Clinical impact of early enteral nutrition on postoperative pain, gastrointestinal function and nutritional status in colorectal cancer patients.

Impacto clínico de la nutrición enteral temprana sobre el dolor post-quirúrgico, función gastrointestinal y estado nutricional de pacientes con cáncer colorrectal.

• Yue Qin Department of Anesthesiology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. https://orcid.org/0000-0002-5650-0149
• Ping Yuan Department of Anesthesiology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. https://orcid.org/0000-0002-6135-5660
• Lingling Tao Department of Anesthesiology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. https://orcid.org/0000-0002-2928-0902

DOI: https://doi.org/10.54817/IC.v66n1a04

Keywords: colorectal cancer, early enteral nutrition, postoperative pain, analgesic pump

Abstract

This research aimed to clarify the clinical impact of early enteral nutrition (EN) on postoperative pain, gastrointestinal function and nutritional status of colorectal cancer (CRC) patients. Eighty rectal cancer patients undergoing surgery in our hospital from October 2021 to October 2023 were selected as research subjects and divided into an experimental group (EG) and a control group (CG) using a random number table method, with 40 cases each. Both groups received conventional nursing, including preoperative, intraoperative, and postoperative nursing. The CG received a traditional preoperative routine diet and postoperative EN support. The EG received five-day preoperative EN support and postoperative parenteral nutrition support based on a traditional preoperative routine diet. The analgesic effect indicators, pain scores, gastrointestinal function recovery indicators, adverse reactions and nutritional indicators in both groups received measurement and comparison. The Average additional amount of flurbiprofen axetil in the EG decreased relative to those in the CG (p<0.05). At six h and 12 h after surgery, VAS scores in the EG were lower than those in the CG during the same period; at 24 h and 48 h after surgery, no statistical significance in VAS scores was shown between both groups (p>0.05). The bowel sound recovery time, first defecating time, first exhaust time, and first getting-out- of-bed time in EG were inferior relative to those in the CG (p<0.05). The incidence of adverse reactions in the EG was reduced relative to that in the CG (p<0.05). Before surgery and one day after surgery, no statistically significant differences in total protein (TP) and serum albumin (ALB) levels were shown between both groups (p>0.05); three days and seven days after surgery, TP and ALB levels in the EG exhibited an elevation relative to those in CG during the same period (p<0.05). In conclusion, early EN can improve not only postoperative gastrointestinal function and nutritional status of patients but also mitigate postoperative pain and facilitate postoperative recovery with high safety, which is worthy of further clinical promotion.

References

Wu T, Xu H, Li W, Zhou F, Guo Z, Wang K, Weng M, Zhou C, Liu M, Lin Y, Li S, He Y, Yao Q, Shi H, Song C; Investigation on Nutrition Status and its Clinical Outcome of Common Cancers (INSCOC) Group. The potential of machine learning models to identify malnutrition diagnosed by GLIM combined with NRS-2002 in colorectal cancer patients without weight loss information. Clin Nutr 2024; 43(5):1151-1161. doi: 10.1016/j.clnu.2024.04.001.

Loyala JV, Down B, Wong E, Tan B. Treatment of Cachexia in Gastric Cancer: Exploring the Use of Anti-Inflammatory Natural Products and Their Derivatives. Nutrients 2024 ;16(8):1246. doi: 10.3390/nu16081246.

Malta FAPS, Gonçalves DC. A triplemasked, two-center, randomized parallel clinical trial to assess the superiority of eight weeks of grape seed flour supplementation against placebo for weight loss attenuation during perioperative period in patients with cachexia associated with colorectal cancer: a study protocol. Front Endocrinol (Lausanne) 2024;14:1146479. doi: 10.3389/fendo.2023.1146479.

Sowerbutts AM, Burden S, Sremanakova J, French C, Knight SR, Harrison EM. Preoperative nutrition therapy in people undergoing gastrointestinal surgery. Cochrane Database Syst Rev 2024;4(4):CD008879. doi: 10.1002/14651858.CD008879.pub3.

Yang M, Zhang Q, Ge YZ, Tang M, Zhang X, Song MM, Ruan GT, Zhang XW, Zhang KP, Shi HP. Association between insulin resistance related indicators with the prognosis of patients with colorectal cancer. Cancer Epidemiol. 2023 Dec;87:102478. doi: 10.1016/j.canep.2023.102478.

Lai Y, Masatoshi H, Ma Y, Guo Y, Zhangn B. Role of Vitamin K in Intestinal Health. Front Immunol 2022;12:791565. doi: 10.3389/fimmu.2021.791565.

Yu S, Wang X, Li Z, Jin D, Yu M, Li J, Li Y, Liu X, Zhang Q, Liu Y, Liu R, Wang X, Fang B, Zhang C, Wang R, Ren F. Solo-bacterium moorei promotes the progression of adenomatous polyps by causing inflammation and disrupting the intestinal barrier. J Transl Med 2024;22(1):169. doi: 10.1186/s12967-024-04977-3.

Wu N, Feng YQ, Lyu N, Wang D, Yu WD, Hu YF. Fusobacterium nucleatum promotes colon cancer progression by changing the mucosal microbiota and colon transcriptome in a mouse model. World J Gastroenterol. 2022;28(18):1981-1995. doi: 10.3748/wjg.v28.i18.1981.

