Download PDF
Clin Colon Rectal Surg 2023; 36(03): 192-197
DOI: 10.1055/s-0043-1761152
Review Article

Perioperative Nutritional Considerations in Colon and Rectal Surgery

Thomas Curran
1   Division of Colon and Rectal Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Malnutrition is common in surgical patients and is associated with substantially increased morbidity and mortality. Dedicated assessment of nutritional status is advised by major nutrition and surgical societies. Assessment may utilize comprehensive and validated nutritional assessment tools or targeted history, physical examination with accompanying serologic markers to identify nutritional risk preoperatively. Emergent surgery in malnourished patients should proceed as the clinical situation dictates with consideration of ostomy or primary anastomosis with proximal fecal diversion to mitigate postoperative infectious complications. Nonemergent surgery should be delayed to facilitate nutritional optimization via oral nutritional supplementation preferably and total parenteral nutrition if necessary for at least 7 to 14 days. Exclusive enteral nutrition may be considered to optimize nutritional status and inflammation in patients with Crohn's disease. Immunonutrition use in the preoperative setting is not supported by evidence. Perioperative and postoperative immunonutrition may be of benefit but requires dedicated study in the contemporary era. Close attention to preoperative nutritional status and optimization represents a critical opportunity to improve outcomes in patients undergoing colorectal surgery.

