Annals of Clinical Nutrition and Metabolism

Role of preoperative immunonutrition in patients with colorectal cancer: a narrative review: Soo Young Lee, Hyeung-min Park, Chang Hyun Kim, Hyeong Rok Kim; Ann Clin Nutr Metab 2023;15(2):46-50. Published online August 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.2.46

Purpose: Colorectal cancer surgery presents challenges due to surgical stress and immunosuppression, leading to postoperative complications. Nutrition is crucial for colorectal cancer patients who are prone to malnutrition. This study aims to provide a comprehensive review of the role of preoperative immunonutrition in colorectal cancer surgery.
Current concept: Preoperative immunonutrition, consisting of immunonutrients such as arginine, ω-3 fatty acids, and nucleotides, has emerged as a potential strategy to enhance surgical outcomes by modulating immune responses and reducing complications. Current guidelines recommend preoperative oral nutritional supplements for major abdominal surgery and immunonutrition for nutritionally high-risk patients. Meta-analysis have demonstrated significant decreases in infectious complications and hospital stay durations with preoperative immunonutrition. However, limitations such as publication bias and heterogeneity in the previous studies should be considered. Further research should focus on the optimal timing, duration, and amount of immunonutrition; the patient populations that would benefit most; and the integration of immunonutrition into enhanced recovery after surgery protocols.
Conclusion: While preoperative immunonutrition shows promise, additional research is crucial to refine protocols and establish optimal clinical practice utilization.

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The 2024 Korean Enhanced Recovery After Surgery (ERAS) guidelines for colorectal cancer: a secondary publication
Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park
Annals of Coloproctology.2025; 41(1): 3. CrossRef
The 2024 Korean Enhanced Recovery After Surgery guidelines for colorectal cancer
Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park
Annals of Clinical Nutrition and Metabolism.2024; 16(2): 22. CrossRef

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Effect of Probiotics/Synbiotics on Postoperative Outcomes in Patients Undergoing Abdominal Surgery: In Ja Park; Ann Clin Nutr Metab 2022;14(1):10-19. Published online June 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.1.10

Abstract PDF ePub: Environmental factors, drugs, diet, and surgery alter the composition of the gut microbiota leading to the production of different metabolites or toxins that can cause disease or delay postoperative recovery. Surgical damage leads to gut barrier disruption, increased intestinal permeability, gut microbial imbalance, and immunologic compromise of the host with subsequent bacterial translocation from the gastrointestinal tract to systemic circulation. Therefore, perioperative stabilization of the intestinal microbiota is a potential method of reducing postoperative complication rates. Probiotics have been proposed as a viable option for prophylaxis of postoperative infections through increased intestinal motility to prevent bacterial overgrowth, improve gut barrier function, and modulate immune response. This review investigates microbial changes after surgery and the influence of probiotics on postoperative microbial composition. Infectious postoperative complications and immunologic changes related to probiotics/synbiotics were also reviewed in patients who underwent abdominal surgery.

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Preoperative Neutrophil to Lymphocyte Ratio and Albumin Level as Predictors for Postoperative Complication in Patients with Colorectal Cancer: Kyung Pil Kang, Young Hun Kim, Kyung Jong Kim PhD.; Surg Metab Nutr 2020;11(2):66-72. Published online December 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.2.66

Abstract PDF ePub: Purpose: Systematic inflammatory response biomarkers are recognized as potential prognostic factors for colorectal cancer (CRC). Recently, the neutrophil-to-lymphocyte ratio (NLR) has emerged as a possible marker for predicting the outcomes of patients with CRC. The purpose of the current study was to determine if NLR could function as a predictive marker of postoperative complications in patients with colorectal cancer who were treated surgically.
Materials and Methods: One hundred and seven patients who underwent radical surgery for colorectal cancer were enrolled in the study. The NLR values were determined from the complete blood counts within one month before surgery. Values of less than or greater than 3 were defined as low (NLR-low) or high (NLR-high), respectively. Statistical comparisons were made between the NLR and the clinical-pathological variables.
Results: Sixty-eight patients met the criteria of NLR-low, and 39 patients were categorized as NLR-high. The NLR status was significantly correlated with T-stage, perineural invasion, and an increased likelihood of complications. Univariate analysis indicated that both low albumin and meeting the criteria for the NLR-high group correlated with an increased occurrence of complications (P=0.004, P=0.004, respectively). Multivariate analysis identified NLR-high and low albumin levels as independent predictors for complications (P=0.007, odd ratio=6.405, P=0.016, odd ratio=9.641, respectively)
Conclusion: The current results suggest that the preoperative NLR levels could be useful tools for predicting the occurrence of postoperative complications.

