Nutritional aspects of colorectal cancer surgery care in a district general hospital
Authors: Morris H. , Thomas J. 
Published: May 2009

Background:  Nutritional screening and support as well as early re‐introduction of enteral feeding can enhance recovery in colorectal surgical patients (Fearon & Luff, 2003; Fearon et al., 2005). Recent advances in multi‐modal surgical care have highlighted many changes that are required in practice compared to traditional approaches. The aim of this study was to compare the current nutritional practice for colorectal cancer patients undergoing elective surgery at Queen Mary's Hospital Sidcup against current evidence‐based recommendations (Fearon et al., 2005; Arends et al., 2006).

Methods:  Surgical and nursing notes of patients that underwent elective procedures for colorectal malignancy in 2006 were examined. Data collected included information regarding preoperative nutritional screening and anthropometrics, the use of preoperative fasting and carbohydrate loading, use of nasogastric tubes and the time to re‐introduction of oral diet and fluids.

Results:  Thirty‐three patients underwent elective surgery for colorectal cancer in 2006. Less than half of patients (37.2%) did not receive any form of preoperative nutritional assessment. No patients received carbohydrate loading; 93.9% were fasted for >6 h prior to surgery for liquids and solids. Post‐operatively (PO); clear fluids were commenced at a mean (SD) of 1.6 (1.1) days, free fluids at 2.7 (1.4) days PO, and diet at 3.9 (1.8) days PO. 90.9% of patients received nasogastric tube intubation; mean (SD) removal time was 4.0 (4.0) days PO.

Audit standard
Aim (%)
Results (%)

Patients should receive nutritional screening prior to surgery
100
37.2

Patients should be fasted for solids for 6 h and clear liquids for 2 h prior to surgery
100
 0.0

Patients should receive preoperative carbohydrate loading
100
 0.0

Nasogastric tubes should not be used post‐operatively
100
 3.0

Oral diet should be restarted immediately after surgery
100
 0.0

Discussion:  Current practice varies between surgical teams within the same hospital. The majority of patients are not being screened for malnutrition prior to surgery using either anthropometrics or a validated method. Patients are not receiving carbohydrate loading prior to surgery and there is often a delay in the re‐removal of nasogastric tubes and the re‐introduction of oral fluids and nutrition post‐operatively.

Conclusions:  In summary, current practice is not in line with current evidence‐based recommendations (Fearon et al., 2005; Arends et al., 2006).

Acknowledgment:  This research was sponsored by Macmillan Cancer Support.

References  Arends, J., Bodoky, G., Bozzetti, F., Fearon, K., Muscaritoli, M., Selga, G., van Bokhorst de van der Schueren, M.A.E., von Meyenfeldt, M., Zurcher, G., Fietkau, R., Aulbert, E., Frick, B., Holm, M., Kneb, M., Mestrom, H.J. & Zander, A. (2006) ESPEN Guidelines on Enteral Nutrition: Non‐surgical oncology. Clin. Nutr.25, 245–259.

Fearon, K.C.H. & Luff, R. (2003) The nutritional management of surgical patients:enhanced recover after surgery. Proc. Nutr. Soc.62, 807–811.

Fearon, K.C.H., Ljungqvist, O., Von Meyenfeldt, M., Revhaug, A., Dejong, C.H.C., Lassen, K., Nygren, J., Hausel, J., Soop, M., Anderson, J. & Kehlet, H. (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin. Nutr.24, 466–477.