Keywords

malnutrition - total parenteral nutrition - immunonutrition - prehabilitation


Publication History

Article published online:
25 January 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Páramo-Zunzunegui J, Ramos-Carrasco A, Alonso-García M, Cuberes-Montserrat R, Rodríguez-Caravaca G, Durán-Poveda M. Altered preoperative nutritional status in colorectal cancer: a not so infrequent issue. J Nutr Metab 2020; 2020: 5049194
    CrossrefPubMedGoogle Scholar
  • 2 Wolf JH, Ahuja V, D'Adamo CR, Coleman J, Katlic M, Blumberg D. Preoperative nutritional status predicts major morbidity after primary rectal cancer resection. J Surg Res 2020; 255: 325-331
    CrossrefPubMedGoogle Scholar
  • 3 Grass F, Pache B, Martin D, Hahnloser D, Demartines N, Hübner M. Preoperative nutritional conditioning of Crohn's patients: systematic review of current evidence and practice. Nutrients 2017; 9 (06) 562
    CrossrefPubMedGoogle Scholar
  • 4 Mijac DD, Janković GL, Jorga J, Krstić MN. Nutritional status in patients with active inflammatory bowel disease: prevalence of malnutrition and methods for routine nutritional assessment. Eur J Intern Med 2010; 21 (04) 315-319
    CrossrefPubMedGoogle Scholar
  • 5 Wahl TS, Patel FC, Goss LE, Chu DI, Grams J, Morris MS. The obese colorectal surgery patient: surgical site infection and outcomes. Dis Colon Rectum 2018; 61 (08) 938-945
    CrossrefPubMedGoogle Scholar
  • 6 Vather R, Josephson R, Jaung R, Robertson J, Bissett I. Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis. Surgery 2015; 157 (04) 764-773
    CrossrefPubMedGoogle Scholar
  • 7 Trejo-Avila M, Bozada-Gutiérrez K, Valenzuela-Salazar C, Herrera-Esquivel J, Moreno-Portillo M. Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36 (06) 1077-1096
    CrossrefPubMedGoogle Scholar
  • 8 Kang CY, Halabi WJ, Chaudhry OO. et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 2013; 148 (01) 65-71
    CrossrefPubMedGoogle Scholar
  • 9 Shah RS, Bachour S, Jia X. et al. Hypoalbuminemia, not biologic exposure, is associated with postoperative complications in Crohn's disease patients undergoing ileocolic resection. J Crohn's Colitis 2021
    PubMedGoogle Scholar
  • 10 Tan JKH, Ang JJ, Chan DKH. Enhanced recovery program versus conventional care after colorectal surgery in the geriatric population: a systematic review and meta-analysis. Surg Endosc 2021; 35 (06) 3166-3174
    CrossrefPubMedGoogle Scholar
  • 11 Liska D, Bora Cengiz T, Novello M. et al. Do patients with inflammatory bowel disease benefit from an enhanced recovery pathway?. Inflamm Bowel Dis 2020; 26 (03) 476-483
    CrossrefPubMedGoogle Scholar
  • 12 Liska D, Novello M, Cengiz BT. et al. Enhanced recovery pathway benefits patients undergoing nonelective colorectal surgery. Ann Surg 2021; 273 (04) 772-777
    CrossrefPubMedGoogle Scholar
  • 13 Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2011; (02) CD007635
    PubMedGoogle Scholar
  • 14 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 (02) 391-410.e4
    CrossrefPubMedGoogle Scholar
  • 15 Gustafsson UO, Scott MJ, Hubner M. et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg 2019; 43 (03) 659-695
    CrossrefPubMedGoogle Scholar
  • 16 Cederholm T, Jensen GL, Correia MITD. et al; GLIM Core Leadership Committee, GLIM Working Group. GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community. Clin Nutr 2019; 38 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 17 Håkonsen SJ, Pedersen PU, Bath-Hextall F, Kirkpatrick P. Diagnostic test accuracy of nutritional tools used to identify undernutrition in patients with colorectal cancer: a systematic review. JBI Database Syst Rev Implement Reports 2015; 13 (04) 141-187
    CrossrefPubMedGoogle Scholar
  • 18 Almasaudi AS, McSorley ST, Dolan RD, Edwards CA, McMillan DC. The relation between Malnutrition Universal Screening Tool (MUST), computed tomography-derived body composition, systemic inflammation, and clinical outcomes in patients undergoing surgery for colorectal cancer. Am J Clin Nutr 2019; 110 (06) 1327-1334
    CrossrefPubMedGoogle Scholar
  • 19 Schwegler I, von Holzen A, Gutzwiller JP, Schlumpf R, Mühlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg 2010; 97 (01) 92-97
    CrossrefPubMedGoogle Scholar
  • 20 White JV, Guenter P, Jensen G, Malone A, Schofield M. Academy Malnutrition Work Group, A.S.P.E.N. Malnutrition Task Force, A.S.P.E.N. Board of Directors. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition—characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr 2012; 36 (03) 275-283
    CrossrefPubMedGoogle Scholar
  • 21 Moghadamyeghaneh Z, Hwang G, Hanna MH. et al. Even modest hypoalbuminemia affects outcomes of colorectal surgery patients. Am J Surg 2015; 210 (02) 276-284
    CrossrefPubMedGoogle Scholar
  • 22 Keller U. Nutritional laboratory markers in malnutrition. J Clin Med 2019; 8 (06) 775
