Optimizing peri-operative feeding to decrease post-operative stress response in patients with colo-rectal cancer

Abstract

Background: Stress hormones and inflammatory mediators provoked by any injury including surgery catabolise glycogen, fat and protein yielding glucose, free fatty acids, and amino acids in the circulation to be used in the immune response and tissue healing. On the other hand, these catabolic reactions inversely affect the process of post-operative recovery both on the short and long run. Hence nutrition for surgical patient must be properly planned to avoid these consequences.
Aim of the study: to prove the alleviating effect of pre-operative carbohydrate load and early post-operative feeding on post-operative catabolic stress response.
 Methods:This prospective randomized comparative study included patients operated for colorectal cancer ending with anastomosis not stoma. The patients were randomly divided into two groups; with the study group adopted carbohydrate loading pre-operatively and early post-operative feeding, while the control group submitted to the traditional pre- and post-operative feeding protocols.
Results: There were statistically significant difference between both groups in which application of study protocal decreases the post-operative ICU stay (P = 0.0005) and hence overall hospital stay. On the other hand, postoperative blood glucose level and pH showed significant difference in the study protocol adopting group (P = 0.00002, 0.00004 respectively), whereas other complications as anastmotic leakage showed no statistically significant difference between the two groups (P = 0.552).
Conclusions: Pre-operative carbohydrate loading and early post-operative feeding as components of Early Recovery After Surgery (ERAS) have a remarkable improving effect on post-operatives outcomes.