Preoperative Nutritional and Anaesthetic Management of Patients Undergoing Digestive Carcinology Surgery
Published: 2022-12-23
Page: 218-225
Issue: 2022 - Volume 5 [Issue 2]
Amal Hajri
Department of Digestive Cancer Surgery and Liver Transplantation, CHU Ibn Rochd, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Nassima Fakhiri
*
Department of Digestive Cancer Surgery and Liver Transplantation, CHU Ibn Rochd, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Driss Erguibi
Department of Digestive Cancer Surgery and Liver Transplantation, CHU Ibn Rochd, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Rachid Boufettal
Department of Digestive Cancer Surgery and Liver Transplantation, CHU Ibn Rochd, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Saad Rifki Eljai
Department of Digestive Cancer Surgery and Liver Transplantation, CHU Ibn Rochd, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Farid Chehab
Department of Digestive Cancer Surgery and Liver Transplantation, CHU Ibn Rochd, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Peri-operative undernutrition is one of the complications that can hamper postoperative rehabilitation and increase morbidity and mortality in digestive surgery. It is currently recommended to assess the nutritional status of patients, especially pre-operatively.
The objective of this study was to evaluate the nutritional and anaesthetic management in major digestive surgery at the Ibn Rochd Casablanca Hospital.
Methods: A two-month retrospective study of patients undergoing scheduled digestive carcinological surgery. Before and after the operation, a weighing was done, the notion of weight loss was looked for, the albumin level was measured and the body mass and nutritional risk indices were calculated. Nutritional stratification of each patient was performed.
Results: Nine patients, predominantly male and with a mean age of 46.9 years, were included in the study. The average duration of preoperative hospitalisation was 8.7 days, 28.2% of the patients were undernourished with a body mass index (BMI) of less than 18.5%, and 25% of the patients were undernourished with a weight loss of over 10%. 9.4% of patients were undernourished with an albumin level below 30g/l, the rate of postoperative complications was almost similar in patients with a weight loss of 10% or more.
Conclusion: The management of patients in scheduled carcinological surgery must respond to the question of comprehensiveness and multidisciplinarity due to the complexity of the interventions and the postoperative complications secondary to any invasive procedure.
Keywords: Undernutrition, albumin, pre-anaesthetic assessment, immunonutrition
How to Cite
Downloads
References
Lorente S, Hautefeuille M, Sanchez-Cedillo A. The liver, a functionalized vascular structure. Scientific Reports. 2020;10(1): 1-10.
Clugston RD. Carotenoids and fatty liver disease: Current knowledge and research gaps. Biochim Biophys Acta Mol Cell Biol Lipids. 2020;1865(11):158597.
Rui L, Energy metabolism in the liver. Compr Physiol. 2014;4(1):177-97.
Eslam M, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol, 2020;73(1):202-209.
Sanyal AJ, et al. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology. 2011;54(1):344-53.
Brunt EM, et al. Nonalcoholic fatty liver disease. Nat Rev Dis Primers. 2015;1: 15080.
Adams LA, et al. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut. 2017;66(6): 1138.
Yang JD, et al. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol. 2019;16(10):589-604.
Njei B, et al. Emerging trends in hepatocellular carcinoma incidence and mortality. Hepatology. 2015;61(1):191-9.
Desjonqueres E, Gigante E. Hepatocellular carcinoma on the background of nonalcoholic fatty liver disease: epidemiological update. Hepatoma Research. 2022;7:16.
Sanyal AJ, SK. Yoon, Lencioni R. The etiology of hepatocellular carcinoma and consequences for treatment. The Oncologist. 2010;15(S4):14-22.
Usman M, Bakhtawar N. Vitamin E as an adjuvant treatment for non-alcoholic fatty liver disease in adults: A systematic review of randomized controlled trials. Cureus. 2020;12(7):e9018.
Neuschwander-Tetri BA. Non-alcoholic fatty liver disease. BMC Med. 2017;15(1): 45.
Angulo P. GI Epidemiology: nonalcoholic fatty liver disease. Alimentary Pharmacology & Therapeutics. 2007;25(8): 883-889.
Nasr P, et al. Natural history of nonalcoholic fatty liver disease: A prospective follow‐up study with serial biopsies. Hepatology Communications. 2018;2(2):199-210.
Younossi Z, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nature Reviews Gastroenterology & Hepatology. 2018; 15(1):11-20.
Chalasani N, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases and American College of Gastroenterology. Gastroenterology. 2012; 142(7):1592-1609.
Dixon JB, Bhathal PS, O'brien PE. Nonalcoholic fatty liver disease: Predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001;121(1):91-100.
Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. The American Journal of Gastroenterology. 2003;98(5):960-967.
Edmison J, McCullough AJ. Pathogenesis of non-alcoholic steatohepatitis: Human data. Clinics in Liver Disease. 2007;11(1): 75-104.
