Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer: A Systematic Review

Emma R.J. Bruns, Tanja E. Argillander, Baukje Van Den Heuvel, Christianne J. Buskens, Peter Van Duijvendijk, Renate M. Winkels, Annette Kalf, Edwin S. Van Der Zaag, Eelco B. Wassenaar, Willem A. Bemelman, Barbara C. Van Munster

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Background: Nutritional status has major impacts on the outcome of surgery, in particular in patients with cancer. The aim of this review was to assess the merit of oral pre-operative nutritional support as a part of prehabilitation in patients undergoing surgery for colorectal cancer. Methods: A systematic literature search and meta-analysis was performed according to the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations in order to review all trials investigating the effect of oral pre-operative nutritional support in patients undergoing colorectal surgery. The primary outcome was overall complication rate. Secondary outcomes were incision infection rate, anastomotic leakage rate, and length of hospital stay. Results: Five randomized controlled trials and one controlled trial were included. The studies contained a total of 583 patients with an average age of 63 y (range 23-88 y), of whom 87% had colorectal cancer. Malnourishment rates ranged from 8%-68%. All investigators provided an oral protein supplement. Overall patient compliance rates ranged from 72%-100%. There was no significant reduction in the overall complication rate in the interventional groups (odds ratio 0.82; 95% confidence interval 0.52 - 1.25). Conclusion: Current studies are too heterogeneous to conclude that pre-operative oral nutritional support could enhance the condition of patients undergoing colorectal surgery. Patients at risk have a relatively lean body mass deficit (sarcopenia) rather than an absolute malnourished status. Compliance is an important element of prehabilitation. Targeting patients at risk, combining protein supplements with strength training, and defining standardized patient-related outcomes will be essential to obtain satisfactory results.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalSurgical Infections
Volume19
Issue number1
DOIs
StatePublished - Jan 2018

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Colorectal Neoplasms
Nutritional Support
Colorectal Surgery
Meta-Analysis
Length of Stay
Sarcopenia
Anastomotic Leak
Resistance Training
Patient Compliance
Nutritional Status
Malnutrition
Compliance
Proteins
Randomized Controlled Trials
Odds Ratio
Research Personnel
Confidence Intervals
Infection
Neoplasms

All Science Journal Classification (ASJC) codes

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Bruns, E. R. J., Argillander, T. E., Van Den Heuvel, B., Buskens, C. J., Van Duijvendijk, P., Winkels, R. M., ... Van Munster, B. C. (2018). Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer: A Systematic Review. Surgical Infections, 19(1), 1-10. https://doi.org/10.1089/sur.2017.143
Bruns, Emma R.J. ; Argillander, Tanja E. ; Van Den Heuvel, Baukje ; Buskens, Christianne J. ; Van Duijvendijk, Peter ; Winkels, Renate M. ; Kalf, Annette ; Van Der Zaag, Edwin S. ; Wassenaar, Eelco B. ; Bemelman, Willem A. ; Van Munster, Barbara C. / Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer : A Systematic Review. In: Surgical Infections. 2018 ; Vol. 19, No. 1. pp. 1-10.
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title = "Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer: A Systematic Review",
abstract = "Background: Nutritional status has major impacts on the outcome of surgery, in particular in patients with cancer. The aim of this review was to assess the merit of oral pre-operative nutritional support as a part of prehabilitation in patients undergoing surgery for colorectal cancer. Methods: A systematic literature search and meta-analysis was performed according to the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations in order to review all trials investigating the effect of oral pre-operative nutritional support in patients undergoing colorectal surgery. The primary outcome was overall complication rate. Secondary outcomes were incision infection rate, anastomotic leakage rate, and length of hospital stay. Results: Five randomized controlled trials and one controlled trial were included. The studies contained a total of 583 patients with an average age of 63 y (range 23-88 y), of whom 87{\%} had colorectal cancer. Malnourishment rates ranged from 8{\%}-68{\%}. All investigators provided an oral protein supplement. Overall patient compliance rates ranged from 72{\%}-100{\%}. There was no significant reduction in the overall complication rate in the interventional groups (odds ratio 0.82; 95{\%} confidence interval 0.52 - 1.25). Conclusion: Current studies are too heterogeneous to conclude that pre-operative oral nutritional support could enhance the condition of patients undergoing colorectal surgery. Patients at risk have a relatively lean body mass deficit (sarcopenia) rather than an absolute malnourished status. Compliance is an important element of prehabilitation. Targeting patients at risk, combining protein supplements with strength training, and defining standardized patient-related outcomes will be essential to obtain satisfactory results.",
author = "Bruns, {Emma R.J.} and Argillander, {Tanja E.} and {Van Den Heuvel}, Baukje and Buskens, {Christianne J.} and {Van Duijvendijk}, Peter and Winkels, {Renate M.} and Annette Kalf and {Van Der Zaag}, {Edwin S.} and Wassenaar, {Eelco B.} and Bemelman, {Willem A.} and {Van Munster}, {Barbara C.}",
year = "2018",
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doi = "10.1089/sur.2017.143",
language = "English (US)",
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Bruns, ERJ, Argillander, TE, Van Den Heuvel, B, Buskens, CJ, Van Duijvendijk, P, Winkels, RM, Kalf, A, Van Der Zaag, ES, Wassenaar, EB, Bemelman, WA & Van Munster, BC 2018, 'Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer: A Systematic Review', Surgical Infections, vol. 19, no. 1, pp. 1-10. https://doi.org/10.1089/sur.2017.143

Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer : A Systematic Review. / Bruns, Emma R.J.; Argillander, Tanja E.; Van Den Heuvel, Baukje; Buskens, Christianne J.; Van Duijvendijk, Peter; Winkels, Renate M.; Kalf, Annette; Van Der Zaag, Edwin S.; Wassenaar, Eelco B.; Bemelman, Willem A.; Van Munster, Barbara C.

In: Surgical Infections, Vol. 19, No. 1, 01.2018, p. 1-10.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer

T2 - A Systematic Review

AU - Bruns, Emma R.J.

AU - Argillander, Tanja E.

AU - Van Den Heuvel, Baukje

AU - Buskens, Christianne J.

AU - Van Duijvendijk, Peter

AU - Winkels, Renate M.

AU - Kalf, Annette

AU - Van Der Zaag, Edwin S.

AU - Wassenaar, Eelco B.

AU - Bemelman, Willem A.

AU - Van Munster, Barbara C.

PY - 2018/1

Y1 - 2018/1

N2 - Background: Nutritional status has major impacts on the outcome of surgery, in particular in patients with cancer. The aim of this review was to assess the merit of oral pre-operative nutritional support as a part of prehabilitation in patients undergoing surgery for colorectal cancer. Methods: A systematic literature search and meta-analysis was performed according to the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations in order to review all trials investigating the effect of oral pre-operative nutritional support in patients undergoing colorectal surgery. The primary outcome was overall complication rate. Secondary outcomes were incision infection rate, anastomotic leakage rate, and length of hospital stay. Results: Five randomized controlled trials and one controlled trial were included. The studies contained a total of 583 patients with an average age of 63 y (range 23-88 y), of whom 87% had colorectal cancer. Malnourishment rates ranged from 8%-68%. All investigators provided an oral protein supplement. Overall patient compliance rates ranged from 72%-100%. There was no significant reduction in the overall complication rate in the interventional groups (odds ratio 0.82; 95% confidence interval 0.52 - 1.25). Conclusion: Current studies are too heterogeneous to conclude that pre-operative oral nutritional support could enhance the condition of patients undergoing colorectal surgery. Patients at risk have a relatively lean body mass deficit (sarcopenia) rather than an absolute malnourished status. Compliance is an important element of prehabilitation. Targeting patients at risk, combining protein supplements with strength training, and defining standardized patient-related outcomes will be essential to obtain satisfactory results.

AB - Background: Nutritional status has major impacts on the outcome of surgery, in particular in patients with cancer. The aim of this review was to assess the merit of oral pre-operative nutritional support as a part of prehabilitation in patients undergoing surgery for colorectal cancer. Methods: A systematic literature search and meta-analysis was performed according to the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations in order to review all trials investigating the effect of oral pre-operative nutritional support in patients undergoing colorectal surgery. The primary outcome was overall complication rate. Secondary outcomes were incision infection rate, anastomotic leakage rate, and length of hospital stay. Results: Five randomized controlled trials and one controlled trial were included. The studies contained a total of 583 patients with an average age of 63 y (range 23-88 y), of whom 87% had colorectal cancer. Malnourishment rates ranged from 8%-68%. All investigators provided an oral protein supplement. Overall patient compliance rates ranged from 72%-100%. There was no significant reduction in the overall complication rate in the interventional groups (odds ratio 0.82; 95% confidence interval 0.52 - 1.25). Conclusion: Current studies are too heterogeneous to conclude that pre-operative oral nutritional support could enhance the condition of patients undergoing colorectal surgery. Patients at risk have a relatively lean body mass deficit (sarcopenia) rather than an absolute malnourished status. Compliance is an important element of prehabilitation. Targeting patients at risk, combining protein supplements with strength training, and defining standardized patient-related outcomes will be essential to obtain satisfactory results.

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U2 - 10.1089/sur.2017.143

DO - 10.1089/sur.2017.143

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JO - Surgical Infections

JF - Surgical Infections

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