decker R. et al. Adverse perioperative outcomes among patients undergoing gastrointestinal cancer surgery: Quantifying attributable risk from malnutrition. JPEN J Parenter Enteral Nutr 2021; DOI: 10.1002/jpen.2200.
• 6 Schwenk W, Lang I, Huhn M. Strukturelle Implementierung eines Fast-Track-Programms – wie geht das?. Zentralbl Chir 2021; 146: 249-259 DOI: 10.1055/a-1385-0357. (PMID: 33782931)
• 7 Weimann A. (Par-)Enterale Ernährungstherapie beim Tumorpatienten – neue Konzepte und aktuelle Leitlinienempfehlungen. Zentralbl Chir 2017; 142: 437-442 DOI: 10.1055/s-0043-110419. (PMID: 29078235)
• 8 Cederholm T, Jensen GL, Correia MITD. et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr 2019; 38: 1-9 DOI: 10.1016/j.clnu.2018.08.002.
• 9 Ishida T, Makino T, Yamasaki M. et al. Quantity and Quality of Skeletal Muscle as an Important Predictor of Clinical Outcomes in Patients with Esophageal Cancer Undergoing Esophagectomy after Neoadjuvant Chemotherapy. Ann Surg Oncol 2021; DOI: 10.1245/s10434-021-10025-x.
• 10 Argillander TE, Spek D, van der Zaag-Loonen HJ. et al. Association between postoperative muscle wasting and survival in older patients undergoing surgery for non-metastatic colorectal cancer. J Geriatr Oncol 2021; DOI: 10.1016/j.jgo.2021.04.004.
• 11 [Anonym]. 8–98 Sonstige multimodale Komplexbehandlung. Im Internet (Stand: 04.07.2021): www.icd-code.de/ops/code/8-98j.html
• 12 Müller A, Weimann A. Implementierung der ernährungsmedizinischen Komplexbehandlung im klinischen Alltag. Aktuel Ernahrungsmed 2021; 46: 105-108
• 13 Wobith M, Alsakka K, Grosser K. et al. Einfluss der präoperativen, kognitiven Funktion auf die Komplikationsrate und die Krankenhausverweildauer bei hochbetagten Patienten. Chirurg 2019; 90: 930-935
• 14 Weimann A, Braga M, Carli F. et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40: 4745-4761 DOI: 10.1016/j.clnu.2021.03.031. (PMID: 34242915)
• 15 Gustafsson UO, Scott MJ, Hübner M. et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery after Surgery (ERAS) Society Recommendations 2018. World J Surg 2019; 43: 659-695 DOI: 10.1007/s00268-018-4844-y. (PMID: 30426190)
• 16 Carli F, Bousquet-Dion G, Awasthi R. et al. Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer: A Randomized Clinical Trial. JAMA Surg 2020; 155: 233-242 DOI: 10.1001/jamasurg.2019.5474.
• 17 Gillis C, Buhler K, Bresee L. et al. Effects of nutritional prehabilitation with and without exercise, on outcomes of patients who undergo colorectal surgery: a systematic review and meta-analysis. Gastroenterology 2018; 155: 391-410 DOI: 10.1053/j.gastro.2018.05.012. (PMID: 29750973)
• 18 Daniels SL, Lee MJ, George J. et al. Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis. BJS Open 2020; 46: 1022-1041 DOI: 10.1002/bjs5.50347. (PMID: 32959532)
• 19 Geiger R, Rieckmann JC, Wolf T. et al. L-Arginine Modulates T Cell Metabolism and Enhances Survival and Anti-tumor Activity. Cell 2016; 167: 829-842.e13 DOI: 10.1016/j.cell.2016.09.031. (PMID: 27745970)
• 20 Troesch B, Eggersdorfer M, Laviano A. et al. Expert opinion on benefits of long-chain omega-3 fatty acids (DHA and EPA) in aging and clinical nutrition. Nutrients 2020; 12: 255 DOI: 10.3390/nu120925555. (PMID: 32846900)
