Mapping the perioperative nutrition journey of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy to identify factors associated with post-operative outcomes and perioperative malnutrition.

BACKGROUND

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is aggressive surgical treatment for peritoneal malignancy. The procedure offers encouraging survival outcomes for selected patients, however post-operative morbidity and malnutrition are common. The primary aim of this study was to examine effect of pre-operative malnutrition on post-operative outcomes in patients undergoing CRS and HIPEC. Two secondary aims of the study were to quantify the extent of perioperative malnutrition at 3-time points from baseline to discharge and to determine predictors of nutrition decline.

METHODS

Consecutive patients with available pre-operative patient-generated subjective global assessment (PG-SGA) who underwent CRS and HIPEC for peritoneal malignancy were included. Nutrition status was diagnosed pre-operatively, post-operative day (POD) 7 and discharge. Pre-operative patient characteristics and post-operative surgical factors were collected and analysed to determine associations.

RESULTS

There were 345 patients included in the study, 57% were female and median age was 55.0 (45.5-64.5) years. Pre-operative malnutrition prevalence was 24% (n = 82). There were no significant differences between well-nourished and malnourished patients with respect to post-operative morbidity, however malnourished patients had significant longer post-operative hospital length of stay (LOS) (20 vs 16 days, p = 0.003). Malnutrition significantly increased at POD 7 (34%) and discharge (50%), with 32 (10.5%) and 72 patients (27%) becoming malnourished respectively. Regression analysis showed peritoneal cancer index and the pre-operative PG-SGA numeric score were significant predictors of the PG-SGA numeric score at discharge.

CONCLUSIONS

Malnutrition is prevalent in patients undergoing CRS and HIPEC and findings suggest prevalence increases perioperatively. Pre-operative malnutrition is associated with increased LOS, therefore highlighting the opportunity to investigate more aggressive and/or multimodal interventions that may improve nutritional and clinical outcomes.