PERIOPERATIVE NUTRITIONAL SUPPORT IN GASTRIC CANCER PATIENTS UNDERGOING RADICAL SURGERY

The purpose of this review was to analyze current data on nutritional support (Ns) in gastric cancer patients undergoing radical surgery. Material and methods. a literature search was conducted in the electronic databases eLIBRaRY.Ru, PubMed using the keywords «surgery», «stomach cancer», «nutrition», «ERas». Emphasis was placed on studies with a high level of evidence (systematic reviews, meta-analyses) and updated clinical recommendations of the European society of Parenteral and Enteral Nutrition (EsPEN, 2017) and the Federation of anesthesiologists and reanimatologists of Russia (FaR, 2018). Results. Nutritional support before surgery is recommended for most patients with gastric cancer. In all cases, priority should be given to nutrients that support immunity. Immunonutrition should commence at least 57 days prior to surgery and continue postoperatively. Patients with severe malnutrition should receive preoperative Ns for 7–14 days with the use of enteral immune mixtures. supplementation of missing calories by parenteral nutrition (PN) is then recommended. In the postoperative period, renewal of Ns during the first 6–12 hours after surgery is indicated. In patients with severe malnutrition, the installation of a nutrient probe beyond distal anastomosis and the early onset of enteral nutrition with supplemental parenteral nutrition are recommended. Conclusion. Nutritional management of patients with gastric cancer represents a challenge. For patients undergoing surgery, the preoperative nutritional condition directly affects postoperative prognosis, overall survival and disease-specific survival. Perioperative nutritional support is recommended for all patients. Nutritional support should be considered as a part of the strategy of accelerated rehabilitation after surgery (ERas), and it should be combined with moderate physical activity. In patients receiving neoadjuvant chemoradiotherapy, the use of full range of pre-rehabilitation measures is recommended.

surgery, gastric cancer, ERAS, nutritive failure, nutritive support, enteral immune mixtures

1. Snegovoi A.V., Kononenko I.B., Larionova V.B., Saltanov A.I., Sel’chuk V.Yu. Anorexia-Cachexia Syndrome in Cancer Patients. Clinical Oncohematology. 2015; 2: 185–190. (in Russian).

2. Rosania R., Chiapponi C., Malfertheiner P., Venerito M. Nutrition in Patients with Gastric Cancer: An Update. Gastrointest Tumors. 2016 May; 2(4): 178–87. doi: 10.1159/000445188.

3. Leyderman I.N., Gritsan A.I., Zabolotskikh I.B., Lomidze S.V., Mazurok V.A., Nekhaev I.V., Nikolaenko E.M., Nikolenko A.V., Poliakov I.V., Sytov A.V., Yaroshetskiy A.I. Perioperative nutritional support. Russian Federation of anesthesiologists and reanimatologists guidelines. Annals of Critical Care. 2018; 3: 5–21. (in Russian). doi: 10.21320/1818-474X-2018-3-5-21.

4. Weimann A., Braga M., Carli F., Higashiguchi T., Hübner M., Klek S., Laviano A., Ljungqvist O., Lobo D.N., Martindale R., Waitzberg D.L., Bischoff S.C., Singer P. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017 Jun; 36(3): 623–650. doi: 10.1016/j.clnu.2017.02.013.

5. Afanasyev S.G., Avdeev S.V., Avgustinovich A.V., Pak A.V. Prevention of acute postoperative pancreatitis in surgical treatment of gastric cancer. Siberian Journal of Oncology. 2011; 5: 24–28 (in Russian).

6. Li Z., Bai B., Zhao Y., Yu D., Lian B., Liu Y., Zhao Q. Severity of complications and long-term survival after laparoscopic total gastrectomy with D2 lymph node dissection for advanced gastric cancer: A propensity score-matched, case-control study. Int J Surg. 2018 Jun; 54(Pt A): 62–69. doi: 10.1016/j.ijsu.2018.04.034.