Milić S, Stimac D. Nonalcoholic fatty liver disease/steatohepatitis: epidemiology, pathogenesis, clinical presentation and treatment. Dig Dis. 2012;30(2):158-62.
Lee YH, et al. Nonalcoholic fatty liver disease in diabetes. Part I: Epidemiology and Diagnosis. Diabetes Metab J. 2019; 43(1):31-45.
Aguilera-Méndez A. Nonalcoholic hepatic steatosis: A silent disease. Rev Med Inst Mex Seguro Soc. 2019;56(6): 544-549.
Day CP, James OF. Steatohepatitis: A tale of two "hits"? Gastroenterology. 1998;114 (4):842-5.
Frediani JK, et al. Arsenic exposure and risk of nonalcoholic fatty liver disease (NAFLD) among U.S. adolescents and adults: an association modified by race/ethnicity, NHANES 2005-2014. Environ Health. 2018;17(1):6.
Bellentani S. et al. Epidemiology of non-alcoholic fatty liver disease. Dig Dis. 2010;28(1):155-61.
Del Campo JA, et al. Genetic and Epigenetic Regulation in Nonalcoholic Fatty Liver Disease (NAFLD). Int J Mol Sci. 2018;19(3).
Brunt EM, Tiniakos DG. Histopathology of nonalcoholic fatty liver disease. World J Gastroenterol. 2010;16(42):5286-96.
Takahashi Y, Fukusato T. Histopathology of nonalcoholic fatty liver disease/ nonalcoholic steatohepatitis. World J Gastroenterol. 2014;20(42):15539-48.
Khoonsari M et al. Clinical manifestations and diagnosis of nonalcoholic fatty liver disease. Iran J Pathol. 2017;12(2): 99-105.
Saokaew S, et al. Clinical risk scoring for predicting non-alcoholic fatty liver disease in metabolic syndrome patients (NAFLD-MS score). Liver Int. 2017;37(10):1535-1543.
Obika M, Noguchi H. Diagnosis and evaluation of nonalcoholic fatty liver disease. Exp Diabetes Res. 2012; 2012:145754.
Machado MV, Cortez-Pinto H. Non-alcoholic fatty liver disease: what the clinician needs to know. World J Gastroenterol. 2014;20(36):12956-80.
Brunt EM, et al. Nonalcoholic steatohepatitis: A proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94(9):2467-74.
Godoy-Matos AF, Silva Júnior WS, Valerio CM. NAFLD as a continuum: From obesity to metabolic syndrome and diabetes. Diabetology & Metabolic Syndrome. 2020; 12(1)60.
Wege H, J Li, Ittrich H. Treatment lines in hepatocellular carcinoma. Visc Med. 2019; 35(4):66-272.
Kovalic AJ, Cholankeril G, Satapathy SK. Nonalcoholic fatty liver disease and alcoholic liver disease: Metabolic diseases with systemic manifestations. Transl Gastroenterol Hepatol. 2019; 4:65.
Fuks D et al. Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: an intention-to-treat analysis. Hepatology. 2012;55(1):132-40.
El–Serag HB, Rudolph KL, Hepatocellular carcinoma: Epidemiology and molecular carcinogenesis. Gastroenterology. 2007; 132(7):2557-2576.
Hashem B, El Serag. Hepatocellular carcinoma. N Engl J Med. 2011;365:1118-27.
Xu J. Trends in liver cancer mortality among adults aged 25 and over in the United States, 2000–2016. Vol. NCHS Data Brief, no. 314. National Center for Health Statistics, Hyattsville, MD; 2018.
Jemal A et al. Global cancer statistics. CA: A Cancer Journal for Clinicians. 2011; 61(2):69-90.
El-Serag HB, et al. The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update. Annals of Internal Medicine. 2003;139 (10):817-823.
Ryerson AB, et al. Annual report to the nation on the status of cancer, 1975‐2012, featuring the increasing incidence of liver cancer. Cancer. 2016;122(9):1312-1337.
Chalasani N, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1): 328-357.
Younossi ZM et al. Global epidemiology of nonalcoholic fatty liver disease—meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84.
Zhou F et al., Unexpected rapid increase in the burden of NAFLD in China from 2008 to 2018: A systematic review and meta‐analysis. Hepatology. 2019;70(4): 1119-1133.
Ozcan M et al. Improvement in the current therapies for hepatocellular carcinoma using a systems medicine approach. Adv Biosyst. 2020;4(6):e2000030.
Huang DQ, El-Serag HB, Loomba R. Global epidemiology of NAFLD-related HCC: trends, predictions, risk factors and prevention. Nature Reviews Gastroenterology & Hepatology. 2021; 18(4): 223-238.
Li J, et al. Prevalence, incidence and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: a systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology. 2019; 4(5):389-398.
Golabi P, et al. Burden of non-alcoholic fatty liver disease in Asia, the Middle East and North Africa: data from global burden of disease 2009-2019. Journal of Hepatology. 2021;75(4):795-809.
