Nutritional support of patients with hepatopancreatodenal tumors: a key element of intensive care in the postoperative period

Abstract

Relevance: Effective intensive therapy of complications arising from malignant neoplasms of the hepatopancreatoduodenal region remains an urgent task. It aims to eliminate energy deficien-cy, restore body weight, and normalize plastic processes that are disrupted due to severe hypercatabolism, increased body needs for nutrients, and the development of intoxication syndrome, especially in the postoperative period.
The study aimed to research the key aspects of nutritional support in patients with tumors of the hepatopancreatoduodenal region by studying and comparing the effectiveness of isolated enteral, parenteral, and mixed nutritional therapy in the early postoperative period.
Methods: The study involved 91 patients over 18 years old with hepatopancreatobiliary malignancies. Patients were divided into three groups depending on the type of nutritional support. The study assessed nutritional status indicators, including screening results, body mass index, basal metabolic rate, and key laboratory indicators: the level of lymphocytes in the blood, total protein, total bilirubin, and ALT and AST activity.
Results: With parenteral nutritional support according to the screening protocols used, by Days 10-12, 17 patients maintained a “normal” nutritional status, 14 patients had “moderate malnutrition” with regression of “severe malnutrition” in 1 patient (3.2%). In the mixed nutrition group, by Days 10-12 of the postoperative period, there was an increase in patients with “moderate malnutrition” according to the SGA and NRI scales by 10% and 6.7%, respectively, with complete elimination of signs of “severe malnutrition” according to the given nutritional assessment scales (p<0.005).
Conclusion: In the group with isolated parenteral nutrition, sufficient effectiveness in stabilizing and maintaining the nutritional status of patients was achieved, which was manifested in an increase in the number of patients with “moderate” and “normal” nutritional status, as well as a decrease in the number of patients with severe and moderate nutritional deficiency.
Mixed nutritional support can be considered a promising alternative to parenteral nutrition since the indicators of the nutritional status of patients achieved in this group were statistically similar to the results of parenteral therapy.