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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2020

01-06-2020 | Malnutrition | Sarcoma

Malnutrition and Perioperative Nutritional Support in Retroperitoneal Sarcoma Patients: Results from a Prospective Study

Authors: Paola Previtali, MD, Marco Fiore, MD, Jacopo Colombo, MD, Irina Arendar, MD, Luca Fumagalli, MD, Marta Pizzocri, MD, Chiara Colombo, MD, Nicolò N. Rampello, DN, Luigi Mariani, MD, Alessandro Gronchi, MD, Daniela Codazzi, MD

Published in: Annals of Surgical Oncology | Issue 6/2020

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Abstract

Introduction

Retroperitoneal soft tissue sarcomas (RPSs) are mesenchymal neoplasms. The prevalence of protein energetic malnutrition (PEM) and its impact in RPS patients who were candidates for surgery is unknown.

Materials and Methods

A prospective feasibility study enrolled 35 patients with primary RPS who were candidates for extended multivisceral resection. PEM was screened at enrollment. Preoperative high protein β-hydroxy-β-methyl butyrate oral nutritional support (ONS) was provided according to the degree of PEM. After surgery, nutritional support followed standard practice, targeting at least 1 g/kg/day protein and 20 kcal/kg/day caloric intake within the third postoperative day (POD). PEM was re-evaluated before surgery on POD 10, and at 4 and 12 months after surgery. Primary outcomes were the patient’s compliance to preoperative ONS and the physician’s compliance to postoperative nutritional targets.

Results

PEM was documented in 46% of patients at baseline; ONS met a 91% adherence (overall well tolerated). After ONS, PEM reduced to 38% (p = 0.45). The postoperative caloric target was reached on day 4.1 (standard error ± 2.7), with a protocol adherence rate of 52%. On POD 10, 91% of patients experienced PEM, the worsening of which was greater after resection of four or more organs (p = 0.06). At 4 and 12 months after surgery, almost all patients had fully recovered. A significant correlation between PEM at surgery and postoperative complications was found (p = 0.04).

Conclusions

Relevant PEM prevalence in RPS is documented for the first time. PEM correlates with greater morbidity. In this setting, preoperative ONS was feasible and well-tolerated. Disease-related factors for PEM and the ideal perioperative caloric target in the context of extended multivisceral resection need to be further investigated. Nutritional support should be included in enhanced recovery after surgery programs for RPS.

Trial Registry

ClinicalTrials.gov identifier: NCT03877588.
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Metadata
Title
Malnutrition and Perioperative Nutritional Support in Retroperitoneal Sarcoma Patients: Results from a Prospective Study
Authors
Paola Previtali, MD
Marco Fiore, MD
Jacopo Colombo, MD
Irina Arendar, MD
Luca Fumagalli, MD
Marta Pizzocri, MD
Chiara Colombo, MD
Nicolò N. Rampello, DN
Luigi Mariani, MD
Alessandro Gronchi, MD
Daniela Codazzi, MD
Publication date
01-06-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-08121-0

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