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Funk Debleds P, Chambrier C, Slim K. Postoperative nutrition in the setting of enhanced recovery programmes. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106866. [PMID: 36914532 DOI: 10.1016/j.ejso.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
Patients undergoing major surgery for gastrointestinal cancer are at high risk of developing or worsening malnutrition and sarcopenia. In malnourished patients, preoperative nutritional support may not be sufficient and so postoperative support is advised. This narrative review addresses several aspects of postoperative nutritional care in the setting of enhanced recovery programmes. Early oral feeding, therapeutic diet, oral nutritional supplements, immunonutrition, and probiotics are discussed. When postoperative intake is insufficient, nutritional support favouring the enteral route is recommended. Whether this approach should use a nasojejunal tube or jejunostomy is still a matter of debate. In the setting of enhanced recovery programmes with early discharge, nutritional follow-up and care should be continued beyond the short time in hospital. In enhanced recovery programmes, the main specific aspects of nutrition are patient education, early oral intake, and post-discharge care. The other aspects do not differ from conventional care.
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Affiliation(s)
- Pamela Funk Debleds
- Department of Supportive Care, Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France
| | - Cécile Chambrier
- Intensive Clinical Nutrition Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Karem Slim
- Department of Digestive Surgery, University Hospital, CHU, Clermont-Ferrand, France; Francophone Group for Enhanced Recovery After Surgery, France.
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Tian W, Zhao R, Luo S, Xu X, Zhao G, Yao Z. Effect of postoperative utilization of somatostatin on clinical outcome after definitive surgery for duodenal fistula. Eur J Med Res 2023; 28:63. [PMID: 36732816 PMCID: PMC9896769 DOI: 10.1186/s40001-023-00988-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the effect of postoperative utilization of somatostatin after definitive surgery for duodenal fistula (DF) in preventing a recurrence. METHODS Patients with definitive surgery for DF between January 2010 and December 2021 were categorized based on the utilization of somatostatin or not after the surgery. Patients in the Somatostatin group were matched to those in the Non-somatostatin group using propensity scores matching (PSM), so as to evaluate the effect of postoperative use of somatostatin by comparing the two groups. RESULTS A total of 154 patients were divided into the in the Somatostatin group (84) and the Non-somatostatin group (70). Forty-three patients (27.9%) exhibited a recurrent fistula, with which the postoperative use of somatostatin was not associated (19 [22.6%] in the Somatostatin group and 24 (34.3%) in the Non-somatostatin group; unadjusted OR 0.56; 95% CI 0.28-1.14; P = 0.11). However, the postoperative usage of somatostatin served as a protective factor for developing into high-output recurrent fistula (eight (13.3%) in the Somatostatin group and 15 (25%) in the Non-somatostatin group; adjusted OR 0.39; 95% CI 0.15-0.93; P = 0.04). After PSM, the recurrent fistula occurred in 29.2% subjects (35/120). The postoperative usage of somatostatin was not associated with recurrent fistula (13 in PSM Somatostatin group vs. 22 in PSM Non-somatostatin group; unadjusted OR 0.48; 95% CI 0.21-1.07; P = 0.07), while its postoperative usage decreased the incidence of recurrent high-output fistula (5/60 in the PSM Somatostatin group, compared with 13/60 in the PSM Non-somatostatin group; adjusted OR 0.30; 95% CI 0.09-0.95). CONCLUSION Postoperative use of somatostatin could effectively reduce the incidence of recurrent high-output fistula, without association with overall incidence of postoperative recurrent fistula.
