scholarly journals Assessment of Body Composition as an Indicator of Early Peripheral Parenteral Nutrition Therapy in Patients Undergoing Colorectal Cancer Surgery in an Enhanced Recovery Program

Nutrients ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 3245
Author(s):  
Francisco López-Rodríguez-Arias ◽  
Luis Sánchez-Guillén ◽  
Cristina Lillo-García ◽  
Verónica Aranaz-Ostáriz ◽  
M José Alcaide ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Body Composition ◽  
High Risk ◽  
Postoperative Complications ◽  
Parenteral Nutrition ◽  
Enhanced Recovery ◽  
Low Risk ◽  
Colorectal Cancer Surgery ◽  
Enhanced Recovery Program ◽  
Recovery Program

Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced recovery program. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Postoperative complications and length of hospital stay (LOS) were assessed. Results: Of the 156 patients analyzed, 88 patients (56.4%) were classified as having high-risk BC according to CT measurements. PPN led to a 15.4% reduction in postoperative complications in high-risk vs. 1.7% in low-risk BC patients. In the multivariate analysis, high-risk BC was related to an OR (95% CI) of 2 (p = 0.044) of presenting complications and of 1.9 (p = 0.066) for major complications, and was associated with an increase in LOS of 3.6 days (p = 0.039). Conclusions: The measurement of patients’ BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes.

scholarly journals Effect of Early Peripheral Parenteral Nutrition Support in an Enhanced Recovery Program for Colorectal Cancer Surgery: A Randomized Open Trial

2021 ◽  
Vol 10 (16) ◽  
pp. 3647
Author(s):  
Luis Sánchez-Guillén ◽  
Leticia Soriano-Irigaray ◽  
Francisco López-Rodríguez-Arias ◽  
Xavier Barber ◽  
Ana Murcia ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Parenteral Nutrition ◽  
Protective Effect ◽  
Enhanced Recovery ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Enhanced Recovery Program ◽  
Major Complications ◽  
Recovery Program

Background: Peripheral parenteral nutrition allows repletion of acute nutrient deficiencies and could prevent further nutrition deficits before and after colorectal surgery. A randomized open study was performed to evaluate the effect of perioperative peripheral parenteral nutrition (PPN) support on postoperative morbidity after colorectal cancer surgery within an enhanced recovery program. Methods: Patients were randomized into two groups: peripheral parenteral nutrition (PPN) (with Peri-Olimel N4-E) versus conventional fluid therapy (FT). Ninety-day postoperative complications, laboratory parameters, length of hospital stay, and compliance with the ERAS protocol were assessed. Results: A total of 158 patients were analysed. The overall 90-day complication rate was 38.6% (61 patients), and 24 patients had major complications (Clavien–Dindo III–V) (15.2%). In the multivariate analysis, the intervention (PPN vs. FC) showed a protective effect against postoperative complications (p = 0.0031, OR = 0.2 (CI: 0.08–0.87)). Following ordinal regression, PPN and early oral tolerance showed a protective effect, being less likely to develop complications or to move from minor to major complications. In patients with low compliance to ERAS during the first postoperative day, PPN showed a protective effect, preventing 28% of morbidity. Conclusions: Perioperative peripheral parenteral nutrition (PPN) support with Peri-Olimel N4-E in colorectal cancer surgery associated with early oral intake could reduce postoperative complications.

Laparoscopy or Open Surgery for Colorectal Cancer Within an Enhanced Recovery Program?

2014 ◽  
Vol 32 (35) ◽  
pp. 4021-4022 ◽  
Author(s):  
Cheng-Le Zhuang ◽  
Dong-Dong Huang ◽  
Xian Shen ◽  
Zhen Yu
Keyword(s):  
Colorectal Cancer ◽  
Open Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery Program ◽  
Recovery Program

scholarly journals Impact of Enhanced Recovery Program (ERP) on Clinical Outcomes After Elective Colorectal Surgery in a Rural Hospital: A Prospective Cohort Study with Retrospective Control.

2021 ◽  
Author(s):  
ANTONIO PESCE ◽  
Mattia Portinari ◽  
Nicolò Fabbri ◽  
Valeria Sciascia ◽  
Lisa Uccellatori ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Functional Recovery ◽  
Enhanced Recovery ◽  
Mortality Rates ◽  
Rural Hospital ◽  
Elective Colorectal Surgery ◽  
Enhanced Recovery Program ◽  
Prolonged Hospital ◽  
Recovery Program

Abstract Introduction: The main purpose was to determine the impact on postoperative outcome of a standardized enhanced recovery program (ERP) for elective colorectal surgery in a rural hospital. Methods A prospective series of patients (N = 80) undergoing elective colorectal resection completing a standardized ERP protocol in 2018–2020 (ERP group) was compared to patients (N = 80) operated at the same rural hospital in 2013–2015 (pre-ERP group), before the implementation of the program. The exclusion criteria for both groups were: ASA score IV, TNM stage IV, inflammatory bowel disease, emergency surgery, and rectal cancer. The primary outcome was hospital length of stay (LoS) which was used as an estimate of functional recovery. Secondary outcomes included 30-day readmission and mortality rates as well as factors predicting both postoperative complications and prolonged hospital LoS. Results Baseline characteristics were comparable in both groups. Laparoscopic approach was performed in 95% of patients in the ERP group versus 0% in pre-ERP group. The median adherence to ERP protocol elements was 68% as opposed to 12% in the retrospective control group. The median hospital LoS in the ERP-group was significantly lower than in the pre-ERP group (5 vs. 10 days) with no increase in 30-day readmission and mortality rates. The Body Mass Index ≥ 30 and the traditional perioperative protocol were the independent predictive factors of postoperative complications, while following a traditional peri-operative protocol was the only factor predicting a prolonged hospital LoS. Conclusions Although limited hospital resources are perceived as a barrier to ERP implementation, the current experience demonstrates how adopting an ERP program in a rural area is feasible and effective, despite it requires greater effort. For patients in such areas, colorectal ERP in elective surgery may also reduce time to functional recovery, postoperative hospital LoS and complications, with no increase in mortality and 30-day re-admissions.

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