Prehabilitation with exercise, anxiety reducing strategies and protein supplementation can help to attenuate loss of lean body mass, improve physical function and post-operative recovery.6-9
Pre-operative nutrition support in surgical oncology
“Keeping patients from physical and nutritional status decline could have a significant effect on the cancer care continuum.”1 However, the prevalence of malnutrition at the time of surgery is high, and the consequences are serious2-4: 2 out of 3 patients coming for gastrointestinal surgery are malnourished at the time of surgery. Malnourished patients have a three times higher risk of having a complication following surgery. In addition, the risk of readmission to hospital is 23% higher5, and malnourished patients are five times more likely to die compared to well-nourished patients.2
Prehabilitation supports rehabilitation
Pre-operative nutritional support
- helps to maintain proper nutritional status10
- can help to reduce the frequency and severity of post-operative complications in patients with or at risk of malnutrition3,11
Follow Hong talking about pre-operative nutrition support in abdominal surgery
Meet Isabella sharing information on pre-operative nutrition support in ovarian cancer surgery
Screening patients for need of pre-operative nutrition support
Indication: Patients scheduled for surgery / Neo-adjuvant chemotherapy
Main questions:
What is the current weight/BMI of the patient?
Has the patient unintentionally lost weight? 
Yes No
Has the patient eaten less last week? Yes No
What are the patient’s reasons for eating less?
*using a validated screening tool
ESPEN definition of severe nutritional risk13:
- BMI < 18.5 kg/m2
- Weight loss >10–15 % within 6 months
- SGA Grade C or NRS > 5
- Pre-operative serum albumin < 30 g/l (with no evidence of hepatic or renal dysfunction).
Nutritional therapy is indicated in patients13:
- unable to eat for more than five days
- reduced oral intake with (< 50% of recommended intake) for more than 7 days
- fulfilling at least one criteria from the ESPEN definition of severe nutritional risk
Preparing patients for surgery - Optimising nutrient stores and metabolic reserves
ERAS / ESPEN guidelines recommend:
- Screening of nutritional status before major surgery2,12,13, e.g. by NRS, SGA, MUST, PONS Score
- Pre-operative oral nutritional supplements (ONS) in patients with nutritional risk2,14
- Overall protein intake goal >1.2g/kg/day2,13
- e.g. high-protein ONS (2-3x a day, minimum of 18 g protein/dose)2
Resources for your information
On demand webinar
The current knowledge compiled by experts from clinical practice provides guidance on managing the needs of different patient groups. By clicking on “Learn more”, you can access the webcast on prehabilitation in cancer surgery.
For more information about nutrition support for patients undergoing cancer surgery and the economic benefits of using ONS in hospitalised patients please download:
Brochure: Fit for surgery
- Filename
- Pre Operative Nutrition Folder.pdf
- Size
- 1 MB
- Format
Resources for your patient
Many patients suffer from taste fatique – They might cook with ONS to enrich their meals and improve their nutritional status. A recipe collection can be found here.
Preparation for training
Exercise to improve balance
Exercise to maintain strength
Exercise to stay flexible
Thai Chi in sitting position
Exercises suitable in bed
Exercises on a chair
Find tips and tricks for the physical training of your patients in the exercise booklet. IT contains a wide variety of different exercises for strength, balance and flexibility. You can download the booklet and provide it to your patients.
Exercise Booklet
Find tips and tricks for the physical training of your patients in the exercise booklet. IT contains a wide variety of different exercises for strength, balance and flexibility. You can download the booklet and provide it to your patients.
- Filename
- Exercise Booklet.pdf
- Size
- 2 MB
- Format
References:
1) Minnella, E.M., et al. JAMA Surg, 2018.
2) Wischmeyer, P.E., et al. Anesth Analg, 2018. 126(6): p. 1883–1895.
3) Fukuda, Y., et al. Ann Surg Oncol, 2015. 22 Suppl 3: p. S778–85.
4) Kwag, S.J., et al. Ann Surg Treat Res, 2014. 86(4): p. 206–11.
5) in cancer patients after elective surgery 23% of the nutrition risk patients were readmitted within 30 days but only 7% of well nourished patients. (Gillis, C., et al. Nutr Clin Pract, 2015. 30(3): p. 414–9.)
6) Gillis, C., et al. Clin Nutr, 2018.
7) Gillis, C., et al. Anesthesiology, 2014. 121(5): p. 937–47.
8) Gillis, C., et al. J Acad Nutr Diet, 2016. 116(5): p. 802–12.
9) Li, C., et al. Surg Endosc, 2013. 27(4): p. 1072–82.
10) Kabata, P., et al. Support Care Cancer, 2015. 23(2): p. 365–70.
11) Jie, B., et al. Nutrition, 2012. 28(10): p. 1022–7.
12) Gustafsson, U.O., et al. World J Surg, 2013. 37(2): p. 259–84.
13) Weimann, A., et al. Clin Nutr, 2017. 36(3): p. 623–650.
14) Philipson, T.J., et al. Am J Manag Care, 2013. 19(2): p. 121–8.
Abbreviations:
MUST: Malnutrition Universal Screening Tool
NRS: Nutritional Risk Screening
PONS: Perioperative Nutrition Screen
SGA: Subjective Goal Assessment