Perioperative nutritional assessment and interventions in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC): A systematic review. Issue 5 (May 2023)

• Record Type: Journal Article
• Authors: Gearing, Peter F.; Hawke, Justin A.; Mohan, Helen; Heriot, Alexander G.; Khan, Ayman; Beaumont, Anna; Laing, Erin; Waters, Peadar S.
• Is Part Of: European journal of surgical oncology. Volume 49:Issue 5(2023)
• Page Start: 902
• Page End: 917
• Publication Date: 2023-05
• Subjects: HIPEC -- Cytoreductive surgery -- Surgical oncology -- Nutrition -- Malnutrition; CRS Cytoreductive Surgery -- HIPEC Hyperthermic Intraperitoneal Chemotherapy -- SNAQ Short Nutritional Assessment Questionnaire -- MUST Malnutrition Universal Screening Tool -- PONS Pre-Operative Nutrition Score -- NRS-2002 Nutrition Risk Screening 2002 -- SGA Subjective Global Assessment -- EWGSOP2 European Working Group on Sarcopenia in Older People 2 -- DXA Dual-energy X-ray Absorptiometry -- ERAS Enhanced Recovery After Surgery -- PSOGI Peritoneal Surface Oncology Group International -- FTT Failure To Thrive -- BMI Body Mass Index -- PMP Pseudomyxoma Peritonei -- PFS Progression-Free Survival -- LOS Length Of Stay -- PRISMA Preferred Reporting Items for Systematic Reviews and Meta Analyses -- TPN Total Parenteral Nutrition -- PNI Prognostic Nutrition Index -- HGS Hand-Grip Strength -- NHD Non-Home Discharge -- MUAC Mid-Upper Arm Circumference -- POD Postoperative Day -- GLIM Global Leadership of Malnutrition -- BIA Bioelectrical Impedence Analysis; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2023.02.015
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: Peritoneal carcinomatosis is a catabolic state and cytoreductive surgery (CRS) is a high morbidity operation. Optimising perioperative nutrition is crucial to improve outcomes. This systematic review sought to examine literature describing clinical outcomes related to preoperative nutrition status and nutrition interventions in patients undergoing CRS with hyperthermic intraperitoneal chemotherapy (HIPEC). Methods: A systematic review was registered with PROSPERO (300326). A search of eight electronic databases was undertaken on 8th May 2022 and reported according to the PRISMA statement. Studies reporting nutrition status through use of screening and assessment tools, nutrition interventions or nutrition-related clinical outcomes for patients undergoing CRS with HIPEC were included. Results: Of 276 screened studies, 25 studies were included for review. Commonly used nutrition assessment tools for CRS-HIPEC patients included Subjective Global Assessment (SGA), sarcopenia assessment with computed tomography, preoperative albumin, and body mass index (BMI). Three retrospective studies compared SGA with postoperative outcomes. Malnourished patients were more likely to have postoperative infectious complications (p = 0.042 SGA-B, p = 0.025 SGA-C). Malnutrition was significantly associated with increased hospital length of stay (LOS) in two studies (p = 0.006, p = 0.02), and with overall survival in another study (p = 0.006). Eight studies analysing preoperative albumin levels reported conflicting associations with postoperative outcomes. BMI in five studies was not associated with morbidity. One study did not support routine nasogastric tube (NGT) feeding. Conclusions: Preoperative nutritional assessment tools, including SGA and objective sarcopaenia measures, have a role in predicting nutritional status for CRS-HIPEC patients. Optimisation of nutrition is important for preventing complications.