Effect of preoperative nutritional support on the main indicators of body composition and nutritional status in patients with high operative and anesthetic risk in abdominal oncological surgery

Introduction. Body composition in cancer patients is changed by the developing of tumor, concomitant pathology and surgical intervention. Bioimpedance analysis (BIA) is a key method of analyzing the body composition. The study of the dynamics of the main indicators of bioimpedance and nutritional status can provide important information about the effectiveness of preoperative preparation, as well as contribute to a more personalized choice of nutritional support in the perioperative period.

The objective was to identify the main patterns of changes in body composition and nutritional status during preoperative nutritional support in patients with high surgical and anesthetic risk in abdominal oncosurgery.

Materials and Methods. An open, randomized, prospective, controlled study was conducted. 89 patients were included, divided into control and main groups, who were scheduled for surgery for malignant neoplasms of the upper gastrointestinal tract. The randomization was carried out using the resource www.randomizer.org and a randomization table for 120 people. In the control group, the preparation for surgery was carried out by «traditional» methods. In the main group, preoperative nutritional support included methods of enteral oral (sip feeding), enteral tube or parenteral nutrition. The dynamics of body weight, BIA parameters, serum total protein, albumin, transferrin, amount of peripheral blood lymphocytes were evaluated in all patients before and after surgery.

Results. Preoperative nutritional support led to a statistically significant increase in body mass index, as well as such BIA indicators as lean body mass, lean body mass index (p < 0.001), skeletal muscle mass, skeletal muscle mass index (p = 0.002), active cell mass, active cell mass index (p < 0.001) ), phase angle (p = 0.002). Both total and extracellular fluid increased (p = 0.001). Intergroup comparative analysis revealed a statistically significant higher level of total protein in the main group compared to the control on the 3rd and 5th day after surgery (p < 0.01). Serum albumin preoperatively, on the 3rd and 5th day of the postoperative period was statistically significant higher in the group of patients with preoperative nutritional preparation (p < 0,001). In the main group, a statistically significant decrease in the incidence of pneumonia in the postoperative period was obtained (p = 0.011).

Conclusion. Preoperative nutritional support in patients with high surgical and anesthesia risk in abdominal oncosurgery positively affects the main body composition indicators characterizing somatic protein pool and muscle tissue reserves. The obtained data fully correlate with the positive dynamics of the main laboratory markers of nutritional status, and are accompanied by a decrease in the incidence of postoperative complications.

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