Adjuvant Perioperative Nutrition Support in Cancer Patients

The effectiveness of perioperative nutrition support in cancer patients has been controversial. Much interest was generated in the role of nutrition as adjuvant therapy to surgery in cancer patients when Muller et al 1 reported significant reduction of major complications and mortality when preoperative parenteral nutrition (PN) was given to patients with gastrointestinal malignancy before undergoing surgery. However, as summarized in an article by Van Way 2 in this issue of Nutrition in Clinical Practice, the efficacy of perioperative nutrition support in patients with cancer is far from being clear. Additional questions arise when a flurry of new studies regarding the safe use of enteral feeding and the potential benefit of immunonutrition appeared recently. Several meta-analyses were performed for nutrition support given during the perioperative period. Lewis et al 3 analyzed 11 randomized, controlled trials comparing nothing by mouth after gastrointestinal surgery with enteral feeding (EN) starting within 24 hours after surgery. The analysis showed that infection complications and length of stay were reduced with early feeding. Another meta-analysis reviewed randomized trials comparing PN to standard care with oral diet plus IV dextrose. 4 It should be noted that, as is a common pitfall for metaanalysis, there was much heterogeneity among the studies included in the analysis. How do we extrapolate these results into patients with cancer? With difficulty. There is some evidence suggesting that patients with cancer and malnutrition respond to nutrition support differently than malnourished patients with benign diseases. 5 This is not surprising because the metabolic alterations in cancer cachexia differ significantly from that in simply starvation.