Fasting abbreviation among patients submitted to oncologic surgery: systematic review

Andressa dos Santos Pinto, Shana Souza Grigoletti, Aline Marcadenti, Andressa dos Santos Pinto, Shana Souza Grigoletti, Aline Marcadenti

Abstract

Introduction: The abbreviation of perioperative fasting among candidates to elective surgery have been associated with shorter hospital stay and decreased postoperative complications.

Objective: To conduct a systematic review from randomized controlled trials to detect whether the abbreviation of fasting is beneficial to patients undergoing cancer surgery compared to traditional fasting protocols.

Method: A literature search was performed in electronic databases: MEDLINE (PubMed), SciELO, EMBASE and Cochrane, without time restriction. Were used the descriptors: "preoperative fasting", "cancer", "diet restriction" and "perioperative period". Randomized trials were included in adults of both sexes, with diagnosis of cancer. Exclusion criteria were: use of parenteral nutrition and publications in duplicate. All analyzes, selections and data extraction were done blinded manner by independent evaluators.

Results: Four studies were included, with a total of 150 patients, 128 with colorectal cancer and 22 gastric cancer. The articles were published from 2006 to 2013. The main outcome measures were heterogeneous, which impaired the unification of the results by means of meta-analysis. Compared to traditional protocols, patients undergoing fasting abbreviation with the administration of fluids containing carbohydrates had improvements in glycemic parameters (fasting glucose and insulin resistance), inflammatory markers (interleukin 6 and 10) and indicators of malnutrition (grip strength hand and CRP/albumin ratio), and shorter hospital stay. The methodological quality of the reviewed articles, however, suggests that the results should be interpreted with caution.

Conclusion: The abbreviation of perioperative fasting in patients with neoplasm appears to be beneficial.

Conflict of interest statement

Conflicts of interest: none

Figures

FIGURE 1
FIGURE 1
Flowchart of the identification and data extraction methodology

References

    1. Abunnaja S, Cuviello A, Sanchez JA. Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients. 2013;5:608–623.
    1. Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C, Silva RM, Cardoso EA, Santos TP. Acerto pós-operatório: avaliação dos resultados da implantação de um protocolo multidisciplinar de cuidados peri-operatórios em cirurgia geral. Rev. Col. Bras. Cir. 2006;33:181–188.
    1. Aguilar-Nascimento JE, Marra JG, Slhessarenko N, Fontes CJ. Efficacy of National Nosocomial Infection Surveillance score, acute-phase proteins, and interleukin-6 for predicting postoperative infections following major gastrointestinal surgery. Sao Paulo Med J. 2007;125:34–41.
    1. Aguilar-Nascimento JE, Perrone F, Prado LIA. Jejum pré-operatório de 8 horas ou de 2 horas: o que revela a evidência? Rev. Col. Bras Cir. 2009;36:350–352.
    1. Associação Médica Brasileira e Conselho Federal de Medicina . Projeto Diretrizes. 2011. Disponível em: .
    1. Awad S, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clinical Nutrition. 2013;32:34–44.
    1. Bicudo-Salomao A, Aguilar-Nascimento JE, Caporossi C. Risco nutricional em cirurgia avaliado pelo índice de massa corporal ajustado ou não para pacientes idosos. Arq Gastroenterol. 2006;43:219–223.
    1. Bicudo-Salomão A, Meireles MB, Caporossi C, Crotti PLR, Aguilar-Nascimento JE. Impacto do projeto acerto na morbi-mortalidade pós-operatória em um hospital universitário. Rev Col Bras Cir. 2011;38:3–10.
    1. Bozzetti F, Gianotti L, Braga M, Di Carlo V, Mariani L. Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support. Clin Nutr. 2007;26:698–709.
    1. Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003;(4):CD004423–CD004423.
    1. Cerantola Y, Grass F, Cristaudi A, Demartines N, Schäfer M, Hübner M. Perioperative nutrition in abdominal surgery: recommendations and reality. Gastroenterol Res Pract. 2011;2011:739347–739347.
    1. Crenshaw JT, Winslow EH. Preoperative fasting: old habits die hard. Am J Nurs. 2002;102:36–44.
    1. de Luis DA, Culebras JM, Aller R, Eiros-Bouza JM. Surgical infection and malnutrition. Nutr Hosp. 2014;30:509–513.
    1. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24:466–477.
    1. Instituto Nacional de Câncer José Alencar Gomes da Silva . Estimativa 2012: incidência de câncer no Brasil [Internet] Rio de Janeiro: INCA; Disponível em: .
    1. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630–641.
    1. Ludwig RB, Paludo J, Fernandes D, Scherer F. Menor tempo de jejum pré-operatório e alimentação precoce no pós-operatório são seguros. ABCD Arq Bras Cir Dig. 2013;26:54–58.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–269.
    1. Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis. 2006;8:563–569.
    1. Pexe-Machado PA, de Oliveira BD, Dock-Nascimento DB, Aguilar-Nascimento JE. Shrinking preoperative fast time with maltodextrin and protein hydrolysate in gastrointestinal resections due to cancer. Nutrition. 2013;29:1054–1059.
    1. Polakowski CB, Britto JCL, Lopes M, Kato M, Targa GZ. Introdução de dieta precoce no pós-operatório de cirurgias por câncer colorretal: elaboração de um protocolo de dieta. Revista Brasileira de Cancerologia. 2012;58:181–187.
    1. Projeto Diretrizes . Terapia Nutricional no Perioperatório. Associação Médica Brasileira (AMB); 2011. Disponível em: .
    1. Schulz KF, Altman DG, Moher D, CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152:726–732.
    1. Smith I, Kranke P, Murat I, Smith A, O'Sullivan G, Søreide E, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28:556–569.
    1. Wang ZG, Wang Q, Wang WJ, Qin HL. Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg. 2010;97:317–327.
    1. Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Enteral Nutrition: Surgery including Organ Transplantation. Clin Nutr. 2006;25:224–244.
    1. Zelic M, Stimac D, Mendrila D, Tokmadzic VS, Fisic E, Uravic M, et al. Influence of preoperative oral feeding on stress response after resection for colon cancer. Hepatogastroenterology. 2012;59:1385–1389.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever