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DOI: 10.1055/s-0043-110419
(Par-)Enterale Ernährungstherapie beim Tumorpatienten – neue Konzepte und aktuelle Leitlinienempfehlungen
Publication History
Publication Date:
27 October 2017 (online)
![](https://www.thieme-connect.de/media/zblchir/201705/lookinside/thumbnails/10-1055-s-0043-110419_zbcm3574829-1.jpg)
Einleitung
Viele chirurgische Tumorpatienten wirken auch bei multimodaler Therapie überernährt oder sogar adipös und nicht mangelernährt. Dies suggeriert auch für den Fall eines komplizierten Verlaufs bestehende Reserven. So ist eine auf den ersten klinischen Blick offensichtliche Mangelernährung eher selten. Deswegen gilt die perioperative Ernährung als „traditionell“ und überholt und wird bei konsequentem Einsatz eines ERAS-Fast-Track-Programms (ERAS: Enhanced Recovery after Surgery) als überflüssig erachtet. Selbst bei Übergewicht und Adipositas können jedoch Defizite in der Körperzusammensetzung vorliegen. Die Verminderung der Muskelmasse – Sarkopenie – hat erhebliche Auswirkungen auf die postoperative Funktionalität mit Mobilisation und Atemfunktion. Die prognostische Bedeutung ist signifikant und aktuell für Patienten mit Magen- und Ösophaguskarzinom gezeigt worden [1].
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Literatur
- 1 Zhuang CL, Huang DD, Pang WY. et al. Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: analysis from a large-scale cohort. Medicine (Baltimore) 2016; 95: e3164
- 2 Scarborough JE, Bennett KM, Englum BR. et al. The impact of functional dependency on outcomes after complex general and vascular surgery. Ann Surg 2015; 261: 432-437
- 3 Meguid RA, Bronsert MR, Juarez-Colunga E. et al. Surgical Risk Preoperative Assessment System (SURPAS): I. parsimonious, clinically meaningful groups of postoperative complications by factor analysis. Ann Surg 2016; 263: 1042-1048
- 4 Hill GL, Blackett RL, Pickford I. et al. Malnutrition in surgical patients. An unrecognised problem. Lancet 1977; 1: 689-692
- 5 Weimann A, Braga M, Harsanyi L. et al. ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr 2006; 25: 224-244
- 6 Weimann A, Breitenstein S, Breuer JP. et al. Klinische Ernährung in der Chirurgie. Chirurg 2014; 85: 320-326
- 7 Weimann A, Braga M, Carli F. et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr 2017; 36: 623-650
- 8 Arends J, Bachmann P, Baracos V. et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017; 36: 11-48
- 9 Gustafsson UO, Scott MJ, Schwenk W. et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr 2012; 31: 783-800
- 10 Kondrup J, Allison SP, Elia M. et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22: 415-421
- 11 Schwegler I, von Holzen A, Gutzwiller JP. et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg 2010; 97: 92-97
- 12 Cheema FN, Abraham NS, Berger DH. et al. Novel approaches to perioperative assessment and intervention may improve long-term outcomes after colorectal cancer resection in older adults. Ann Surg 2011; 253: 867-874
- 13 Aust J, Werner A, Grünewald G. et al. Ergebnisse der Einführung eines allgemeinen „Screening auf Mangelernährung“ in einem großen Versorgungskrankenhaus. Aktuel Ernahrungsmed 2016; 41: 352-358
- 14 Cederholm T, Bosaeus I, Barazzoni R. et al. Diagnostic criteria for malnutrition – An ESPEN Consensus Statement. Clin Nutr 2015; 34: 335-340
- 15 Aahlin EK, Tranø G, Johns N. et al. Risk factors, complications and survival after upper abdominal surgery: a prospective cohort study. BMC Surgery 2015; 15: 83
- 16 Gomez-Perez SL, Haus JM, Sheean P. et al. Measuring abdominal circumference and skeletal muscle from a single cross-sectional CT image: a step-by-step guide for clinicians using National Institutes of Health ImageJ. JPEN J Parenter Enteral Nutr 2016; 40: 308-318
- 17 Carrara G, Pecorelli N, De Cobelli F. et al. Preoperative sarcopenia determinants in pancreatic cancer patients. Clin Nutr 2016; DOI: 10.1016/j.clnu.2016.10.014.
