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Nutrition clinique et métabolisme
Volume 15, n° 4
pages 298-307 (décembre 2001)
Nutrition péri-opératoire chez les patients cancéreux
Peri-operative nutrition in cancer patients

Luca  Gianotti a * ,  Marco  Braga b
aDepartment of surgery, Milano-Bicocca University, Monza, Italy 
bdepartment of surgery, S. Raffaele university, Milan, Italy 

*Correspondance et tirés à part. Luca Gianotti, MD, ScD, Department of surgery (chirurgia 3), San Gerardo hospital, Via Donizetti 106, 20052 Monza, Italy.

En chirurgie oncologique, une nutrition artificielle devrait être considérée comme un outil essentiel dans la prise en charge des patients dénutris ou cataboliques. Toutefois, ses objectifs ne peuvent être pleinement atteints que si la prescription est parfaitement bien adaptée aux besoins du patient et surveillée régulièrement. Comme tout autre arme thérapeutique, la nutrition artificielle a un coût et certains effets secondaires et donc devrait être prescrite sur la base d'indications bien définies. L'usage d'une nutrition entérale devrait être préférée à la nutrition parentérale dans la mesure où le tube digestif fonctionne. L'utilisation clinique de nouvelles solutions nutritives donne des résultats prometteurs et enthousiasmants. Chez les patients cancéreux, une nutrition pré- ou péri-opératoire appara circ;t être la stratégie la plus logique et a fait la preuve d'effets bénéfiques sur l'évolution clinique. En effet, les résultats suggèrent qu'une immunonutrition est efficace uniquement chez les sujets qui reçoivent une nutrition correcte ou lorsqu'un apport suffisant d'immunonutriments est atteint.

Mots clés  : immunonutrition ; nutrition postopératoire ; nutrition préopératoire.


In oncologic surgery, artificial nutrition (AN) should be considered as an essential tool in the management of malnourished or catabolic patients. Its performance can be remarkable, but its objective is only fully achieved when the prescription is perfectly adapted to the patient's need and is regularly monitored. As any other therapeutic tool, AN carries costs and some adverse effects and thus it should be prescribed based on precise indications. The use of the enteral feeding should be preferred to parenteral nutrition whenever there is a functioning gut. The clinical use of new nutritional substrates is giving exciting and promising results. In elective cancer patients the pre- and peri-operative approaches appear the most rational and demonstrated clear benefits on clinical outcome. Indeed, the results suggest that immunonutrition is effective only in subjects who are successfully fed or when an adequate amount of substrates is achieved.

Mots clés  : immunonutrition ; postoperative nutrition ; preoperative nutrition.

© 2001  Éditions scientifiques et médicales Elsevier SAS. All Rights Reserved.

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