1. Periopperative nutritional support in GI surgery : Past, Present, and future on oncology perspective observation and evidence base Sirikan Yamada, MD Division of Gastrointestinal Surgery and Endoscopy Department of Surgery Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand

2. There is a high incidence of malnutrition in hospitalized patients undergoing gastrointestinal surgery. There is a high incidence of malnutrition in hospitalized patients undergoing gastrointestinal surgery. Malnutrition is clearly associated with increased morbidity and mortality after major gastrointestinal surgery. Malnutrition is clearly associated with increased morbidity and mortality after major gastrointestinal surgery. Cancer cachexia may be an immunologic phenomenon. Routine preoperative TPN may not proper for all types of cancer. Cancer cachexia may be an immunologic phenomenon. Routine preoperative TPN may not proper for all types of cancer.

3. The efficacy of perioperative nutrition support to reduce surgical complications and mortality significantly has been an area of active clinical investigation over the past three decades. The efficacy of perioperative nutrition support to reduce surgical complications and mortality significantly has been an area of active clinical investigation over the past three decades. From multiple prospective, randomized trials, significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. From multiple prospective, randomized trials, significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. Results of the prospective, randomized trials studying the effects of perioperative nutrition support on patients undergoing gastrointestinal surgery are reviewed and critically analyzed. Results of the prospective, randomized trials studying the effects of perioperative nutrition support on patients undergoing gastrointestinal surgery are reviewed and critically analyzed.

4. Why ? Disease causes starvation and defect of immunity Disease causes starvation and defect of immunity Major stress on elective complex GI Surgery; especially, on upper GI cancer surgery Major stress on elective complex GI Surgery; especially, on upper GI cancer surgery Underestimation for nutritional risk by surgeon Underestimation for nutritional risk by surgeon

5. WHO? Nutritional Risk Screening SGA BMI? In ASIAN

6. Which type of operation Which type of formula, and When? For Complex Surgery Preparation For Complex Surgery Preparation Enteral or TPN ? Enteral or TPN ? BOTH ! BOTH !, and Early as soon as possible., and Early as soon as possible.

7. HOW? Need not to do over TPN calory or over feeding. Need not to do over TPN calory or over feeding. Use the actual weight. Use the actual weight. Normal energy base requirement. Normal energy base requirement.

9. Immuno-nutrition TPN + glutamine dipeptide in bone marrow transplantation patients. TPN + glutamine dipeptide in bone marrow transplantation patients. In Esophageal cancer patients, preoperative TPN + amino acids+ certain fatty acids decrease postoperative infections, and it was improved postoperatively when given enteral nutrition supplemented with arginine and omega 3-fatty acids In Esophageal cancer patients, preoperative TPN + amino acids+ certain fatty acids decrease postoperative infections, and it was improved postoperatively when given enteral nutrition supplemented with arginine and omega 3-fatty acids Oncology 1996:10

10. The effects of perioperative oral enteral support with glutamine-added elemental formulas in patients with gastrointestinal cancers. A prospective, randomized, clinical study 32patients with gastrointestinal (GI) system cancer 33% of the daily energy requirements was covered with 32patients with gastrointestinal (GI) system cancer 33% of the daily energy requirements was covered with polymeric enteral formulas (Ensure®) in the control group (n =16), and with glutamine enriched elemental formulas (Alitraq®) in the study group (n = 16). polymeric enteral formulas (Ensure®) in the control group (n =16), and with glutamine enriched elemental formulas (Alitraq®) in the study group (n = 16). ERDEM Nihal Zekiye, 2002 at the4 th Surgical Department of the Ankara Numune Research and Education Hospital. In addition to hospital diet

11. Patients had these regimens 7 days in the preoperative period and 10 days in the postoperative period. The effects of additional enteral feeding support on anthropometric and plasma protein levels in the preoperative (days 1 and 7) and postoperative (days1 and 10) periods were assessed In both groups Patients had these regimens 7 days in the preoperative period and 10 days in the postoperative period. The effects of additional enteral feeding support on anthropometric and plasma protein levels in the preoperative (days 1 and 7) and postoperative (days1 and 10) periods were assessed In both groups

12. no differences were observed among the no differences were observed among the anthropometric assessments, except for the Nutritional Risk Index. Total protein, albumin, transferrin, prealbumin, NRI, and nutritional prognostic index were affirmatively affected by both enteral formulas. ***** However, the increments of these parameters were higher and more significant in the study group. Energy, protein, carbohydrate and lipid consumption of the patients were managed as the referred amounts. Pre- and post-operative nutritional support with glutamine enriched enteral formulas had beneficial effects on the patients with GI cancers.

13. PREVENTION PREVENTION is better than is better than ONLY TREATMENT ONLY TREATMENT