Anderin K1*, Thorell A2, Nygren J2 and Gustafsson UO3
1Center for Digestive Diseases, Karolinska University Hospital & Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
2Department of Surgery, Ersta Hospital & Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
3Department of Surgery & Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
Background: Preoperative weight loss and malnutrition is common among patients undergoing surgery for rectal cancer. We investigated the effect of Oral Nutritional Supplements (ONS) in combination with rectal enema compared to standard treatment with Mechanical Bowel Preparation (MBP), Polyethylene Glycol (PEG) before rectal cancer surgery on perioperative nutritional status, degree of bowel cleansing and postoperative morbidity.
Materials and Methods: Patients planned for rectal cancer surgery were randomized to either ONS treatment and rectal enema or no nutritional intervention and MBP before surgery. All patients were treated according to an Enhanced Recovery after Surgery (ERAS) protocol and prospectively registered in the international ERAS database. Physiological and nutritional tests were performed at four occasions; after randomization (i.e. 4-6 weeks before surgery), one day before surgery, three days and four weeks after surgery, Degree of bowel cleansing was recorded during surgery. Postoperative morbidity and rate of recovery after surgery was registered in the ERAS database.
Results: A total of 29 patients were included: 13 in the ONS-group and 16 in the PEG-group. Basic characteristics, tumor stage and type of surgery performed did not differ. From randomization until surgery, patients in the ONS-group had a higher caloric intake; 34(24-65) kcal/kg/day in median (range) compared to 26(14-37) in the PEG-group (p 0.005) and gained 1.9% in body fat (p 0.041) whereas the PEG-group lost 1.6 mm in subcutaneous fat (p 0.019). From randomization until 4 weeks after surgery, the ONS-group lost less in weight, -1.6 kg vs. -4.6 kg in the PEG-group (p 0.028). Right and mid colon were considered less clean in the ONS-group, as perceived by the surgeons, compared to the PEG-group (p 0.015 and 0.003, resp.), but there was no difference in the sigmoid and rectum. The postoperative complications, 23% in the ONS group compared to 38% in the PEGgroup, was not significantly different (p 0.454).
Conclusion: ONS prior to rectal cancer surgery may improve patients’ perioperative nutritional status and be a safe alternative to traditional bowel cleansing. However, further studies with a larger sample size are needed to verify this association.
Rectal cancer; Rectal enema; Oral nutritional supplements; Polyethylene glycol
Anderin K, Thorell A, Nygren J, Gustafsson UO. Oral Nutritional Supplements before Rectal Cancer Surgery-Hitting Two Birds with One Stone? Results of a Randomized Controlled Trial. Clin Surg. 2019; 4: 2340.