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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Preoperative consumption of a carbohydrate drink before laparoscopic cholecystectomy is safe and beneficial in Korea: a non-randomized controlled study: Yoo Jin Choi, Yoonhyeong Byun, Seong Mi Yang, Ho-Jin Lee, Hongbeom Kim; Ann Clin Nutr Metab 2023;15(1):15-21. Published online April 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.1.15

Abstract PDF Supplementary Material ePub

Purpose: Overnight fasting prior to elective surgery is the traditional way of avoiding the risk of aspiration during anesthesia induction. However, it causes mental and metabolic stress to patients. Therefore, we investigated the safety and potential benefits of the preoperative consumption of a carbohydrate drink.
Methods: This was a single-center prospective, nonrandomized study with questionnaire. Patients scheduled for elective laparoscopic cholecystectomy were included. There was no restriction on age, underlying diseases, and biliary drainage prior to surgery. They were preoperatively given either a carbohydrate drink or were instructed to fast from midnight before surgery. Perioperative emotional status was measured using the visual analog scale.
Results: The 132 patients completed the questionnaire, with 68 receiving the carbohydrate drink and 64 following nil per oral after-midnight instruction. There were no postoperative complications related to preoperative drink consumption or the cholecystectomy procedure itself in both groups. There were no significant differences in all the assessed feelings postoperatively except that preoperative discomforts, such as hunger and thirst, were significantly more alleviated in the group of preoperative consumption of a carbohydrate drink.
Conclusion: Preoperative consumption of a carbohydrate drink was found to be safe and effective in alleviating preoperative discomfort in elective surgery patients, including older patients and those with underlying comorbidities, who were at greater risk for aspiration. Therefore, we recommend considering preoperative drink consumption as an alternative to traditional overnight fasting in elective surgery patients.

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MODERN CONCEPT OF POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING URGENT LAPAROSCOPIC CHOLECYSTECTOMY
O. PYLYPENKO, O. KRAVETS
Pain anesthesia and intensive care.2024; (4(109)): 55. 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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Risk of Malnutrition after Gastrointestinal Cancer Surgery: A Propensity Score Matched Retrospective Cohort Study: Sung-Hoon Yoon, Bong-Hyeon Kye, Hyung-Jin Kim, Kyong-Hwa Jun, Hyeon-Min Cho, Hyung-Min Chin; Surg Metab Nutr 2018;9(1):16-25. Published online June 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.1.16

Abstract PDF ePub

Purpose:

Patients with cancers arising from the gastrointestinal tract can suffer from nutritional inadequacies caused by various factors. This study investigated the risk of malnutrition after curative surgery in patients with gastric cancer (GC) or colorectal cancer (CRC) using various preoperative and postoperative nutritional screening tools.

Materials and Methods:

In the authors’ hospital, 407 patients (206 patients with GC and 201 patients with CRC) underwent surgery between July 2011 and June 2012. The patients from the two groups were matched using the propensity score and then analyzed the nutritional data from 170 patients (85 patients in each group), retrospectively.

Results:

In both groups, the postoperative nutritional status was impaired significantly compared to the preoperative status. The postoperative risk of undernutrition in CRC patients was significantly lower than that of the GC patients according to the Malnutrition Universal Screening Tool (P=0.007). At the time of hospital discharge after surgery, the incidence of a lower serum albumin level (P=0.002) and more than 5% weight loss (P=0.013) were higher in the GC group than in the CRC group. A comparison of the postoperative nutritional status among the types of surgery in each group, total gastrectomy in the GC group (P=0.015) and proctectomy with diverting stoma in the CRC group (P=0.06), were related to more than 5% weight loss.

Conclusion:

Gastrointestinal cancer surgery might increase the patients’ postoperative risk of malnutrition, particularly in GC surgery. Therefore, consecutive assessments of the nutritional status and appropriate nutritional support are necessary after surgery for GC and CRC.

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Feasibility and Safety of Early Oral Feeding After Radical Gastrectomy in Patients With Gastric Carcinoma: A Systematic Review
Wahida Ali, Wahidullah Dost, Mohammad Nazir Zaman, Mohammad Qaher Rasully , Jamaluddin Niazi, Farzad Qasemi, Raisa Dost, Wahida Dost, Danyal Bakht, Syed Faqeer Hussain Bokhari
Cureus.2024;[Epub] CrossRef
Preoperative Body Mass Index, Waist Circumference, and Mortality After Major Cancer Surgery: A Nationwide Cohort Study in Korea
Tak Kyu Oh, In-Ae Song
Journal of Korean Medical Science.2023;[Epub] CrossRef
Nutritional Counseling Protocol for Colorectal Cancer Patients after Surgery Improves Outcome
Isabelle R. Novelli, Bruno A. D. Araújo, Laura F. Grandisoli, Elianete C. G. Furtado, Evelyn K. N. Aguchiku, Marina C. G. Bertocco, Tassiane P. Sudbrak, Isabel C. de Araújo, Ana C. F. Bosko, Nágila R. T. Damasceno
Nutrition and Cancer.2021; 73(11-12): 2278. CrossRef