7. Kaprin A.D., Starinsky V.V., Petrova G.V. Malignant neoplasms in Russia in 2016 (morbidity and mortality). Moscow, 2017. P. 30. (in Russian).

8. Ter-Ovanesov M.D., Kukosh M.Yu., Gaboyan A.S., Levitsky A.V., Zraibia Arbia. Concept of ERAS in surgery of esophagus and gastric cancer: problem aspects. Medical alphabet. 2017; 16: 17–22. (in Russian).

9. Mortensen K., Nilsson M., Slim K., Schäfer M., Mariette C., Braga M., Carli F., Demartines N., Griffi n S.M., Lassen K.; Enhanced Recovery After Surgery (ERAS®) Group. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg. 2014 Sep; 101(10): 1209–29. doi: 10.1002/bjs.9582.

10. Wang L.H., Zhu R.F., Gao C., Wang S.L., Shen L.Z. Application of enhanced recovery after gastric cancer surgery: An updated metaanalysis. World J Gastroenterol. 2018; 24(14): 1562–1578. doi: 10.3748/wjg.v24.i14.1562.

11. Arends J., Bachmann P., Baracos V., Barthelemy N., Bertz H., Bozzetti F., Fearon K., Hütterer E., Isenring E., Kaasa S., Krznaric Z., Laird B., Larsson M., Laviano A., Mühlebach S., Muscaritoli M., Oldervoll L., Ravasco P., Solheim T., Strasser F., de van der Schueren M., Preiser J.C. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017 Feb; 36(1): 11–48. doi: 10.1016/j.clnu.2016.07.015.

12. Bruggeman A.R., Kamal A.H., LeBlanc T.W., Ma J.D., Baracos V.E., Roeland E.J. Cancer Cachexia: Beyond Weight Loss. J Oncol Pract. 2016 Nov; 12(11): 1163–1171. doi: 10.1200/JOP.2016.016832.

13. Fukuda Y., Yamamoto K., Hirao M., Nishikawa K., Maeda S., Haraguchi N., Miyake M., Hama N., Miyamoto A., Ikeda M., Nakamori S., Sekimoto M., Fujitani K., Tsujinaka T. Prevalence of Malnutrition Among Gastric Cancer Patients Undergoing Gastrectomy and Optimal Preoperative Nutritional Support for Preventing Surgical Site Infections. Ann Surg Oncol. 2015 Dec; 22 Suppl 3: S778–85. doi: 10.1245/s10434-015-4820-9.

14. Migita K., Matsumoto S., Wakatsuki K., Ito M., Kunishige T., Nakade H., Kitano M., Nakatani M., Kanehiro H. A decrease in the prognostic nutritional index is associated with a worse long-term outcome in gastric cancer patients undergoing neoadjuvant chemotherapy. Surg Today. 2017 Aug; 47(8): 1018–1026. doi: 10.1007/s00595-017-1469-y.

15. Sun J., Wang D., Mei Y., Jin H., Zhu K., Liu X., Zhang Q., Yu J. Value of the prognostic nutritional index in advanced gastric cancer treated with preoperative chemotherapy. J Surg Res. 2017 Mar; 209: 37–44. doi: 10.1016/j.jss.2016.09.050.

16. Luu C., Arrington A.K., Falor A. Impact of gastric cancer resection on body mass index. Am Surg. 2014 Oct; 80(10): 1022–5.

17. Yang Y., Gao P., Song Y., Sun J., Chen X., Zhao J., Ma B., Wang Z. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis. Eur J Surg Oncol. 2016 Aug; 42(8): 1176–82. doi: 10.1016/j.ejso.2016.05.029.

