Clinical effectiveness of a differentiated approach to perioperative nutritional support for high-risk patients undergoing abdominal surgery for cancer

Objective. To evaluate clinical effectiveness of a differentiated approach to perioperative nutritional support for high-risk patients undergoing abdominal surgery for cancer. Material and methods. A single-center prospective randomized controlled study included 140 patients at the onco-abdominal department. Twenty patients were excluded. Group 1 included 50 patients (conventional preoperative nutritional support), group 2 enrolled 70 patients (preoperative care according to original algorithm based on analysis of precachexia or cachexia 2 weeks before surgery). Dynamics of body weight, total serum protein, albumin, transferrin, blood lymphocytes, and body component composition (bioelectrical impedance analysis) were assessed. Results. In the 2nd group, preoperative nutritional support was followed by increased body mass index and main components of body composition (p<0.0001): lean mass, skeletal muscle mass, active cell mass. This was accompanied by increased total serum protein, albumin and transferrin (p<0.0001). Group 2 showed higher levels of total protein on the 3rd day (p=0.022), albumin on the 3rd and 5th postoperative day (p=0.004 and p=0.038, respectively) compared to group 1. There was a clear trend towards lower incidence of pneumonia (p=0.069) and anastomositis (p=0.57) in postoperative period. Length of ICU-stay was shorter in group 2 compared to group 1 (p=0.004). Conclusion. Original algorithm of a differentiated perioperative nutritional support for high-risk patients in abdominal oncosurgery is effective. This approach improves nutritional status and reduces ICU-stay compared to undifferentiated approach.