ABSTRACT
OBJECTIVE: To determine whether nutritional supplementation following hospital discharge in patients who undergo gastrointestinal (GI) surgery is beneficial in specific outcome measures. METHODS: A systematic review was conducted of randomized controlled trials comparing nutritional supplements vs a "standard care" regimen given to patients following discharge from hospital after GI surgery. Outcome measures were weight change, quality of life, clinical complications, fatigue, and hand grip strength. RESULTS: Four studies were identified. Postdischarge oral nutritional supplements were found to be safe and increased energy intake, protein intake, and weight in patients after discharge from hospital. The greatest gains in weight were seen in malnourished patients. Little evidence was found that nutritional supplements reduce morbidity or improve quality of life, fatigue, or hand-grip strength. Only one study was methodologically adequate, and none were powered to detect differences in clinical complications. CONCLUSIONS: In patients who undergo GI surgery and receive nutritional supplements after discharge from hospital, little evidence of clinical benefit was found, principally through lack of robust data. All the studies were under-powered or not specifically designed to show benefit during this period. It is recommended that nutritional supplements be offered to malnourished patients or those at high risk of poor dietary intake at discharge from hospital.
Subject(s)
Dietary Supplements , Digestive System Surgical Procedures , Gastrointestinal Diseases/surgery , Nutritional Support/methods , Postoperative Care/methods , Humans , Malnutrition/prevention & control , Randomized Controlled Trials as TopicABSTRACT
Surgery is the definitive tool in the management of patients with rectal carcinoma. Early failure of treatment remains problematic and is manifest in local recurrence. Development of surgical techniques and inclusion of other treatment modalities aim to reduce the incidence of local recurrence and improve survival. This article examines the role of radiotherapy in the management of patients with rectal carcinoma and explores the controversies that exist in its application. The evidence for the use and benefits of radiotherapy in adjuvant and neoadjuvant settings is reviewed, and its application in association with total mesorectal excision considered.
Subject(s)
Rectal Neoplasms/radiotherapy , Humans , Neoadjuvant Therapy , Neoplasm Recurrence, Local , Palliative Care , Radiotherapy Dosage , Radiotherapy, Adjuvant , Rectal Neoplasms/drug therapy , Rectal Neoplasms/surgeryABSTRACT
Nutritional deficiency among hospitalized patients is common, and is often unrecognized and untreated. Perioperative starvation is detrimental to recovery. Nutritional support can reduce morbidity, mortality and length of hospital stay. This article reviews the evidence for parenteral, enteral and oral nutritional support in the perioperative and postoperative period.