18. Al-Batran S.E., Homann N., Pauligk C., Illerhaus G., Martens U.M., Stoehlmacher J., Schmalenberg H., Luley K.B., Prasnikar N., Egger M., Probst S., Messmann H., Moehler M., Fischbach W., Hartmann J.T., Mayer F., Höffkes H.G., Koenigsmann M., Arnold D., Kraus T.W., Grimm K., Berkhoff S., Post S., Jäger E., Bechstein W., Ronellenfi tsch U., Mönig S., Hofheinz R.D. Effect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer: The AIO-FLOT3 Trial. JAMA Oncol. 2017; 3(9): 1237–1244. doi: 10.1001/jamaoncol.2017.0515.

19. Bu J., Li N., Huang X., He S., Wen J., Wu X. Feasibility of FastTrack Surgery in Elderly Patients with Gastric Cancer. J Gastrointest Surg. 2015 Aug; 19(8): 1391–8. doi: 10.1007/s11605-015-2839-7.

20. Zhao J., Wang G., Jiang Z.W., Sun J., Chen X., Zhao J., Ma B., Wang Z. Patients Administered Neoadjuvant Chemotherapy Could be Enrolled into an Enhanced Recovery after Surgery Program for Locally Advanced Gastric Cancer. Chin Med J (Engl). 2018 Feb 20; 131(4): 413–419. doi: 10.4103/0366-6999.225047.

21. West M.A., Wischmeyer P.E., Grocott M.P.W. Prehabilitation and Nutritional Support to Improve Perioperative Outcomes. Curr Anesthesiol Rep. 2017; 7(4): 340–349. doi: 10.1007/s40140-017-0245-2.

22. Obukhova O.A., Bagrova S.G., Besova N.S., Borovkova N.B., Golovnya E.G., Kashiya Sh.R., Kurmukov I.A., Titova T.A., Kharitidi T.Yu., Fedenko A.A. Evaluation of Nutritional Status of Patients with Inoperable Gastric Cancer at the Start of Antitumor Treatment. Preliminary Results of a Prospective Observational Study. Diffi cult Patient. 2018; 6: 6–11. (in Russian).

23. Chen Z.H., Lin S.Y., Dai Q.B., Hua J., Chen S.Q. The Effects of Pre-Operative Enteral Nutrition from Nasal Feeding Tubes on Gastric Outlet Obstruction. Nutrients. 2017 Apr 10; 9(4): pii: E373. doi: 10.3390/nu9040373.

24. Leyderman I.N., Yaroshetskiy A.I Discussing protein requirements of intensive care UNIT (ICU) patients. Annals of Critical Care. 2018; 3: 59–66. (in Russian). doi: 10.21320/1818-474X-2018-3-59-66.

25. Cheng Y., Zhang J., Zhang L., Wu J., Zhan Z. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis. BMC Gastroenterol. 2018 Jan 16; 18(1): 11. doi: 10.1186/s12876-018-0741-y.

26. Liu X., Wang D., Zheng L. Mou T., Liu H., Li G. Is early oral feeding after gastric cancer surgery feasible? A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014 Nov 14; 9(11): e112062. doi: 10.1371/journal.pone.0112062.

27. Nakaseko Y., Ohdaira H., Yoshida M., Kitajima M., Suzuki Y. Clinical pathway after gastrectomy for gastric cancer: A case series of laparoscopic gastrectomy and early oral intake with «iEat™». Ann Med Surg (Lond). 2018 Apr 3; 31: 20–24. doi: 10.1016/j.amsu.2018.03.023.

28. Khomichuk A.L. Optimization of nutrition for patients after gastrectomy. Nutrition. 2013; 3: 22–28. (in Russian).

29. Le Roy B., Pereira B., Bouteloup C., Costes F., Richard R., Selvy M., Petorin C., Gagniere J., Futier E., Slim K., Meunier B., Mabrut J., Mariette C. Pezet D. Effect of prehabilitation in gastro-oesophageal adenocarcinoma: study protocol of a multicentric, randomised, control trial-the PREHAB study. BMJ Open. 2016 Dec 7; 6(12): e012876. doi: 10.1136/bmjopen-2016-012876.