• 21 Li XK, Cong ZZ, Wu WJ. et al. Enteral immunonutrition versus enteral nutrition for patients undergoing esophagectomy: a randomized controlled trial. Ann Palliat Med 2021; 10: 1351-1361 DOI: 10.21037/apm-20-1399. (PMID: 33222455)
• 22 Moya P, Soriano-Irigiaray L, Ramirez JM. et al. Perioperative standard oral nutrition supplements versus immunonutrition in patients undergoing colorectal resection in an enhanced recovery (ERAS) protocol: a multicenter randomized Clinical Trial (SONVI Study). Medicine (Baltimore) 2016; 95: e3704
• 23 Adiamah A, Skořepa P, Weimann A. et al. The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for Gastrointestinal Cancer: A Systematic Review and Meta-analysis. Ann Surg 2019; 270: 247-256 DOI: 10.1097/SLA.0000000000003256. (PMID: 30817349)
• 24 Zhang B, Najarali Z, Ruo L. et al. Effect of Perioperative Nutritional Supplementation on Postoperative Complications-Systematic Review and Meta-Analysis. J Gastrointest Surg 2019; 23: 1682-1693 DOI: 10.1007/s11605-019-04173-5. (PMID: 31062270)
• 25 Burcharth J, Falkenberg A, Schack A. et al. The effects of early enteral nutrition on mortality after major emergency abdominal surgery: A systematic review and meta-analysis with Trial Sequential Analysis. Clin Nutr 2021; 40: 1604-1612 DOI: 10.1016/j.clnu.2021.02.050. (PMID: 33744604)
• 26 Ma BQ, Chen SY, Jiang ZB. et al. Effect of postoperative early enteral nutrition on clinical outcomes and immune function of cholangiocarcinoma patients with malignant obstructive jaundice. World J Gastroenterol 2020; 26: 7405-7415 DOI: 10.3748/wjg.v26.i46.7405. (PMID: 33362392)
• 27 Hogan S, Reece L, Solomon M. et al. Early enteral feeding is beneficial for patients after pelvic exenteration surgery: A randomized controlled trial. JPEN J Parenter Enteral Nutr 2021; DOI: 10.1002/jpen.2120. (PMID: 33884645)
• 28 Berkelmans GHK, Fransen LFC, Dolmans-Zwartjes ACP. et al. Direct oral feeding following minimally invasive esophagectomy (NUTRIENT II trial): An international, multicenter, open-label randomized controlled trial. Ann Surg 2020; 271: 41-47 DOI: 10.1097/SLA.0000000000003278. (PMID: 31090563)
• 29 Constansia RDN, Hentzen JEKR, Hogenbirk RNM. et al. Actual postoperative protein and calorie intake in patients undergoing major open abdominal cancer surgery: A prospective, observational cohort study. Nutr Clin Pract 2021; DOI: 10.1002/ncp.10678.
• 30 Jang A, Jeong O. Early postoperative oral feeding after total gastrectomy in gastric carcinoma patients: a retrospective before-after study using propensity score matching. JPEN J Parenter Enteral Nutr 2019; 43: 649-657 DOI: 10.1002/jpen.1438. (PMID: 30144113)
• 31 Zhuang W, Wu H, Liu H. et al. Utility of feeding jejunostomy in patients with esophageal cancer undergoing esophagectomy with a high risk of anastomotic leakage. J Gastrointest Oncol 2021; 12: 433-445 DOI: 10.21037/jgo-21-133. (PMID: 34012637)
• 32 Li HN, Chen Y, Dai L. et al. A Meta-analysis of Jejunostomy Versus Nasoenteral Tube for Enteral Nutrition Following Esophagectomy. J Surg Res 2021; 264: 553-561 DOI: 10.1016/j.Jss.2021.02.027. (PMID: 33864963)
• 33 Holmén A, Hayami M, Szabo E. et al. Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival. Langenbecks Arch Surg 2020; DOI: 10.1007/s00423-020-02037-0.
