Nationwide medical database study for postoperative nutritional management in patients undergoing gastroenterological cancer surgery

Aim

The study aimed to clarify how nutrition was managed in patients based on surgical site during the first 7 d after gastroenterological cancer surgery.

Methods

A Japanese medical claims database was used to identify patients who had gastroenterological cancer surgery from 2011 to 2022. Patients were divided into groups based on the surgical sites, and postoperative feeding routes and timing of initiation of oral intake for groups were assessed. For the subset of patients fasting postoperatively for ≥7 d, the proportion of patients prescribed target doses of energy (20 kcal/kg) and amino acids (0.8 g/kg) on postoperative d 7 were assessed.

Results

Surgical sites of 360 296 study patients were: esophagus, 14 784; stomach, 103 339; colon/rectum, 194 049; liver, 19 277; gallbladder/bile duct, 8279; pancreas, 20 568. The median postoperative day of oral intake initiation was: esophagus, seven; stomach and pancreas, four; colon/rectum and gallbladder/bile duct, three; liver, two. The proportions of fasting patients prescribed target doses of energy and amino acids on postoperative d 7 were: esophagus, 42.6% and 34.4%; stomach, 21.8% and 28.0%; colon/rectum, 20.9% and 29.1%; liver, 21.2% and 22.5%; gallbladder/bile duct, 31.0% and 33.4%; pancreas, 28.2% and 37.8%, respectively.

Conclusion

Oral intake after gastroenterological cancer surgery was started earliest in patients undergoing liver surgery and latest in patients undergoing esophageal surgery. Target parenteral energy and amino acid doses were prescribed to less than half of fasting patients. Education is needed to promote early initiation of oral intake and the use of guidelines-based parenteral nutrition dosing in patients after gastroenterological cancer surgery.