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Postoperative Weight Changes, Nutritional Status and Clinical Significance of Colorectal Cancer Patients: Sun Young Kim, Ji Sun Kim, Eon Chul Han; Surg Metab Nutr 2019;10(2):46-53. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.46

Abstract PDF ePub

Purpose:

Although weight loss is an important factor for assessing the nutritional status, patient counselling or management is limited due to fewer studies on weight loss after colorectal cancer surgery.

Materials and Methods:

Totally, 374 patients were included in the analysis (between August 2010 to December 2016). Patients’ weight was determined before surgery, and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Change in weight was reviewed based on the gender and administration of chemotherapy. Severe weight loss is defined as greater than 5% weight loss after surgery.

Results:

The weight changes post-surgery at 1 week (−2.56±2.62 vs. −3.36±2.68, P<0.005), 6 weeks (−3.23±3.82 vs. −4.57±3.96, P=0.001), and 3 months (−0.93±5.01 vs. −2.79±4.86, P<0.001) were significantly greater in male subjects, as compared to female patients. However, at 6 months post-surgery, most patients showed weight gain with no statistical significance between the genders (1.11±4.64 vs. 1.94±6.26, P=0.143). Weight change based on treatment (with or without chemotherapy) reveal significant differences between the genders at 3 months post-surgery only (−1.33±4.65 vs. −2.52 ±5.15, P=0.027). Multivariate analysis for factors of severe weight loss show that the male gender [adjusted odds ratio (OR): 1.83, P=0.027)], adjuvant chemotherapy (adjusted OR 2.11, P=0.008), and presence of post-operative complications (adjusted OR 2.12, P=0.029) were significant factors.

Conclusion:

In postoperative colorectal cancer patients, the weight and nutritional status require careful monitoring for at least 2 months after surgery, in order to prevent hindrance to chemotherapy. (Surg Metab Nutr 2019;10:-53)

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Serial measurements of body composition using bioelectrical impedance and clinical usefulness of phase angle in colorectal cancer
Seung‐Rim Han, Jung Hoon Bae, Chul Seung Lee, Abdullah Al‐Sawat, Soo Ji Park, Hyo Jin Lee, Mi Ran Yoon, Hyeong Yong Jin, Yoon Suk Lee, Do Sang Lee, In Kyu Lee
Nutrition in Clinical Practice.2022; 37(1): 153. CrossRef

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Nutrition Support for Pediatric Surgical Patients: Jun Beom Park; Surg Metab Nutr 2019;10(1):9-14. Published online June 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.1.9

Abstract PDF ePub: Pediatric patients have characteristics such as a low capacity for storing energy/nutrients and high energy metabolism as compared those of adults. Because of the inherent characteristics that they are continually growing, supplying both rapid and adequate nutrition is of the utmost importance. In the case of children undergoing surgery (and particularly gastrointestinal surgery), there is a high possibility of a restricted supply of nutrition, and so active intervention to supply sufficient nutrition must be carried out. Of course, enteral nutrition is preferred, but continuous monitoring of nutrition is of paramount importance; thus, parenteral nutrition should be provided when necessary. Nutritional support requires continuous monitoring when and if complications arise. The complications of parenteral nutrition have yet to be overcome, so further research on this topic is certainly warranted.

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Major Surgery in Sarcopenic Patients: Kyung Won Seo; Surg Metab Nutr 2019;10(1):5-8. Published online June 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.1.5

Abstract PDF ePub: Sarcopenia refers to reduced muscle mass in the elderly population, and this malady is of great interest in clinical course, including postoperative complications and mortality when treating major cancer in the elderly. The definition of sarcopenia varies according to the method of measuring muscle mass, and the skeletal muscle index (SMI) tends to be extensively used in retrospective studies. In many reports, sarcopenia has been reported to be a poor prognostic factor after gastrectomy, colectomy, pancreatectomy and liver transplantation, with regards to complications and the length of the hospital stay. Additionally, patients suffering from sarcopenia have a higher medical burden due to their poor clinical outcome after surgery. To overcome these difficulties, nutritional support and exercise training to improve sarcopenia before surgery is helpful, and so further studies that focus on these treatments need to be conducted.

