J.Jpn. Surg. Soc.. 111(6): 358-362, 2010

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Feature topic

PRE- AND POSTOPERATIVE NUTRITIONAL SUPPORT IN UPPER DISGESTIVE TRACT SURGERY

Patients undergoing upper digestive tract surgery are at risk for malnutrition and must be supported with careful nutritional management after a thorough assessment is performed. Parenteral nutrition is suitable for patients who cannot be fed enterally. However, total parenteral nutrition (TPN) has several metabolic disadvantages and affects the function of the gastrointestional tract. Both enteral nutrition and TPN can be combined for patients undergoing gastrointestinal surgical procedures. Immune-enhancing diets (IEDs) are useful for patients who have moderate to severe malnutrition due to postoperative inflammatory complications and poor motility. They should be supported with an IED for at least 5 days. However, postoperative IEDs have not shown benefits for those patients in a meta-analysis. Recently, there have been reports that intensive insulin therapy to maintain normal glucose levels in useful in the management of critically ill patients. Maintenance of normal glucose levels is difficult in the clinical setting because hypoglycemia is extremely dangerous for patients, and the NICE-SUGAR study showed that intensive insulin therapy significantly increased the risk of hypoglycemia. Postoperative management using TPN combined with enteral nutrition is recommended in patients who undergo invasive surgery for the treatment of upper gastrointestinal tract cancer.

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