醫學五：80題 ( 包括外科,骨科,泌尿科等科目及其相關臨床實例與醫學倫理 )題庫下載題庫

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Early evaluation and intervention may allow some patients to maintain nutrition through the course of therapy. While the use of oral nutritional supplementation does not dramatically alter surgical outcomes, it improves perioperative weight gain.

Patients who fail conservative measures may need additional nutritional supplementation. While the evidence base to support the benefit of supplemental feeding is weak, retrospective series suggest that nutritional support may improve the higher mortality associated with preoperative nutritional depletion in patients undergoing neoadjuvant chemoradiotherapy, and prevent further nutritional deterioration. In a retrospective review of 30 patients who were unable to maintain an oral diet and who received total parenteral nutrition (TPN) during neoadjuvant therapy for esophageal cancer, the patients receiving TPN tolerated higher doses of chemotherapy than did those who did not, and their surgical outcomes were similar to that of patients who were able to maintain an oral diet. Whether the benefit had anything to do with TPN, or was simply a reflection of patient selection bias is unclear.

Although randomized trials have failed to demonstrate either improved treatment tolerance, or a survival benefit from nutritional support, they were not restricted to malnourished patients. Benefit has been shown when this intervention is restricted to malnourished patients undergoing major cancer surgery.