- 18 Ljungqvist O. ERAS–enhanced recovery after surgery: moving evidence-based perioperative care to practice. JPEN J Parenter Enteral Nutr 2014; 38: 559-566
- 19 Slieker J, Frauche P, Jurt J. et al. Enhanced recovery ERAS for elderly: a safe and beneficial pathway in colorectal surgery. Int J Colorectal Dis 2017; 32: 215-221
- 20 Braga M, Pecorelli N, Scatizzi M. et al. Enhanced recovery program in high-risk patients undergoing colorectal surgery: results from the PeriOperative Italian Society Registry. World J Surg 2017; 41: 860-867
- 21 Elia M, Normand C, Norman K. et al. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr 2016; 35: 370-380
- 22 Ligthart-Melis GC, Weijs PJM, te Boveldt ND. et al. Dietician-delivered intensive nutritional support is associated with a decrease in severe postoperative complications after surgery in patients with esophageal cancer. Dis Esophagus 2013; 26: 587-593
- 23 Minnella EM, Bousquet-Dion G, Awasthi R. et al. Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. Acta Oncol 2017; 56: 295-300
- 24 Dunne DF, Jack S, Jones L. et al. Randomized clinical trial of prehabilitation before planned liver resection. Br J Surg 2016; 103: 504-512
- 25 Alverdy JC, Krezalek MA. Collapse of the microbiome, emergence of the pathobiome, and the immunopathology of sepsis. Crit Care Med 2017; 45: 337-347
- 26 Alverdy JC, Luo JN. The influence of host stress on the mechanism of infection: lost microbiomes, emergent pathobiomes, and the role of interkingdom signaling. Front Microbiol 2017; 8: 322
- 27 Kinross JM, Markar S, Karthikesalingam A. et al. A meta-analysis of probiotic and synbiotic use in elective surgery: does nutrition modulation of the gut microbiome improve clinical outcome?. JPEN J Parenter Enteral Nutr 2013; 37: 243-253
- 28 Awad S, Varadhan KK, Ljungqvist O. et al. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr 2013; 32: 34-44
- 29 Smith MD, McCall J, Plank L. et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev 2014; (08) CD009161 DOI: 10.1002/14651858.CD009161.pub2.
- 30 Amer MA, Smith MD, Herbison GP. et al. Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery. Br J Surg 2017; 104: 187-197
- 31 Alazawi W, Pirmadid N, Lahiri R. et al. Inflammatory and immune responses to surgery and their clinical impact. Ann Surg 2016; 64: 73-80
- 32 Geiger R, Rieckmann JC, Wolf T. et al. L-Arginine modulates T cell metabolism and enhances survival and anti-tumor activity. Cell 2016; 20: 829-842.e13
- 33 Hegazi RA, Hustead DS, Evans DC. Preoperative standard oral nutrition supplements vs. immunonutrition: results of a systematic review and meta-analysis. J Am Coll Surg 2014; 219: 1078-1087
- 34 Wong CS, Aly EH. The effects of enteral immunonutrition in upper gastrointestinal surgery: a systematic review and meta-analysis. Int J Surg 2016; 29: 137-150
- 35 Chevrou-Séverac H, Pinget C, Cerantola Y. et al. Cost-effictiveness analysis of immune-modulating nutritional support for gastrointestinal cancer patients. Clin Nutr 2014; 33: 649-654
- 36 Moya P, Soriano-Irigaray L, Ramirez JM. et al. Perioperative standard oral nutrition supplements versus immunonutrition in patients undergoing colorectal resection in an Enhanced Recovery (ERAS) protocol: a multicenter randomized clinical trial (SONVI study). Medicine (Baltimore) 2016; 95: e3704
- 37 Fukuda Y, Yamamoto K, Hirao N. et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol 2015; 22 (Suppl. 03) S778-S785
- 38 Hill GL. Impact of nutritional support on the clinical outcome of the surgical patient. Clin Nutr 1994; 13: 331-340
- 39 Weimann A, Felbinger TW. Gastrointestinal dysmotility in the critically ill: a role for nutrition. Curr Opin Clin Nutr Metab Care 2016; DOI: 10.1097/MCO.0000000000000300.
- 40 Hurt RT, McClave SA, Martindale RG. et al. Summary points and consensus recommendations from the International Protein Summit. Nutr Clin Pract 2017; 32. (1_Suppl.): 142S-151S
- 41 Stehle P, Ellger B, Kojic D. et al. Glutamine dipeptide-supplemented parenteral nutrition improves the clinical outcomes of critically ill patients: a systematic evaluation of randomised controlled trials. Clin Nutr ESPEN 2017; 17: 75-85
- 42 Ziegler TR, May AK, Hebbar G. et al. Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical ICU patients: an American multicenter randomized controlled trial. Ann Surg 2016; 263: 646-665
- 43 Pradelli L, Mayer K, Muscaritoli M. et al. n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis. Crit Care 2012; 16: R184
- 44 Gong Y, Liu Z, Liao Y. et al. Effectiveness of ω-3 polyunsaturated fatty acids based lipid emulsions for treatment of patients after hepatectomy: a prospective clinical trial. Nutrients 2016; 8 pii:E357 DOI: 10.3390/nu8060357.
- 45 Grass FG, Benoit M, Coti Bertrand PM. Nutritional status deteriorates postoperatively despite preoperative nutritional support. Ann Nutr Metab 2016; 68: 291-297
- 46 Weimann A, Gockel I, Hölscher AH. et al. Bedeutung der perioperativen Ernährungstherapie beim Risiko- und Komplikationsmanagement von Patienten mit Ösophaguskarzinom. Chirurg 2016; 87: 1046-1053
- 47 Heneghan HM, Zaborowski A, Fanning M. et al. Prospective study of malabsorption and malnutrition after esophageal and gastric cancer surgery. Ann Surg 2015; 262: 803-808