    CrossrefPubMedGoogle Scholar
  • 23 Portuondo JI, Probstfeld L, Massarweh NN. et al. Malnutrition in elective surgery: how traditional markers might be failing surgeons and patients. Surgery 2020; 168 (06) 1144-1151
    CrossrefPubMedGoogle Scholar
  • 24 Martin L, Hopkins J, Malietzis G. et al. Assessment of computed tomography (CT)-defined muscle and adipose tissue features in relation to short-term outcomes after elective surgery for colorectal cancer: a multicenter approach. Ann Surg Oncol 2018; 25 (09) 2669-2680
    CrossrefPubMedGoogle Scholar
  • 25 Xie H, Gong Y, Kuang J. et al. Computed tomography-determined sarcopenia is a useful imaging biomarker for predicting postoperative outcomes in elderly colorectal cancer patients. Cancer Res Treat 2020; 52 (03) 957-972
    CrossrefPubMedGoogle Scholar
  • 26 Gao X, Liu Y, Zhang L. et al. Effect of early vs late supplemental parenteral nutrition in patients undergoing abdominal surgery: a randomized clinical trial. JAMA Surg 2022; 157 (05) 384-393
    CrossrefPubMedGoogle Scholar
  • 27 Wanis KN, Patel SVB, Brackstone M. do moderate surgical treatment delays influence survival in colon cancer?. Dis Colon Rectum 2017; 60 (12) 1241-1249
    CrossrefPubMedGoogle Scholar
  • 28 Hangaard Hansen C, Gögenur M, Tvilling Madsen M, Gögenur I. The effect of time from diagnosis to surgery on oncological outcomes in patients undergoing surgery for colon cancer: a systematic review. Eur J Surg Oncol 2018; 44 (10) 1479-1485
    CrossrefPubMedGoogle Scholar
  • 29 Kucejko RJ, Holleran TJ, Stein DE, Poggio JL. How soon should patients with colon cancer undergo definitive resection?. Dis Colon Rectum 2020; 63 (02) 172-182
    CrossrefPubMedGoogle Scholar
  • 30 Kaltenmeier C, Shen C, Medich DS. et al. Time to surgery and colon cancer survival in the United States. Ann Surg 2021; 274 (06) 1025-1031
    CrossrefPubMedGoogle Scholar
  • 31 Weimann A, Braga M, Carli F. et al. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr 2021; 40 (07) 4745-4761
    CrossrefPubMedGoogle Scholar
  • 32 Adamina M, Gerasimidis K, Sigall-Boneh R. et al. Perioperative dietary therapy in inflammatory bowel disease. J Crohn's Colitis 2020; 14 (04) 431-444
    CrossrefPubMedGoogle Scholar
  • 33 Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr 2001; 74 (04) 534-542
    CrossrefPubMedGoogle Scholar
  • 34 Fukuda Y, Yamamoto K, Hirao M. et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol 2015; 22 (Suppl. 03) S778-S785
    CrossrefPubMedGoogle Scholar
  • 35 Burden S, Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev 2012; 11: CD008879
    CrossrefPubMedGoogle Scholar
  • 36 Bruns ERJ, Argillander TE, Van Den Heuvel B. et al. Oral nutrition as a form of pre-operative enhancement in patients undergoing surgery for colorectal cancer: a systematic review. Surg Infect (Larchmt) 2018; 19 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 37 Damas OM, Garces L, Abreu MT. Diet as adjunctive treatment for inflammatory bowel disease: review and update of the latest literature. Curr Treat Options Gastroenterol 2019; 17 (02) 313-325
    CrossrefPubMedGoogle Scholar
  • 38 Lee D, Baldassano RN, Otley AR. et al. Comparative effectiveness of nutritional and biological therapy in North American children with active Crohn's disease. Inflamm Bowel Dis 2015; 21 (08) 1786-1793
    CrossrefPubMedGoogle Scholar
  • 39 Brennan GT, Ha I, Hogan C. et al. Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn's disease patients: a meta-analysis. Eur J Gastroenterol Hepatol 2018; 30 (09) 997-1002
    CrossrefPubMedGoogle Scholar
  • 40 Abdalla S, Benoist S, Maggiori L. et al; GETAID Chirurgie group. Impact of preoperative enteral nutritional support on postoperative outcome in patients with Crohn's disease complicated by malnutrition: results of a subgroup analysis of the nationwide cohort registry from the GETAID Chirurgie group. Colorectal Dis 2021; 23 (06) 1451-1462
    CrossrefPubMedGoogle Scholar
  • 41 Zhu X, Herrera G, Ochoa JB. Immunosupression and infection after major surgery: a nutritional deficiency. Crit Care Clin 2010; 26 (03) 491-500 , ix
    CrossrefPubMedGoogle Scholar
  • 42 Hegazi RA, Hustead DS, Evans DC. Preoperative standard oral nutrition supplements vs immunonutrition: results of a systematic review and meta-analysis. J Am Coll Surg 2014; 219 (05) 1078-1087
    CrossrefPubMedGoogle Scholar
  • 43 Probst P, Ohmann S, Klaiber U. et al. Meta-analysis of immunonutrition in major abdominal surgery. Br J Surg 2017; 104 (12) 1594-1608
    CrossrefPubMedGoogle Scholar
  • 44 Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. N Engl J Med 1991; 325 (08) 525-532
    CrossrefPubMedGoogle Scholar
  • 45 Bozzetti F, Gavazzi C, Miceli R. et al. Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. JPEN J Parenter Enteral Nutr 2000; 24 (01) 7-14
    CrossrefPubMedGoogle Scholar