Paraskevis D et al. Dating the origin and dispersal of hepatitis B virus infection in humans and primates. Hepatology. 2013; 57(3): 908-16.
Orci LA, et al. Incidence of hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: A systematic review, meta-analysis, and meta-regression. Clinical Gastroenterology and Hepatology; 2021.
Simmonds P. Reconstructing the origins of human hepatitis viruses. Philos Trans R Soc Lond B Biol Sci. 2001;356(1411): 1013-26.
Yang JD et al. Cirrhosis is present in most patients with hepatitis B and hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2011;9(1):64-70.
Teng YX, et al. Hepatocellular carcinoma in non-alcoholic fatty liver disease: Current progresses and challenges. J Clin Transl Hepatol. 2022;10(5):955-964.
Cheung O, et al. Nonalcoholic steatohepatitis is associated with altered hepatic MicroRNA expression. Hepatology. 2008;48(6):1810-20.
Marengo A, Rosso C, Bugianesi E. Liver cancer: Connections with obesity, fatty liver, and cirrhosis. Annu Rev Med. 2016; 67:103-17.
Dyson J, et al. Hepatocellular cancer: the impact of obesity, type 2 diabetes and a multidisciplinary team. J Hepatol. 2014; 60(1):110-7.
Vanni E, Bugianesi E. Obesity and liver cancer. Clin Liver Dis. 2014;18(1):191-203.
Budhu A et al. Integrated metabolite and gene expression profiles identify lipid biomarkers associated with progression of hepatocellular carcinoma and patient outcomes. Gastroenterology. 2013;44(5): 1066-1075.e1.
Montero J et al. Mitochondrial cholesterol contributes to chemotherapy resistance in hepatocellular carcinoma. Cancer Res. 2008;68(13):5246-56.
Brown GT, Kleiner DE. Histopathology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Metabolism. 2016;65(8):1080-6.
Ekstedt M, et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006;44(4):865-73.
White DL, Kanwal F, El-Serag HB. Association between nonalcoholic fatty liver disease and risk for hepatocellular cancer, based on systematic review. Clin Gastroenterol Hepatol. 2012;10(12):1342-1359.e2.
Yoshimoto S, et al. Obesity-induced gut microbial metabolite promotes liver cancer through senescence secretome. Nature. 2013;499(7456): 97-101.
Chalasani N et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005-23.
Sung KC, et al. Effect of exercise on the development of new fatty liver and the resolution of existing fatty liver. J Hepatol. 2016;65(4):791-797.
Shields WW et al. The effect of metformin and standard therapy versus standard therapy alone in nondiabetic patients with insulin resistance and nonalcoholic steatohepatitis (NASH): A pilot trial. Therap Adv Gastroenterol, 2009;2(3):157-63.
Arab JP, Arrese M, Trauner M. Recent Insights into the Pathogenesis of Nonalcoholic Fatty Liver Disease. Annu Rev Pathol. 2018;13:321-350.
Liver EAFTSOT. EASL clinical practice guidelines: management of hepatocellular carcinoma. Journal of Hepatology. 2018; 69(1):182-236.
Reig M, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. Journal of Hepatology; 2021.
Molinari M, et al. Hepatic resection for hepatocellular carcinoma in nonalcoholic fatty liver disease: a systematic review and meta-analysis of 7226 patients. Annals of Surgery Open. 2021;2(2): e065.
Foerster F, et al. NAFLD-driven HCC: Safety and efficacy of current and emerging treatment options. Journal of Hepatology; 2021.
El-Khoueiry AB, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. The Lancet. 2017;389(10088):2492-2502.
Sangro B, et al. A clinical trial of CTLA-4 blockade with tremelimumab in patients with hepatocellular carcinoma and chronic hepatitis C. Journal of Hepatology. 2013; 59(1):81-88.
Xie Y, et al. Immunotherapy for hepatocellular carcinoma: Current advances and future expectations. Journal of Immunology Research; 2018.
Masoodi M, et al. Metabolomics and lipidomics in NAFLD: Biomarkers and non-invasive diagnostic tests. Nature Reviews Gastroenterology & Hepatology. 2021;18 (12):835-856.
Geh D, Manas DM, Reeves HL. Hepatocellular carcinoma in non-alcoholic fatty liver disease—A review of an emerging challenge facing clinicians. Hepatobiliary Surgery and Nutrition. 2021; 10(1):59.
Stojsavljevic-Shapeski S, et al. New drugs on the block—Emerging treatments for nonalcoholic steatohepatitis. Journal of Clinical and Translational Hepatology. 2021;9(1):51.
Loomba R, et al. AGA clinical practice update on screening and surveillance for hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: Expert review. Gastroenterology. 2020;158(6): 1822-1830.
Scheiner B, et al. Prognosis of patients with hepatocellular carcinoma treated with immunotherapy–development and validation of the CRAFITY score. Journal of Hepatology. 2022;76(2):353-363.