Nutrition of the patient is an integral component of treatment. The development of medical nutrition issues is a very important link in the complex of therapeutic measures for cancer patients. Adequate nutrition for the patient and correction of metabolic disorders after surgery or anticancer drug treatment are absolutely necessary. Oncological patients are faced with the problem of the impossibility of taking sufficient amounts of food that meet the nutritional needs of the body; Protein breakdown processes prevail in the body, which requires nutrition of high calorie content.
A very complex postoperative contingent – patients with tumors of the gastrointestinal tract, patients after preoperative chemotherapy – all who for a long time could not eat normally and varied. Deficiency of proteins, fats, carbohydrates, vitamins, minerals – nutritional deficiency – is observed in the vast majority of patients with malignant tumors of the gastrointestinal tract – in 70-80%. The most significant reason for the development of nutritional deficiency is the production of biologically active substances by the tumor, which leads to an acceleration of metabolic processes with the consumption of a huge amount of energy. Against this background, there is a persistent decrease in appetite, along with a change in taste and smell, which lead to nutritional deficiency. Developing exhaustion does not allow for adequate treatment and is a direct cause of life-threatening complications. Surgery in itself also leads to a significant increase in energy needs, which cannot be compensated for due to the natural restriction of food intake.
Doctors have long understood that after the operation, there should be a special medicinal diet available at any pharmacy that helps to survive in such a difficult period in the patient’s life, without violating man-made results. After operations performed under anesthesia, to avoid vomiting, drinking was allowed only 4-5 hours after waking up and only when the swallowing reflex was restored. After operations on the organs of the gastrointestinal tract on the first day, you are not allowed to drink or eat at all (“hunger table”). To maintain water-salt metabolism, compensate for protein and vitamin deficiency, water, salt, proteins and vitamins are administered bypassing the digestive tract – intravenously. But to compensate for the losses already suffered by patients, it is possible only with large volumes of nutrient solutions, not excluding the need for the introduction of solutions that carry antibiotics, antifungal drugs, blood substitutes, which inevitably led to a supersaturation of the patient with fluids. Therefore, the restriction was solely due to nutrients, and the patient did not receive the minimum necessary. And the long postoperative recovery was not surprising.
With the development of surgical technique, approaches to nutrition were also improved. Clinical nutrition can be carried out naturally or artificially. Natural diets include therapeutic diets from natural and enriched products or artificial high-calorie balanced mixtures obtained by mouth. Artificial or clinical nutrition is divided into parenteral and enteral nutrition. Artificial nutrition involves the consumption of nutrients in an unnatural way – not through the oral cavity.
Parenteral nutrition is a method of introducing the necessary nutrients to the body directly into the blood, bypassing the gastrointestinal tract. This type is used in a hospital, usually after surgery. Calculation of nutrient ingredients is carried out by an anesthetist-resuscitator based on certain blood parameters.
Enteral nutrition delivery of nutrients directly to the gastrointestinal tract. For short-term enteral nutrition, special tubes are used – probes installed in the stomach or small intestine through the nose (nasogastric or nasojejunal). When conducting long-term nutritional support, it is customary to use surgically formed entrances to the stomach or esophagus from the chest or abdominal wall – a gastrostomy or esophagostomy.
Clinical nutrition is part of the treatment, but is used to correct disorders of protein and energy metabolism in critical conditions. Clinical nutrition is inherently wider and implies nutrition as a component of the treatment of a disease at all stages of its development. By the 90s of the last century, the principles of artificial clinical nutrition were formulated. The appointment of clinical nutrition is necessary in all cases of excess energy costs over consumption.