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Debate 2B - Should Preoperative Carbohydrate Loading be Routine prior to Debulking Surgery?

No

from Section I - Perioperative Management

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

Preoperative nutritional status plays a key role in perioperative outcomes in oncologic patients. For those with nutritional deficits, several weeks of nutritional support may be required to induce meaningful metabolic change, representing an unrealistic surgical delay for many patients. In an effort to address nutritional status in surgical patients over shorter periods of time, enhanced recovery after surgery (ERAS) programs have developed nutritional bundles during the perioperative period. One such component is preoperative carbohydrate loading, which consists of consuming carbohydrate-heavy beverages the night before and the day of surgery. Trials assessing the impact of carbohydrate loading across various surgical subspecialties have had mixed results and have not translated to significant differences in clinical outcomes. While many components of ERAS have proven beneficial, preoperative carbohydrate loading in particular may be “too little, too late” and does not appear to improve outcomes in patients undergoing debulking surgery.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Nelson, G, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations2019 update. Int J Gynecol Cancer 2019;29(4):651668.CrossRefGoogle ScholarPubMed
Amer, MA, et al. Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery. Br J Surg 2017;104(3):187197.CrossRefGoogle ScholarPubMed
Li, L, et al. Preoperative carbohydrate loading for elective surgery: a systematic review and meta-analysis. Surg Today 2012;42(7):613624.CrossRefGoogle ScholarPubMed
Smith, MD, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev 2014;8:CD009161. https://doi.org/10.1002/14651858.CD009161.pub2Google Scholar
Bilku, DK, et al. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl 2014;96(1): 1522.CrossRefGoogle ScholarPubMed

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