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.
Keywords
Abbreviations:
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 27, 2023
Accepted:
February 23,
2023
Received in revised form:
February 13,
2023
Received:
October 22,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
