Patient optimization for gastrointestinal cancer surgery

• Published in: British journal of surgery Vol. 100; no. 1; pp. 15 - 27
• Main Authors: Fearon, K. C., Jenkins, J. T., Carli, F., Lassen, K.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.01.2013; Wiley; Oxford University Press
• Subjects: Anemia - epidemiology; Biological and medical sciences; Comorbidity; Diabetes Mellitus - epidemiology; Disease-Free Survival; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Neoplasms - mortality; Gastrointestinal Neoplasms - surgery; Gastrointestinal Neoplasms - therapy; General aspects; Humans; Medical sciences; Neoadjuvant Therapy; Neoplasm Metastasis; Nutritional Status; Perioperative Care - methods; Quality of Life; Renal Insufficiency - epidemiology; Risk Reduction Behavior; Sarcopenia - epidemiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Treatment Outcome; Tumors; Human; Medicine; Gastrointestinal cancer; Digestive diseases; Intestinal disease; Patient; Malignant tumor; Optimization; Cancer; Gastric disease
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.8988

Background: Although surgical resection remains the central element in curative treatment of gastrointestinal cancer, increasing emphasis and resource has been focused on neoadjuvant or adjuvant therapy. Developments in these modalities have improved outcomes, but far less attention has been paid to improving oncological outcomes through optimization of perioperative care. Methods: A narrative review is presented based on available and updated literature in English and the authors' experience with enhanced recovery research. Results: A range of perioperative factors (such as lifestyle, co‐morbidity, anaemia, sarcopenia, medications, regional analgesia and minimal access surgery) are modifiable, and can be optimized to reduce short‐ and long‐term morbidity and mortality, improve functional capacity and quality of life, and possibly improve oncological outcome. The effect on cancer‐free and overall survival may be of equal magnitude to that achieved by many adjuvant oncological regimens. Modulation of core factors, such as nutritional status, systemic inflammation, and surgical and disease‐mediated stress, probably influences the host's immune surveillance and defence status both directly and through reduced postoperative morbidity. Conclusion: A wider view on long‐term effects of expanded or targeted enhanced recovery protocols is warranted. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Every bit as important as the operation itself