Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review
Abstract
Background and aim: Preoperative nutritional status (NS) has consequences on postoperative (POSTOP) recovery. Our aim was to systematically review the nutritional interventions (NI) in fast-track protocols for colorectal cancer surgery and assess morbidity-mortality and patient's recovery. Method: Systematic review of scientific literature after consulting bibliographic databases: Medline, The Cochrane Library, Scopus, Embase, Web of Science, Institute for Scientific Information, Latin American and Caribbean Health Sciences Literature, The Cumulative Index to Nursing and Allied Health Literature. MeSH Descriptors: "colorectal surgery", "fast-track", "perioperative care", "nutrition therapy" and "enhanced recovery programme". Filters: "humans", adult (19+ years) and "clinical trial". Variables POSTOP outcomes: bowel recovery (BR), hospital stay (HS), complications and death. Results: Selected studies, 27, had good or excellent methodological quality. From 25 to 597 patients were included. Aged between 16-94 years, men were predominant in 66.6%. NS was evaluated in 13 studies; 7 by body mass index while one by subjective global assessment. One presented POSTOP data. Fast-track groups had solids, liquids or supplements (SS) in prior 2-8 hours. SS were high in carbohydrates, immune-nutrients and non-residue. Free liquids, solids and SS intake was allowed in POSTOP. Half traditional groups fasted between 3-12 hours and resumed POSTOP food intake progressively. Conclusions: Fast-track groups had early BR (p < 0.01). Traditional groups had more infections episodes, deaths and a longer HS. Great variability between NI but had a common item; early intake. Although was seen patient's recovery. Future studies with detailed NI characteristics are need. Nutritional status must be assessed for a higher acknowledgement of NI impact.
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