Nutritional Risk Screening in Gynaecologic Oncology Surgery: Importance, Scoring Systems, Recommendations and Practical Applications.

Background/

Objectives

Malnutrition is common among women undergoing gynaecologic oncology (GO) surgery and is associated with increased morbidity, prolonged hospitalisation, and reduced survival. Nevertheless, the optimal nutritional screening tools remain uncertain.

Methods

We conducted a narrative review of commonly used nutritional screening and assessment tools in surgical GO patients. To highlight practical challenges in accurately identifying at risk individuals, we incorporated findings from our clinical audit.

Results

There was a considerable variation between tools. While many tools were associated with adverse outcomes, their clinical value in this population was unclear. The presence of ascites and rapid deterioration in oral intake may contribute to under-recognition of at-risk patients, as illustrated by our audit findings. Emerging strategies including determining body composition from routine pre-operative Computed Tomography (CT) scans, which have shown statistical associations with survival and toxicity in observational studies, but their clinical utility is not yet established.

Conclusions

Although several screening tools were statistically associated with adverse outcomes, robust data on their clinical utility are lacking. Current tools may inadequately factor for the specific considerations when screening this group. Consequently, nutritionally vulnerable surgical GO patients requiring nutritional intervention may be missed. As no gold standard currently exists for this population, bespoke, objective approaches and prospective studies are urgently needed to address disease-specific nutritional considerations.