• 34 Shen X, Zhuo ZG, Li G. et al. Is the routine placement of a feeding jejunostomy during esophagectomy worthwhile?-a systematic review and meta-analysis. Ann Palliat Med 2021; 10: 4232-4241 DOI: 10.21037/apm-20-2519. (PMID: 33894727)
• 35 Elke G, Hartl WH, Kreymann KG. et al. DGEM Leitlinie Klinische Ernährung in der Intensivmedizin –Kurzversion. Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 63-73 DOI: 10.1055/a-0805-4118. (PMID: 30620956)
• 36 Pradelli L, Mayer K, Klek S. et al. ω-3 Fatty-Acid Enriched Parenteral Nutrition in Hospitalized Patients: Systematic Review With Meta-Analysis and Trial Sequential Analysis. JPEN J Parenter Enteral Nutr 2020; 44: 44-57 DOI: 10.1002/jpen.1672. (PMID: 31250474)
• 37 Martindale RG, Berlana D, Boullata JI. et al. Summary of Proceedings and Expert Consensus Statements From the International Summit “Lipids in Parenteral Nutrition”. JPEN J Parenter Enteral Nutr 2020; 44 (Suppl. 01) 7-20 DOI: 10.1002/jpen.1746. (PMID: 32049392)
• 38 Linecker M, Botea F, Aristotele Raptis D. et al. Perioperative omega-3 fatty acids fail to confer protection in liver surgery: Results of a multicentric, double-blind, randomized controlled trial. J Hepatol 2020; 72: 498-505 DOI: 10.1016/j.jhep.2019.10.004. (PMID: 31626819)
• 39 Bakker N, van den Helder RS, Stoutjesdijk E. et al. Effects of perioperative intravenous ω-3 fatty acids in colon cancer patients: a randomized, double-blind, placebo-controlled clinical trial. Am J Clin Nutr 2020; 111: 385-395 DOI: 10.1093/ajcn/nqz281. (PMID: 31826232)
• 40 Ridley EJ, Parke RL, Davies AR. et al. What happens to nutrition intake in the post-intensive care unit hospitalization period? An observational cohort study in critically ill adults. JPEN J Parenter Enteral Nutr 2019; 43: 88-95 DOI: 10.1002/jpen.1196. (PMID: 29924393)
• 41 Singer P, Bendavid I, Mesilati-Stahy R. et al. Enteral and supplemental parenteral nutrition enriched with omega-3 polyunsaturated fatty acids in intensive care patients – A randomized, controlled, double-blind clinical trial. Clin Nutr 2021; 40: 2544-2554 DOI: 10.1016/j.clnu.2021.03.034. (PMID: 33932802)
• 42 Baker M, Halliday V, Williams RN. et al. A systematic review of the nutritional consequences of esophagectomy. Clin Nutr 2016; 35: 987-994 DOI: 10.1016/j.clnu.2015.08.010. (PMID: 26411750)
• 43 Koterazawa Y, Oshikiri T, Hasegawa H. et al. Routine placement of feeding jejunostomy tube during esophagectomy increases postoperative complications and does not improve postoperative malnutrition. Dis Esophagus 2020; 33: doz021 DOI: 10.1093/dote/doz021. (PMID: 30997494)
• 44 Wobith M, Wehle L, Haberzettl D. et al. Needle catheter jejunostomy in patients undergoing surgery for upper gastrointestinal and pancreato-biliary cancer – impact on nutritional and clinical outcome in the early and late postoperative period. Nutrients 2020; 12: 2564 DOI: 10.3390/nu12092564. (PMID: 32854177)
• 45 Chen X, Zhao G, Zhu L. Home enteral nutrition for postoperative elderly patients with esophageal cancer. Ann Palliat Med 2021; 10: 278-284 DOI: 10.21037/apm-20-2197. (PMID: 33545764)
• 46 Xueting H, Li L, Meng Y. et al. Home enteral nutrition and oral nutritional supplements in postoperative patients with upper gastrointestinal malignancy: A systematic review and meta-analysis. Clin Nutr 2021; 40: 3082-3093 DOI: 10.1016/j.clnu.2020.11.023. (PMID: 33279310)
• 47 Hatao F, Chen KY, Wu JM. et al. Randomized controlled clinical trial assessing the effects of oral nutritional supplements in postoperative gastric cancer patients. Langenbecks Arch Surg 2017; 402: 203-211 DOI: 10.1007/s00423-016-1527-8. (PMID: 27807617)
• 48 Meng Q, Tan S, Jiang Y. et al. Post-discharge oral nutritional supplements with dietary advice in patients at nutritional risk after surgery for gastric cancer: A randomized clinical trial. Clin Nutr 2020; DOI: 10.1016/j.clnu.2020.04.043.
• 49 Grass F, Bertrand PC, Schäfer M. et al. Compliance with preoperative oral nutritional supplements in patients at nutritional risk--only a question of will?. Eur J Clin Nutr 2015; 69: 525-529 DOI: 10.1038/ejcn.2014.285. (PMID: 25604779)
• 50 Miyazaki Y, Omori T, Fujitani K. et al. Oral nutritional supplements versus a regular diet alone for body weight loss after gastrectomy: a phase 3, multicenter, open-label randomized controlled trial. Gastric Cancer 2021; DOI: 10.1007/s10120-021-01188-3. (PMID: 33835329)
• 51 Weimann A. Perioperative Nahrungssupplementation – was ist wirklich evidenzbasiert?. Chirurg 2021; 92: 397-404 DOI: 10.1007/s00104-020-01329-x. (PMID: 33415408)
• 52 Sørensen LS, Rasmussen SL, Calder PC. et al. Long-term outcomes after perioperative treatment with omega-3 fatty acid supplements in colorectal cancer. BJS Open 2020; 4: 678-684 DOI: 10.1002/bjs5.50295. (PMID: 32391656)