Nutrition in Gastrointestinal Cancer Patient: Intensive Care Unit RSPAD Gatot Soebroto 2021
Nutrition in Gastrointestinal Cancer Patient: Intensive Care Unit RSPAD Gatot Soebroto 2021
Nutrition in Gastrointestinal Cancer Patient: Intensive Care Unit RSPAD Gatot Soebroto 2021
GASTROINTESTINAL CANCER
PATIENT
Intensive Care Unit RSPAD Gatot Soebroto
2021
• Neoplastic diseases represent the second leading cause of death worldwide. The number of new cases is
expected to rise significantly over the next decades
• Gastric cancer (GC) remains the fifth most common malignancy in the world and the third leading cause
of cancer death in both sexes worldwide
• Malnutrition is a symptom that usually appears in cancer patients or as a result of cancer therapy
• About 10-20 percent of deaths are caused by malnutrition
• Weight loss is reported for 31–87% of patients at first diagnosis of malignancy, and the scope of weight
loss depends directly on the type of cancer, whereas malnutrition occurs in up to 80% of GC patients in
an advanced stage
• Nutritional therapy should be started when the diagnosis is made
CLINICAL NUTRITION IN CANCER
REFEEDING SYNDROME
INTERVENTIONS RELEVANT TO SPECIFIC PATIENT
CATEGORIES
ERAS ( ENHANCE RECOVERY AFTER
SURGERY)
• ERAS program
• Minimize surgical stress,
• Maintain nutritional status,
• Reduce complications and
• Optimize rate of recovery
PRE OPERATIVE NUTRITION
• The role of postoperative nutritional support is to maintain nutritional status in the catabolic
period after surgery.
• IIn line with this notion, a study by Gabor et al. showed that it is safe to begin EN 6 h after
surgery
• Early oral nutrition after surgery for gastrointestinal cancer is safe as well, and does not
increase the incidence of postoperative complications when compared to EN through a
nasogastric tube and reduces the length of hospitalization as well.
• In an RCT on 105 patients undergoing surgery for gastrointestinal cancer, early
postoperative nutritional support reduced surgical trauma-related high metabolism,
maintained the function of the intestinal mucosal barrier and decreased the incidence of
intestinal-borne infections, improving the recovery of patients
N U T R I T I O N A L S U P P L E ME N TAT I O N A F TE R
G A S T R E C TO M Y
• Vitamin B 12 and iron deficiency are common metabolic sequelae after gastrectomy
and warrant appropriate replacement. In malnourished patients with advanced GC,
short-term home complementary parenteral nutrition improves the quality of life,
nutritional status and functional status.
• Anemia develops in 50% of patients who undergo total gastrectomy.
• Malabsorption of dietary iron possibly results from a reduction of gastric acid
secretion and bypassing of the duodenum.
• Vitamin B 12 deficiency can develop as early as 1 year after total gastrectomy
• Current guidelines recommend supplementation with vitamin B 12 after gastrectomy
REFERENCE