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Affiliation(s)
- Weiliang Tian
- grid.440259.e0000 0001 0115 7868Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu China
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road No.169, Nanjing, Jiangsu China
| | - Shikun Luo
- Department of General Surgery, Jiangning Hospital, Hushan Road No.169, Nanjing, Jiangsu China
| | - Xi Xu
- Department of General Surgery, Jiangning Hospital, Hushan Road No.169, Nanjing, Jiangsu China
| | - Guoping Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road No.169, Nanjing, Jiangsu China
| | - Zheng Yao
- Department of General Surgery, Jiangning Hospital, Hushan Road No.169, Nanjing, Jiangsu China
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Zhang Z, Sun W, Wang J, Deng Y, Yan Y, Li D, Fu W. A nomogram to predict the risk of colorectal anastomotic leakage combining inflammatory-nutritional and abdominal aorta calcium index. Front Surg 2023; 9:1008448. [PMID: 36684195 PMCID: PMC9852538 DOI: 10.3389/fsurg.2022.1008448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/24/2022] [Indexed: 01/09/2023] Open
Abstract
Background Anastomotic leakage is a serious complication after colorectal cancer surgery, which affects the quality of life and the prognosis. This study aims to create a novel nomogram to predict the risk of anastomotic leakage for patients with colorectal cancer based on the preoperative inflammatory-nutritional index and abdominal aorta calcium index. Methods 292 patients at Tianjin Medical University General Hospital (Tianjin, China) from January 2018 to October 2021 who underwent colorectal cancer surgery with a primary anastomosis were retrospectively reviewed. A nomogram was constructed based on the results of multivariate logistic regression model. The calibration curves and receiver operating characteristic curves were used to verify the efficacy of the nomogram. Results Univariate and multivariate analyses showed that tumor location (P = 0.002), preoperative albumin (P = 0.006), preoperative lymphocyte (P = 0.035), preoperative neutrophil to lymphocyte ratio (P = 0.024), and superior mesenteric artery calcium volumes score (P = 0.004) were identified as the independent risk factors for postoperative anastomotic leakage in patients with colorectal carcinoma. A nomogram was constructed based on the results of the multivariate analysis, and the C-index of the calibration curves was 0.913 (95%CI: 0.870-0.957) in the training cohort and 0.840 (95%CI: 0.753-0.927) in the validation cohort. Conclusion The nomogram, combining basic variables, inflammatory-nutritional index and abdominal aorta calcium index, could effectively predict the possibility of postoperative anastomotic leakage for patients with colorectal cancer, which could guide surgeons to carry out the appropriate treatment for the prevention of anastomotic leakage.
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Affiliation(s)
- Zhaoxiong Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Weilin Sun
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China,Department of Gastrointestinal Surgery, The People's Hospital of Qiannan, Duyun, China
| | - Yuanlin Deng
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yongjia Yan
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dong Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Weihua Fu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China,Correspondence: Weihua Fu
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Tian W, Zhao R, Xu X, Zhao Y, Luo S, Tao S, Yao Z. Chyme Reinfusion Reducing the Postoperative Complications After Definitive Surgery for Small Intestinal Enteroatmospheric Fistula: A Cohort Study. Front Nutr 2022; 9:708534. [PMID: 35265651 PMCID: PMC8898887 DOI: 10.3389/fnut.2022.708534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study is aimed to reveal the role of preoperative chyme reinfusion (CR) in reducing the complications occurring after definitive surgery (DS) for small intestinal enteroatmospheric fistula (EAF). Methods In this study, from January 2012 to December 2019, the patients with small intestinal EAF and receiving a definitive surgery were recruited. Depending on whether the CR has been performed, these patients were divided into either the CR group or the non-CR group. Then, propensity scores matching (PSM) was used to further divide these patients into the PSM CR group or the PSM none-CR group. The clinical characteristics exhibited by the groups were analyzed, and the effect of preoperative CR was investigated. Result A total of 159 patients were finally recruited with 72 patients in the CR group and 87 patients in the non-CR group. The postoperative complications were manifested in a total of 126 cases (79.3%). There were 49 cases in the CR group, and 77 cases in the non-CR group. CR was associated with the occurrence of postoperative complications (multivariate odds ratio [OR] = 0.289; 95% CI: 0.123-0.733; p = 0.006). After 1:1 PSM, there were 92 patients included. The postoperative complications were observed in 67 out of these 92 patients. There were 26 patients in the PSM CR group, and 41 patients in the PSM non-CR group. CR was associated with postoperative complications (multivariate OR = 0.161; 95% CI: 0.040-0.591; p = 0.002). In addition, CR played a role in reducing the recurrence of fistula both before (multivariate OR = 0.382; 95% CI: 0.174-0.839; p = 0.017) and after (multivariate OR = 0.223; 95% CI: 0.064-0.983; p = 0.034) PSM. In addition, there is a protective factor at play for those patients with postoperative ileus before (multivariate OR = 0.209; 95% CI: 0.095-0.437; p < 0.001) and after (multivariate OR = 0.222; 95% CI: 0.089-0.524; p < 0.001) PSM. However, the relationship between CR and incision-related complications was not observed in this study. Conclusion Preoperative CR is effective in reducing postoperative complications after definitive surgery was performed for EAF.
