A systematic review of the effect of preoperative nutrition support on nutritional status and treatment outcomes in upper gastrointestinal cancer resection

Background: Malnutrition is highly prevalent in patients with Upper Gastrointestinal (UGI) cancer and is associated with poor outcomes. However, there are no evidence-based guidelines for nutrition support specific to UGI cancer surgery. Methods: Databases including MEDLINE, PUBMED, CINAHL, Web of Science, Cochrane Central and Clinicaltrials.gov were systematically searched. Abstracts of studies investigating the effect of preoperative nutrition support on nutritional status, functional status, body composition, quality of life and treatment outcomes in adult patients undergoing oesophageal, gastric or pancreatic cancer resection were identified. Screening of studies, quality assessment using the Downs and Black checklist, data extraction, and appraisal of evidence using GRADE were performed by two reviewers. Due to heterogeneity of the studies, results were synthesised narratively. The protocol was registered in PROSPERO (CRD42018111930). Results: Nine studies with a total of 442 oesophageal and 418 gastric patients were included. Individualised dietary counselling, and enteral feeding in neoadjuvant therapy for oesophageal cancer demonstrated positive effects for weight maintenance and surgical complications, however the GRADE evidence quality was very low. Preoperative nutrition support in gastric cancer decreased the incidence of surgical site infections, length of stay and hospital costs, but GRADE assessment was unable to be completed due to only one study reporting on each outcome measure. Conclusions: This review demonstrates the lack of strong evidence to determine the most optimal methods of nutrition support prior to UGI cancer resection. Current surgical oncology guidelines should be utilised until further research from high quality trials enable the development of specific clinical practice guidelines.