Annals of Clinical Nutrition and Metabolism

Original Articles

Development of a pre- and re-habilitation protocol for gastrointestinal cancer surgery: Eun Young Kim, Jung Hoon Bae, Jiseon Kim, Eun Joo Yang, Sang-Jae Park, In Kyu Lee, on behalf of the Task Force Team for Development and Trial Application of Pre/Rehabilitation Protocol in GI Cancer Surgery; Ann Clin Nutr Metab 2025;17(1):25-40. Published online April 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0001

Abstract PDF Supplementary Material: Purpose
Surgical resection is the primary curative treatment for gastrointestinal (GI) cancer; however, it is associated with high postoperative complication rates and impaired recovery. Frailty, malnutrition, and sarcopenia increase morbidity and mortality, underscoring the need for perioperative rehabilitation programs. Standardized rehabilitation protocols during the perioperative period are currently lacking in Korea. We aimed to develop an evidence-based rehabilitation protocol for GI cancer patients to enhance postoperative outcomes and facilitate clinical implementation.
Methods
A multidisciplinary task force team comprising experts in surgery, clinical nutrition, and rehabilitation medicine conducted a systematic literature search and comprehensive review from 2012 to 2022 to develop a standardized pre- and re-habilitation protocol for GI cancer surgery. The protocol underwent external validation and subsequent refinements before being finalized through expert consensus.
Results
The protocol development process was organized into four consecutive phases: keyword selection, literature review and case report form development, initial protocol drafting, and external validation leading to the final version of the protocol. The final version of the rehabilitation protocol is presented in the main text and included as Supplements.
Conclusion
This protocol provides a standardized clinical guideline based on the latest evidence-based pre- and re-habilitation strategies and is designed for seamless integration into routine clinical practice. By facilitating proactive rehabilitation interventions, it aims to improve outcomes in GI cancer patients who are at high risk of postoperative complications, functional decline, and malnutrition.

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Status of Nutritional Support after Emergency Gastrointestinal Surgery in Korea: Retrospective Multicenter Study: Dae Sang Lee, Young Eun Park, Kyoung Hoon Lim, Ye Rim Chang, Suk-Kyung Hong, Minchang Kang, Jung-Min Bae, Ji Young Jang, Young Goun Jo, Ki Hoon Kim, Gil Jae Lee; Surg Metab Nutr 2020;11(1):1-6. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.1

Abstract PDF: Purpose: Surgery itself causes an inflammatory response to an injury to the patient that leads to a stress metabolic state. Emergency gastrointestinal surgery may cause complications, such as ileus, bowel obstruction, ischemia, or anastomotic leakage, resulting in a delayed oral diet or poor overall nutrition. This study investigated the route of nutrition for patients who underwent emergency gastrointestinal surgery and when to provide nutrition after surgery.
Materials and Methods: Ten hospitals collected data retrospectively on the nutritional status and nutritional status of patients undergoing emergency gastrointestinal surgery for one year from January to December 2016. The clinical outcomes of the nutrient supply method, duration of supply, and type of surgery were performed. The dates from the time of surgery to the start of enteral nutrition, oral nutrition, and parenteral nutrition were calculated.
Results: Of 706 patients, there were 187 (26.5%) trauma patients, of which 63.5% were male. The onset of nutrition began after an average of 10.7 days postoperatively and after an average of 12.1 days of enteral nutrition. On average, it took 7.7 days to provide adequate calories, of which 63.3% had achieved adequate calories within a week. In the case of minimally invasive surgery, such as laparoscopic surgery, the adequate calorie supply time was five days, which was reached within one week.
Conclusion: In a retrospective multicenter analysis, the patients who underwent emergency gastrointestinal surgery had a late start of oral or enteral nutrition, and the ratio of adequate calorie supply within a week was low.

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