FACING a tumor and its treatment requires a strong physique, which unfortunately very often elderly people do not have. But showing up at the appointment of both surgical and chemotherapy treatments, with an appropriate physical form, has important repercussions on the success of the therapies and reduces complications. As the results of a study published in Nutrients by experts from the Agostino Gemelli Irccs University Hospital Foundation.
The research examined the effects of a perioperative nutritional protocol (NutriCatt) on body composition and treatment outcomes (operative complications, length of stay and other surgical parameters) in a group of 302 elderly (> 75 years) undergoing surgery. surgery for colorectal cancer between 2015 and 2020.
Patients were divided according to their adherence, according to whether they followed the NutriCatt + Eras protocol (55 percent of the total) or standard Eras (45 percent of the total). Those treated with the NutriCatt Eras protocol showed a significant reduction in post-operative complications (severe ones were reduced by 10 percent compared to patients undergoing the standard ERAS protocol); hospitalization times were also shortened by one day on average.
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In light of these results, the authors hope that the NutriCatt protocol will be recommended within the Eras (Enhanced Recovery After Surgery) protocol in colorectal cancer surgery.
“In 2015 at the Gemelli Irccs Polyclinic Foundation – explains the professor in a note Maria Cristina Mele, Uosd Head of Advanced Nutrition in Oncology, Agostino Gemelli Irccs University Polyclinic Foundation and Aggregate Professor of Applied Dietary Technical Sciences, Catholic University of the Sacred Heart, Rome campus – a path has been established to accompany patients with colon cancer, to prepare them adequately to withstand major surgery. Nutrition is very important in this setting of patients, who are generally older in age (the average age is 70). Arriving at the surgery in an almost optimal nutritional condition gives them the opportunity to recover quickly and to be in such conditions as to be able to continue their oncological treatments “.
“Having already observed a good response to treatment with the NutriCatt protocol, in a group of patients not stratified by age (the first work was published in 2018), in this new work we went to see what were the nutritional conditions of the most patients. advanced with age, evaluating length of hospitalization and postoperative complications in a group of patients over-75. The results show that, in patients undergoing the NutriCatt protocol, there are no significant differences in postoperative complications, compared to more Young people. Patients are evaluated at least 20 days before surgery and provided with suitable home diets and, if indicated, with specific supplements or foods for special medical purposes to improve their nutritional and immune status, so as to prepare them in the best possible way for the marathon. surgery – oncological treatments. Thus, even the elderly, an increasingly large population, given that surgery is always pushing more later, they have the same surgical outcomes as younger patients. Within the Eras procedures which involve various professional figures (from the surgeon to the physiotherapist), nutrition, started at least two weeks before the surgical event, allows to deliver to the surgeon a more efficient patient from an immunological point of view, less sarcopenic, more ready to face treatment and recover sooner. At this time we can boast of discharge times that are among the lowest in Italy. We can send home a patient undergoing major surgery, such as colic resection, on the fourth-fifth day (the average post-operative hospitalization for colorectal cancer in laparoscopy is 8 days nationwide) “.
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“They were important because it is known that the elderly are more frail and may more frequently experience a series of age-related complications and comorbidities; those over 80 are at particular risk of sarcopenia. Malnutrition in the elderly with pathologies cancer is frequently found (affects up to 85 percent of patients with some types of cancer). This study shows that personalized nutritional support, such as that of the NutriCatt protocol, can reduce the number of serious postoperative complications in elderly patients major surgery for colon cancer and therefore represents, within the Eras program, a valid strategy to reduce serious post-operative complications in this category of patients “, continues the note.
“We did not expect such brilliant data on the elderly – adds the professor in the note Roberto Persiani, Uos Head of Minimally Invasive Oncological Surgery, Agostino Gemelli Irccs University Hospital Foundation and associate professor of General Surgery, Catholic University of the Sacred Heart, Rome campus – even if the theoretical rationale of the study was very solid. Intervening on the most fragile people with many co-morbidities is an important investment to make to bring the patient in better conditions to the operating table. Being able to offer an elderly patient a path of support not only psychological and procedural, but also nutritional is the way forward “.
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“In the future, this approach will become more and more widespread and will create a link with other items of the Eras protocol; the nutritional status that reduces complications makes all those supportive measures that are still used in many hospitals, such as fluid, unnecessary. – post-operative therapy, antibiotics, the use of monitoring systems such as abdominal drainages or bladder catheters. These are all measures that are adopted on the patient who is still considered not autonomous; on the contrary, starting from a ‘strong’ nutritional condition, which allows the patient to have a very quick recovery, 24 hours after surgery, it eliminates these needs, more linked to ‘tradition’ than to scientific evidence. We are lucky because at Gemelli we have all the skills and professionals who are dedicated to this; the real challenge will be to bring this approach even in those realities, where the nutritionist is still an absent figure “, adds Persiani.
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“It is only surprising how much the adoption of the Enhanced Recovery After Surgery (Eras) protocols has been delayed – and not only in Italy – over 20 years since its first theorization – comments the professor Domenico D’Ugo, Director of the Uoc of General Surgery of the Agostino Gemelli Irccs University Polyclinic Foundation, Full Professor of General Surgery at the Catholic University and current president of the European Society of Surgical Oncology (Esso) – It is in fact a concept as simple as it is full of economic advantages , clinical and scientific: facing a major surgery can be compared to an athlete who has to prepare his body for a competition. Prehabilitation (training) based on scientifically sound criteria, attention to technical and anesthetic factors during the intervention (minimization of trauma), the most rapid recovery of physiological functions (post-competition rehabilitation) are the cornerstones of a winning protocol to which today with the ‘NutriCatt’ protocol an immuno-nutrition component is added, with evidence of results that show promising implications also in terms of better control of oncological disease “.
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