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Role of Postoperative Parenteral Nutrition in Elective Surgery; Selection of Patients and Conditions for Postoperative Parenteral Nutrition: Jong Won Kim; Surg Metab Nutr 2018;9(1):1-4. Published online June 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.1.1

Abstract PDF ePub: Postoperative early enteral nutrition or early oral ingestion is recommended in surgical patients. In this situation, this study examined the role of parenteral nutrition in the postoperative period in patients undergoing elective surgery. The nutritional status should be assessed before surgery and in the case of malnutrition, nutritional support should be provided before surgery to obtain good results. More than 2 weeks of insufficient nutritional support after surgery may worsen the patient’s progress. Therefore, it is recommended to start nutritional care if the oral intake is not appropriate until 7 days or 5 to 7 days after surgery. Enteral nutrition is related to the quick restoration of the bowel function and reduction of infection-related complications. Therefore, enteral nutrition has priority. On the other hand, depending on the patient’s condition, it may not be possible to perform enteral nutrition, and the uniform implementation of the early enteral nutrition may be a burden to the patient. Parenteral nutrition has the advantage that it can supply nutrition without being affected by the intestinal condition, and it can be calculated to supply as much energy as required. The situation, where parenteral nutrition is required after elective surgery, could be summarized as 1) the patients who underwent nutritional therapy before surgery and could not tolerate oral intake or enteral nutrition after surgery. or 2) in the case where enteral nutrition did not satisfy 50% of the demand at 7 days after surgery, and it is judged that this situation should continue for 7 days.

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Analysis of Current Status and Predisposing Factors for Nutritional Support of Patients in Surgical Intensive Care Unit: Byung Chul Kim, In Kyu Lee, Eun Young Kim; Surg Metab Nutr 2016;7(2):32-38. Published online December 30, 2016; DOI: https://doi.org/10.18858/smn.2016.7.2.32

Abstract PDF ePub

Purpose:

Enteral feeding is strongly recommended for critically ill patients since it can enhance the immunologic function, which serves as a host defense mechanism against inflammation or metabolic response to stress. Herein, we investigated nutritional status and estimated the adequacy of the nutritional supply for acutely ill patients admitted to the surgical intensive care unit (SICU) after a major operation.

Materials and Methods:

From February to October 2016, patients admitted and stayed over 48 hours after major surgical procedures at SICU in Seoul St. Mary’s Hospital were reviewed. The nutritional parameters and surgical outcomes were compared according to the status of nutritional support.

Results:

A total of 220 patients composed of 130 males (59.1%) and 90 females (40.9%) were enrolled, and mean age was 61.4±13.6 years. All patients were classified into two groups according to nutritional status, which was assessed by the ratio of total delivered calories to total required calories (D/R); group A (54 cases, 24.5%, D/R≥0.7) versus group B (166 cases, 75.5%, D/R<0.7). In multivariate analysis, incision in the lower abdomen (Odds Ratio 2.277, P=0.078), absence of NST consultation (Odds Ratio 2.728, P=0.011), and not receive minimal invasive surgery (Odds Ratio 3.518, P=0.001) were independent risk factors associated with poor nutritional status.

Conclusion:

Clinicians should pay more attention to patients who had an incision in the lower abdomen or did not receive minimal invasive surgery or NST consultation, which would be predisposing factors for nutritional insufficiency resulting in postoperative morbidities.

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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

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Evaluation of Postoperative Nutrition Support with Commercial Peripheral Parenteral Nutrition after an Ivor-Lewis Esophagectomy in Patients with Esophageal Cancer: Sun-woo Lee, Na-ri Lim, Hyo Jung Park, Yong-won In, Jeong-meen Seo, Young-mee Lee; J Clin Nutr 2015;7(3):87-92. Published online December 31, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.3.87

Abstract PDF ePub: Purpose:
Deteriorated nutritional status is common during a hospital stay for esophagectomy in patients with esophageal cancer. Malnutrition in those patients is often marked compared with other gastrointestinal cancer. The purpose of this study is to evaluate the appropriateness of commercial peripheral parenteral nutrition (CPPN) use in patients who underwent Ivor-Lewis esophagectomy (I-L op).
Methods:
Patients who were provided with CPPN after I-L op were enrolled in this study from January to May 2015. Body weight, height, nutritional status, length of hospital stay, duration of CPPN therapy, and parenteral nutrition (PN) induced complications were assessed, respectively, using electronic medical records.
Results:
Thirty-nine patients were enrolled. Average age was 65.9 years and 36 patients were male. All patients were provided with the same CPPN. The duration of fasting and CPPN use was 5.8±1.4 days and 7.5±1.8 days, respectively. Calorie supported by CPPN was 22.6±3.5 kcal/kg/day and only 20.5% of patients (n=8) reached the daily target calories. Most frequent PN induced complication was phlebitis which occurred in 8 patients (20.5%). Calcium, magnesium, and transthyretin levels in serum were not monitored during the PN support period.
Conclusion:
The indications for CPPN were appropriate because the fasting duration in patients with I-L op was 5 to 10 days. Although a large portion of patients could not be supplied daily target calories, their nutrition status was not significantly changed on admission and at discharge. We did not find it necessary to individualize PN support for a short period after an I-L op in patients with esophageal cancer. Further study will be needed to determine why the incidence of phlebitis was dominant.

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