Importance of nutritional support in gastrointestinal cancers [Importance du support nutritionnel dans les cancers digestifs]

摘要

In patients with gastrointestinal cancer, the systematic screening of nutritional status is mandatory. Malnutrition is widely recognized as a significant source of postoperative morbidity and high rates of toxicity during chemotherapy or radiotherapy, resulting in longer hospital stays, increased medical costs, decreased performance status, and lower quality of life. Patients who experience weight loss should receive dietary counselling and immunonutrition. For surgical patients, practical information, such as weight status and subjective global assessment data, provides a solid basis for deciding whether or not to delay surgery. At least 10 days of nutritional support is recommended in severely malnourished patients before major gastrointestinal surgery. In patients with less severe malnutrition, preoperative oral immunonutrition is associated with a 50% decrease in postoperative complications. The benefit of immune-enhancing diets in severely malnourished patients remains to be proven. Dietary counselling should be offered to all patients undergoing radiochemotherapy. In cases of severely malnourished patients, or if dietary counselling is ineffective, enteral nutrition is recommended. Parenteral nutrition should be reserved for patients with severe digestive intolerance when enteral nutrition is not possible. In conclusion, it is essential to provide individualized nutritional support at every step in a multimodal treatment programme for gastrointestinal cancer. These recommendations should be used in daily practice but should also be included in all clinical research protocols.