Nutrición Hospitalaria (Oct 2011)
Evaluación de la terapia nutricional perioperatoria en pacientes con neoplasia del tracto gastrointestinal superior Evaluation of perioperative nutritional therapy in patients with gastrointestinal tract neoplasms
Abstract
Objetivos: La enfermedad oncológica se acompaña de un grado importante de desnutrición que se asocia con elevadas tasas de morbi-mortalidad postoperatoria. El propósito de este estudio fue evaluar la efectividad de un programa de apoyo nutricional perioperatorio de cara a reducir complicaciones postoperatorias, estancias hospitalarias y mortalidad entre pacientes sometidos a cirugía oncológica del tracto digestivo superior. Métodos: Estudio prospectivo aleatorizado sobre una muestra de pacientes intervenidos por cáncer gastrointestinal alto (esófago, estómago, cardias y duodeno/páncreas) durante un periodo de 4 años. Se realizó una valoración nutricional y se administró de forma perioperatoria una formula enteral inmunomoduladora a un grupo de pacientes malnutridos (DS), mientras que otro grupo de pacientes malnutridos (DNS) y los normonutridos (NN) recibieron consejo dietético antes de la cirugía y después de esta sueros por vía intravenosa hasta la reintroducción de la dieta normal. Las variables estudiadas fueron edad, sexo, estadio tumoral, tipo de neoplasia y estancia hospitalaria. También se recogieron la situación nutricional, mortalidad, complicaciones postoperatorias y alteraciones gastrointestinales. Para el análisis estadístico realizamos un estudio de frecuencias y aplicamos el test de Chi-cuadrado en las variables cualitativas. Para las cuantitativas usamos la ANOVA y el test Post-hoc de Tukey. Se consideraron significativos aquellos valores de p Objectives: Cancer is usually associated to an important level of desnutrition together with a postoperative morbidity and mortality increase. The purpose of this study was evaluating its efficacy perioperative nutritional support to reduce surgical complications, stances and mortality significantly in patients undergoing higher digestive tract procedures. Method: A prospective, randomized trial was done among a sample of neoplasic patients undergoing higher intestinal tract resective surgery during a period of 4 years. After a nutritional assessment, a perioperative immune-enhancing formula was randomly assigned to a group of patients who presented malnourished preoperatively (DS) while well-nourished and the rest of malnourished patients (DNS) received pre-surgical dietetic guidance and intravenous fluids after surgery until the reintroduction of normal diet. The variables studied were: age, sex, tumor stage and length of hospital stay. Nutritional status at admission and discharge, mortality, outcome from surgery and gastrointestinal side effects (tolerability, diarrhoea, vomits or distension) were also collected. Statistical analyses were performed with the with the chi(2) for qualitative variables, ANOVA and the Turkey post-hoc tests for the quantitative ones, with a significance of 95%. Results: Sample conformed by 50 patients in 3 groups that were compared for all baseline and surgical characteristics. Significant differences were observed in the incidence of gastrointestinal and infectius complications with better progress in DS group. It was obtained a reduction in the length of hospital stay in 12.29 days in DS group in contrast to DNS group (P = 0,224). Conclusions: Significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. A statistically significant decrease in the incidence of postoperative gastrointestinal symptoms, a reduction in the length of hospital stay and less morbidity occurred on the group that received perioperative nutrition.
