The importance of good nutrition in oncological surgery

Nutrition and the surgical outcome

Eating well before and after oncological surgery reduces complications and shortens recovery.

At Quenet Torrent Institute we run personalised perioperative nutritional optimisation programmes that have been shown to reduce postoperative complications by up to 50% and to shorten hospital stays significantly.

Malnutrition in cancer patients: a common problem

Between 40-80% of cancer patients have some degree of malnutrition at diagnosis or during treatment. This is due to several factors:

Causes of malnutrition:

• Tumour hypermetabolism: The tumour consumes energy and nutrients

• Loss of appetite: Anorexia induced by inflammatory cytokines

• Digestive obstruction: In gastrointestinal tumours

• Treatment effects: Nausea, vomiting, mucositis from chemotherapy

• Malabsorption: After intestinal or pancreatic resections

Preoperative nutritional assessment

Before any major oncological surgery, we carry out a thorough nutritional assessment that includes:

Anthropometric parameters: Current weight, recent weight loss (>5% in 1 month or >10% in 6 months is significant), body mass index (BMI)

Body composition: Bioimpedance or CT to assess muscle mass (sarcopenia is an independent risk factor for complications)

Blood tests: Albumin, prealbumin, transferrin, lymphocyte count, nitrogen balance

Functional assessment: Dynamometry (hand grip strength), 6-minute walk test

Preoperative nutritional optimisation

If we detect malnutrition, we start a nutritional prehabilitation programme 2-4 weeks before surgery:

Oral nutritional supplements: High-calorie, high-protein formulas (1.5-2 kcal/ml) with at least 20-30 g of protein per serving. Target: 25-30 kcal/kg/day and 1.5-2 g protein/kg/day

Immunonutrition: Supplements enriched with arginine, omega-3 fatty acids and nucleotides, which modulate the immune response and reduce infectious complications. Recommended for 5-7 days before surgery

Enteral nutrition: If oral intake is insufficient: nasogastric tube or percutaneous gastrostomy

Parenteral nutrition: Reserved for complete bowel obstruction or severe ileus. Nutrients are given intravenously

More information on prehabilitation and nutrition.

Postoperative nutrition: enhanced recovery (ERAS)

We apply ERAS (Enhanced Recovery After Surgery) protocols, which include early feeding:

Shorter preoperative fasting: Clear fluids up to 2 hours before surgery, solids up to 6 hours (vs traditional fasting from midnight)

Early oral feeding: Fluids 4-6 hours after surgery, soft diet at 24 hours, even after intestinal resections. This reduces paralytic ileus and speeds up recovery

Avoiding the nasogastric tube: Except in specific cases, we do not use a routine NG tube in digestive surgery

Protein supplementation: Supplements are continued until baseline weight is recovered

Nutrition by type of surgery

Gastric resections: Small, frequent meals (6-8 a day), avoid drinking with meals (dumping syndrome), supplement vitamin B12, iron and calcium. More on stomach cancer.

Intestinal resections: Low-fibre diet at first, with gradual reintroduction. In extensive resections: temporary parenteral nutrition

Pancreatic resections: Pancreatic enzymes with every meal, strict blood glucose control, split meals

Surgery with a stoma: Specific dietary advice. More on stomas.

Essential macronutrients

Protein (1.5-2 g/kg/day): Needed for wound healing and muscle recovery. Sources: lean meat, fish, eggs, dairy, pulses

Complex carbohydrates: Sustained energy. Wholegrain cereals, potatoes, rice, pasta

Healthy fats: Omega-3 (oily fish, walnuts, flaxseed) with an anti-inflammatory effect

Hydration: At least 2 litres a day, more with fever, drains or diarrhoea

Micronutrients

Vitamin C: Collagen synthesis, wound healing. Citrus fruit, kiwi, peppers

Vitamin A: Mucosal integrity, immunity. Carrots, pumpkin, liver

Zinc: Wound healing, immune function. Red meat, shellfish, nuts

Iron: Prevents anaemia. Red meat, pulses, taken with vitamin C for better absorption

Vitamin D: Immunity, recovery. Sun exposure, oily fish, supplements if deficient

Managing side effects

Nausea and vomiting: Cold meals, avoid strong smells, ginger, anti-emetic medication

Mucositis: Soft, cold foods, avoid acidic and spicy foods, bicarbonate mouthwashes

Diarrhoea: Binding diet (rice, banana, apple), avoid dairy, probiotics

Constipation: Gradual fibre, hydration, gentle exercise, laxatives if needed