Loon MM, Goshe M, Rashid M, Shehryar A, Rehman A, Abdallah S, Baluch SK, Ahmed A, Batat H, Quinn M. Impact of Preoperative Nutritional Support on Surgical Outcomes in Gastrointestinal Surgeries: A Systematic Review. Cureus 2024;16(3):e56416. doi: 10.7759/cureus.56416.

Wang C, Yang D. Effect of different pre-operative nutritional treatments on postoperative recovery and clinical outcomes in patients with gastric cancer and early gastric outlet obstruction. Oncol Lett 2024;27(5):214. doi: 10.3892/ol.2024.14348.

Sun XJ, Feng TC, Wang YM, Wang F, Zhao JB, Liu X, Li FL. The effect of the enhanced recovery after surgery protocol and the reduced use of opioids on post-operative outcomes in elderly patients with colorectal cancer. Eur Rev Med Pharmacol Sci 2023; 27(20):10053-10060. doi:10.26355/eurrev_202310_34185.

Qi L, Shi H, Zhang Y, Zhang X, Jia H, Tian H. The effect of acupuncture on recovery after colorectal cancer resection: A systematic review meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023;102(35):e34678. doi: 10.1097/ MD.0000000000034678.

Lu DH, Xu XX, Zhou R, Wang C, Lan LT, Yang XY, Feng X. Ultrasound-guided stellate ganglion block benefits the post-operative recovery of patients undergoing laparoscopic colorectal surgery: a single-center, double-blinded, randomized controlled clinical trial. BMC Anesthesiol 2024;24(1):137. doi: 10.1186/s12871-024-02518-5.

Jakobsen DD, Brader L, Bruun JM. Effect of a higher protein diet and lifestyle camp intervention on childhood obesity (The COPE study): results from a nonrandomized controlled trail with 52-weeks follow- up. Eur J Nutr 2024. doi: 10.1007/s00394- 024-03420-z.

Wu Z, Xiao C, Long J, Huang W, You F, Li X. Mitochondrial dynamics and colorectal cancer biology: mechanisms and potential targets. Cell Commun Signal 2024 ;22(1):91. doi: 10.1186/s12964-024-01490-4.

Tong Y, Sun J, Xin W, Chen L, Kong S, Mi X, Feng Y, Jin W, Wu Y, Ding H, Fang L. Pharmacist-led standardization of total parenteral nutrition improves post-operative nutritional status in colorectal cancer patients. Ann Transl Med 2022;10(6):339. doi: 10.21037/atm-22-1172.

López-Rodríguez-Arias F, Sánchez-Guillén L, Lillo-García C, Aranaz-Ostáriz V, Alcaide MJ, Soler-Silva Á, Soriano-Irigaray L, Barber X, Arroyo A. Assessment of Body Composition as an Indicator of Early Peripheral Parenteral Nutrition Therapy in Patients Undergoing Colorectal Cancer Surgery in an Enhanced Recovery Program. Nutrients 2021;13(9):3245. doi: 10.3390/nu13093245.

Kirupananthan D, Bertolo RF, Brunton JA. Lysine Dipeptide Enhances Gut Structure and Whole-Body Protein Synthesis in Neonatal Piglets with Intestinal Atrophy. J Nutr 2022 ;152(8):1843-1850. doi:10.1093/jn/nxac095.

Dijk S, Jarman M, Zhang Z, Lawley M, Ahmad M, Suarez R, Rossi L, Chen M, Wu J, Carroll MW, Otley A, Sherlock M, Mack DR, Jacobson K, deBruyn JC, El-Matary W, Deslandres C, Rashid M, Church PC, Walters TD, Huynh HQ, Surette MG, Griffiths AM, Wine E; Canadian Children IBD Network. Pre-Diagnosis Diet Predicts Response to Exclusive Enteral Nutrition and Correlates with Microbiome in Pediatric Crohn Disease. Nutrients 2024;16(7):1033. doi: 10.3390/ nu16071033.

Bar-Yoseph H, Metcalfe-Roach A, Cirstea M, Finlay BB. Microbiome changes under enteral deprivation are dynamic and dependent on intestinal location. JPEN J Pa- renter Enteral Nutr 2024;48(4):502-511. doi: 10.1002/jpen.2624.

Hou TY, Lin YH, Liu YW, Liu YY, Li WF, Kuo MC, Huang SW, Yeh ChH, Lin YCh, Yin ShM. The impact of preoperative nutritional status on postoperative outcomes: an insight from Geriatric Nutritional Risk Index in elderly pancreaticoduodenectomy patients. BMC Surg 2024; 24: 100. https:// doi.org/10.1186/s12893-024-02397-0

Herzog I, Panchal D, Sikder S, Park JB, Mendiratta D, Mansukhani PA, Lee ES. Malnutrition in Head and Neck Free Flap Reconstruction as a Predictor of Adverse Outcomes. Ann Plast Surg 2024;92(4S Suppl 2):S251-S254. doi: 10.1097/SAP.000 0000000003868.

Acharya R, Blackwell S, Simoes J, Harris B, Booth L, Bhangu A, Glasbey J. Non-pharmacological interventions to improve sleep quality and quantity for hospitalized adult patients-co-produced study with surgical patient partners: systematic review. BJS Open 2024;8(2):zrae018. doi: 10.1093/bjsopen/zrae018.