Проблемы ранней диагностики и коррекции белково-энергетической недостаточности у пациентов высокого операционно-анестезиологического риска в абдоминальной онкохирургии: обзор литературы

Abstract

INTRODUCTION: The share of patients with high surgical and anesthesia risk in the total structure of oncological patients is increasing every year. Patients with protein-energy malnutrition (PEM) are characterized by a high frequency of postoperative complications. Progression of PEM in patients with high surgical and anesthesia risk occurs faster due to both the oncologic process itself and severe comorbidity. OBJECTIVE: To summarize and analyze information on modern methods of early diagnosis and correction of PEM in abdominal oncosurgery patients at high operative and anesthetic risk in the perioperative period. MATERIALS AND METHODS: A systematic search and selection of publications was performed using the bibliographic databases PubMed and eLibrary. Studies published in the last 15 years (2008–2023) were analyzed to investigate the problem. Relevant studies were limited to systematic literature reviews, meta-analyses, randomized controlled trials, prospective observational studies, retrospective studies. RESULTS: The use of special assessment systems that identify different stages of PEM (CASC IN, miniCASCO, new cachexia staging scale 2018) in cancer patients at high surgical and anesthetic risk creates conditions for the implementation of a personalized approach to the selection of nutritional support program in the perioperative period. Assessment of nutritional status, including the analysis of laboratory markers of malnutrition (total protein, albumin, serum transferrin), as well as qualitative assessment of body composition using bioimpedance analysis contribute to the early detection of PEM and allow for maximum personalization of nutritional support and hydration of this patients. CONCLUSIONS: This narrative review has shown that currently it is rather difficult to formulate algorithms for diagnostics and correction of PEM in patients with high surgical and anesthesia risk in abdominal oncosurgery. Research is required to determine the effectiveness of different scales of PEM staging. A personalized approach to early diagnosis and correction of PEM is one of the most promising strategies to reduce the incidence of postoperative complications in this category of patients.