Perioperative nutritional support in gastric cancer patients undergoing radical surgery

The purpose of this review was to analyze current data on nutritional support (NS) in gastric cancer patients undergoing radical surgery. Material and Methods. A literature search was conducted in the electronic databases eLIBRARY.RU, PubMed using the keywords «surgery», «stomach cancer», «nutrition», «ERAS». Emphasis was placed on studies with a high level of evidence (systematic reviews, meta-analyses) and updated clinical recommendations of the European society of Parenteral and Enteral Nutrition (ESPEN, 2017) and the Federation of anesthesiologists and reanimatologists of Russia (FAR, 2018). Results. Nutritional support before surgery is recommended for most patients with gastric cancer. In all cases, priority should be given to nutrients that support immunity. Immunonutrition should commence at least 57 days prior to surgery and continue postoperatively. Patients with severe malnutrition should receive preoperative NS for 7-14 days with the use of enteral immune mixtures. Supplementation of missing calories by parenteral nutrition (PN) is then recommended. In the postoperative period, renewal of NS during the first 6-12 hours after surgery is indicated. In patients with severe malnutrition, the installation of a nutrient probe beyond distal anastomosis and the early onset of enteral nutrition with supplemental parenteral nutrition are recommended. Conclusion. Nutritional management of patients with gastric cancer represents a challenge. For patients undergoing surgery, the preoperative nutritional condition directly affects postoperative prognosis, overall survival and disease-specific survival. Perioperative nutritional support is recommended for all patients. Nutritional support should be considered as a part of the strategy of accelerated rehabilitation after surgery (ERAS), and it should be combined with moderate physical activity. In patients receiving neoadjuvant chemoradiotherapy, the use of full range of pre-rehabilitation measures is recommended.