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Affiliation(s)
- Weiliang Tian
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, China
| | - Xin Xu
- Department of General Surgery, Jiangning Hospital, Nanjing, China
| | - Yunzhao Zhao
- Department of General Surgery, Jinling Hospital, Nanjing, China.,Department of General Surgery, Jiangning Hospital, Nanjing, China
| | - Shikun Luo
- Department of General Surgery, Jiangning Hospital, Nanjing, China
| | - Shen Tao
- Department of General Surgery, Nanjing 83 Hospital, Nanjing, China
| | - Zheng Yao
- Department of General Surgery, Jiangning Hospital, Nanjing, China
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Liao Y, Tao S, Yao Z, Tian W, Xu X, Zhao R, Zhao Y, Huang Q. Chyme reinfusion improved outcomes after definitive surgery for small‐intestinal enteroatmospheric fistula in patients with enteral nutrition. Nutr Clin Pract 2022; 37:634-644. [PMID: 35094427 DOI: 10.1002/ncp.10823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Yannian Liao
- Medical College of Nanjing University Nanjing Jiangsu China
| | - Shen Tao
- Department of General Surgery Nanjing 83 Hospital Nanjing Jiangsu China
| | - Zheng Yao
- Department of Enterocutaneous Fistula Surgery Jiangning Hospital Nanjing Jiangsu China
| | - Weiliang Tian
- Department of General Surgery Jinling Hospital Nanjing Jiangsu China
| | - Xin Xu
- Department of Enterocutaneous Fistula Surgery Jiangning Hospital Nanjing Jiangsu China
| | - Risheng Zhao
- Department of Enterocutaneous Fistula Surgery Jiangning Hospital Nanjing Jiangsu China
| | - Yunzhao Zhao
- Department of Enterocutaneous Fistula Surgery Jiangning Hospital Nanjing Jiangsu China
- Department of General Surgery Jinling Hospital Nanjing Jiangsu China
| | - Qian Huang
- Department of General Surgery Jinling Hospital Nanjing Jiangsu China
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Huang M, Tian W, Luo S, Xu X, Yao Z, Zhao R, Huang Q. Duration of postoperative hyperlactatemia has predictive value in recurrent fistula after major definitive surgery for intestinal fistula. BMC Surg 2022; 22:14. [PMID: 35033052 PMCID: PMC8761294 DOI: 10.1186/s12893-022-01465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The present study aimed to identify the predictive value of duration of postoperative hyperlactatemia in screening patients at high risk of recurrent fistula after major definitive surgery (DS) for intestinal fistula. Methods If the initial postoperative lactate (IPL) > 2 mmol/L, DS was defined as major definitive surgery. The 315 enrolled patients with major DS were divided into group A (2 mmol/L < IPL ≤ 4 mmol/L), group B (mmol/L < IPL ≤ 6 mmol/L), and group C (IPL > 6 mmol/L). The characteristics of patients were collected, and the duration of postoperative hyperlactatemia was analyzed. According to the occurrence of recurrent fistula (RF), patients were further divided into RF group A, and Non-RF group A; RF group B, and Non-RF group B; and RF group C, and Non-RF group C. Results The duration of postoperative hyperlactatemia was comparable between the RF group A and the Non-RF group A [12 (IQR: 12–24) vs 24 (IQR: 12–24), p = 0.387]. However, the duration of hyperlactatemia was associated with RF in group B (adjusted OR = 1.061; 95% CI: 1.029–1.094; p < 0.001) and group C (adjusted OR = 1.059; 95% CI: 1.012–1.129; p = 0.017). In group B, the cutoff point of duration of 42 h had the optimal predictive value (area under ROC = 0.791, sensitivity = 0.717, specificity = 0.794, p < 0.001). In group C, the cutoff point of duration of 54 h had the optimal predictive value (area under ROC = 0.781, sensitivity = 0.730, specificity = 0.804, p < 0.001). Conclusion The duration of postoperative hyperlactatemia has a value in predicting RF in patients with an IPL of more than 4 mmol/L after major definitive surgery for intestinal fistula.
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Affiliation(s)
- Ming Huang
- Department of General Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China
| | - Weiliang Tian
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - Shikun Luo
- Department of General Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China.
| | - Xi Xu
- Department of General Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China
| | - Zheng Yao
- Department of General Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China.