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Nutritional Therapy Related Complications in Hospitalized Adult Patients: A Korean Multicenter Trial: Eun-Mi Seol, Kye Sook Kwon, Jeong Goo Kim, Jung-Tae Kim, Jihoon Kim, Sun-Mi Moon, Do Joong Park, Jung Hyun Park, Je Hoon Park, Ji Young Park, Jung-Min Bae, Seung Wan Ryu, Ji-Young Sul, Dong Woo Shin, Cheung Soo Shin, Byung Kyu Ahn, Soo Min Ahn, Hee Chul Yu, Gil Jae Lee, Sanghoon Lee, A Ran Lee, Jae Young Jang, Hyun Jeong Jeon, Sung Min Jung, Sung-Sik Han, Suk-Kyung Hong, Sun-Hwi Hwang, Yunhee Choi, Hyuk-Joon Lee; J Clin Nutr 2019;11(1):12-22. Published online June 30, 2019; DOI: https://doi.org/10.15747/jcn.2019.11.1.12

Abstract PDF ePub

Purpose:

Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking.

Methods:

Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients’ demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected.

Results:

A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m². The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay.

Conclusion:

NT may induce or be associated with several complications, and some of them may seriously affect the patient’s outcome. NST personnel in each hospital should be aware of each problem during nutritional support.

Citations

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Provision of Enteral Nutrition in the Surgical Intensive Care Unit: A Multicenter Prospective Observational Study
Chan-Hee Park, Hak-Jae Lee, Suk-Kyung Hong, Yang-Hee Jun, Jeong-Woo Lee, Nak-Jun Choi, Kyu-Hyouck Kyoung
Annals of Clinical Nutrition and Metabolism.2022; 14(2): 66. CrossRef
Pathophysiology and protective approaches of gut injury in critical illness
Chang Yeon Jung, Jung Min Bae
Yeungnam University Journal of Medicine.2021; 38(1): 27. CrossRef
Nutrition Support Team Reconsultation During Nutrition Therapy in Korea
Eun‐Mi Seol, Yun‐Suhk Suh, Dal Lae Ju, Hye Jung Bae, Eunjung Kim, Hyuk‐Joon Lee
Journal of Parenteral and Enteral Nutrition.2021; 45(2): 357. CrossRef

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Quality Improvement Activities to Facilitate the Filing of Complexity Payment Claims for Patients with Malnutrition: Kuk Hwan Kwon, Hyung Soon Lee, Jee Hyoung Yoo, Soo Na Chi, Hyun Hee Park, So Won Kim, Kyung Ran Kim, Nan Hee Yun, Kyoung Taek Ra, Hyun Jung Song; J Clin Nutr 2018;10(1):20-24. Published online June 30, 2018; DOI: https://doi.org/10.15747/jcn.2018.10.1.20

Abstract PDF ePub: Purpose:
The grade of complexity in the diagnosis related group (DRG) payment system is influenced by the secondary diagnosis of specific complication and comorbidity level, in which moderate or severe malnutrition is included. This study examined an existing proportion of patients with malnutrition who were supposed to be qualified for the complexity level and devised quality improvement measures to increase the proportion of qualifying complexity payments.
Methods:
The goal of the activities was to increase the rate of complexity payment claims for patients with malnutrition (%). Cases ineligible for the DRG payment system and cases with no diagnosis of malnutrition were excluded. We established a collaborative system between the nutrition support team and departments related to each improvement factor (i.e., patient care, medical records, insurance review, and medical information).
Results:
Before implementing the activities, this study investigated the current level of complexity payment claims for malnutrition patients who were discharged within a specific period (June 1, 2015∼August 31, 2015). The results showed that complexity payment claims were filed in 10.00% (2 of the 20 malnutrition cases). After the activities, the rate of complexity payment claims for the patients with malnutrition within the study period (June 1, 2016∼August 31, 2016) was 46.43% (26 out of 56), showing an approximately 364% increase from the pre activity rate. This change was statistically significant according to the chi-square test on Microsoft Excel 2010 (P<0.01).
Conclusion:
Collaborative efforts by the related departments enabled the smooth implementation of each activity. In addition, moderate or severe malnutrition was revealed to be a variable in the complexity-specific payment system. In the future, hospital-wide awareness and effort are crucial to promot the steady practice of these activities and expand their implementation.

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