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road No. 169, Nanjing, Jiangsu, China
| | - Qian Huang
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
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Lederer AK, Chikhladze S, Kohnert E, Huber R, Müller A. Current Insights: The Impact of Gut Microbiota on Postoperative Complications in Visceral Surgery-A Narrative Review. Diagnostics (Basel) 2021; 11:diagnostics11112099. [PMID: 34829446 PMCID: PMC8625751 DOI: 10.3390/diagnostics11112099] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 12/19/2022] Open
Abstract
Postoperative complications are a major problem occurring in up to 50% of patients undergoing major abdominal surgery. Occurrence of postoperative complications is associated with a significantly higher morbidity and mortality in affected patients. The most common postoperative complications are caused by an infectious genesis and include anastomotic leakage in case of gastrointestinal anastomosis and surgical site infections. Recent research highlighted the importance of gut microbiota in health and disease. It is plausible that the gut microbiota also plays a pivotal role in the development of postoperative complications. This narrative review critically summarizes results of recent research in this particular field. The review evaluates the role of gut microbiota alteration in postoperative complications, including postoperative ileus, anastomotic leakage, and surgical site infections in visceral surgery. We tried to put a special focus on a potential diagnostic value of pre- and post-operative gut microbiota sampling showing that recent data are inhomogeneous to identify a high-risk microbial profile for development of postoperative complications.
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Affiliation(s)
- Ann-Kathrin Lederer
- Center for Complementary Medicine, Department of Medicine II, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.M.)
- Chirurgische Klinik, Evangelisches Diakoniekrankenhaus Freiburg, 79106 Freiburg, Germany
- Correspondence: ; Tel.: +49-761-2708-2010
| | - Sophia Chikhladze
- Department of General and Visceral Surgery, Medical Center—University of Freiburg, 79106 Freiburg, Germany;
| | - Eva Kohnert
- Institute of Medical Biometry and Statistics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany;
| | - Roman Huber
- Center for Complementary Medicine, Department of Medicine II, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.M.)
| | - Alexander Müller
- Center for Complementary Medicine, Department of Medicine II, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.M.)
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Tian W, Yan M, Xu X, Yao Z, Zhao R. Risk Factors and Outcomes for Postoperative Ileus After Small Intestinal Fistula Excision in Patients With Diffuse Extensive Abdominal Adhesions. Front Surg 2021; 8:632241. [PMID: 33681284 PMCID: PMC7934964 DOI: 10.3389/fsurg.2021.632241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/02/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose: The study aimed to investigate the risk factors for postoperative ileus (POI) after small intestinal fistula excision (SIFE) in patients with diffuse extensive abdominal adhesions. Methods: From October 2010 to December 2019, we enrolled patients who underwent SIFE and had diffuse extensive abdominal adhesions. Patients were divided into the POI group and the non-POI group according to its occurrence. We then investigated and analyzed the clinical characteristics of both groups. Result: A total of 247 patients were enrolled into the study. There were 100 patients in the POI group, and 147 patients in the non-POI group. A multi-variable logistic regression analysis revealed that blood loss during SIFE (OR = 1.001; 95% CI: 1.000-1.259; P = 0.012), postoperative lactate(OR = 1.212; 95% CI: 1.001-1.304; P = 0.015), grade V abdominal adhesions (OR = 2.518; 95% CI: 1.814-3.44; P = 0.024), and time for recovery of lactate <2 mmol/L (OR = 2.079; 95% CI: 1.599-3.616; P = 0.026) were associated with POI. Moreover, POI was also associated with prolonged postoperative stay in the hospital (HR = 3.291; 95% CI: 2.511-4.172; P = 0.014). Conclusion: Blood loss during operation, grade V abdominal adhesions, positive fluid balance within 48 h of operation, and time for recovery of lactate were the risk factors for POI after SIFE in patients with diffuse extensive abdominal adhesions.
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Affiliation(s)
- Weiliang Tian
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Ming Yan
- Department of General Surgery, Nanjing Jiangning Hospital, Nanjing, China
| | - Xin Xu
- Department of General Surgery, Nanjing Jiangning Hospital, Nanjing, China
| | - Zheng Yao
- Department of General Surgery, Nanjing Jiangning Hospital, Nanjing, China
| | - Risheng Zhao
- Department of General Surgery, Nanjing Jiangning Hospital, Nanjing, China
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