Invest Clin 66(1): 39 - 48, 2025 https://doi.org/10.54817/IC.v66n1a04

Corresponding author: Lingling Tao. Address: Department of Anesthesiology, Jiangsu Cancer Hospital and Jiangsu

Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, No. 42 Baiziting, Xuan-

wu District, Nanjing 210009, Jiangsu, China. Email: Taolingling2024@163.com

Clinical impact of early enteral nutrition

on postoperative pain, gastrointestinal

function and nutritional status in colorectal

cancer patients.

Yue Qin, Ping Yuan and Lingling Tao

Department of Anesthesiology, Jiangsu Cancer Hospital and Jiangsu Institute

of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University,

Nanjing, Jiangsu, China.

Keywords: colorectal cancer; early enteral nutrition; postoperative pain; analgesic

pump.

Abstract. This research aimed to clarify the clinical impact of early enteral nu-

trition (EN) on postoperative pain, gastrointestinal function and nutritional status

of colorectal cancer (CRC) patients. Eighty rectal cancer patients undergoing sur-

gery in our hospital from October 2021 to October 2023 were selected as research

subjects and divided into an experimental group (EG) and a control group (CG)

using a random number table method, with 40 cases each. Both groups received

conventional nursing, including preoperative, intraoperative, and postoperative

nursing. The CG received a traditional preoperative routine diet and postoperative

EN support. The EG received five-day preoperative EN support and postoperative

parenteral nutrition support based on a traditional preoperative routine diet. The

analgesic effect indicators, pain scores, gastrointestinal function recovery indica-

tors, adverse reactions and nutritional indicators in both groups received measure-

ment and comparison. The Average additional amount of flurbiprofen axetil in the

EG decreased relative to those in the CG (p<0.05). At six h and 12 h after surgery,

VAS scores in the EG were lower than those in the CG during the same period; at

24 h and 48 h after surgery, no statistical significance in VAS scores was shown be-

tween both groups (p>0.05). The bowel sound recovery time, first defecating time,

first exhaust time, and first getting-out-of-bed time in EG were inferior relative to

those in the CG (p<0.05). The incidence of adverse reactions in the EG was reduced

relative to that in the CG (p<0.05). Before surgery and one day after surgery, no

statistically significant differences in total protein (TP) and serum albumin (ALB)

levels were shown between both groups (p>0.05); three days and seven days after

surgery, TP and ALB levels in the EG exhibited an elevation relative to those in CG

during the same period (p<0.05). In conclusion, early EN can improve not only

postoperative gastrointestinal function and nutritional status of patients but also

mitigate postoperative pain and facilitate postoperative recovery with high safety,

which is worthy of further clinical promotion.

40 Qin et al.

Investigación Clínica 66(1): 2025

Impacto clínico de la nutrición enteral temprana sobre el dolor

post-quirúrgico, función gastrointestinal y estado nutricional

de pacientes con cáncer colorrectal.

Invest Clin 2025; 66 (1): 39 – 48

Palabras clave: cáncer colorrectal; nutrición enteral temprana; dolor postoperatorio;

bomba analgésica.

Resumen. Esta investigación tuvo como objetivo aclarar el impacto clíni-

co de la nutrición enteral temprana (EN) en el dolor posoperatorio, la función

gastrointestinal y el estado nutricional de los pacientes con cáncer colorrectal

(CCR). Se seleccionaron ochenta pacientes con cáncer de recto sometidos a

cirugía en nuestro hospital desde octubre de 2021 hasta octubre de 2023 como

sujetos de investigación y se dividieron en un grupo experimental (GE) y un

grupo de control (GC) utilizando un método de tabla de números aleatorios,

con 40 casos cada uno. Ambos grupos recibieron enfermería convencional, in-

cluida enfermería preoperatoria, intraoperatoria y posoperatoria. El GC recibió

una dieta de rutina preoperatoria tradicional y apoyo de EN posoperatorio. El

GE recibió apoyo de EN preoperatoria durante cinco días y apoyo de nutrición

parenteral posoperatoria basado en una dieta de rutina preoperatoria tradicio-

nal. Los indicadores de efecto analgésico, las puntuaciones de dolor, los indica-

dores de recuperación de la función gastrointestinal, las reacciones adversas y

los indicadores nutricionales en ambos grupos recibieron medición y compara-

ción. La cantidad adicional promedio de flurbiprofeno axetilo en el GE mostró

un descenso en relación con los del GC (p<0,05). A las seis y 12 h después de

la cirugía, las puntuaciones VAS en el GE fueron inferiores a las del GC durante

el mismo período; a las 24 y 48 h después de la cirugía, no hubo significación

estadística en las puntuaciones VAS entre ambos grupos (p>0,05). El tiempo

de recuperación del sonido intestinal, el tiempo de la primera defecación, el

tiempo del primer escape y el tiempo del primer levantamiento de la cama en

el GE fueron inferiores en relación con los del GC (p<0,05). La incidencia de

reacciones adversas en el GE se redujo en relación con la del GC (p<0,05).

Antes de la cirugía y un día después de la cirugía, no se mostraron diferencias

estadísticamente significativas en los niveles de proteína total (TP) y albúmina

sérica (ALB) entre ambos grupos (p>0,05); tres y siete días después de la ciru-

gía, los niveles de TP y ALB en el GE exhibieron una elevación en relación con

los del GC durante el mismo período (p<0,05). En conclusión, la EN temprana

puede mejorar no solo la función gastrointestinal posoperatoria y el estado nu-

tricional de los pacientes, sino también mitigar el dolor posoperatorio y facili-

tar la recuperación posoperatoria con alta seguridad, lo que merece una mayor

promoción clínica.

Received: 16-10-2024 Accepted: 14-12-2024

Early enteral nutrition in surgical treatment of colorectal cancer patients 41

Vol. 66(1): 39 - 48, 2025

INTRODUCTION

Colorectal cancer (CRC) is a prevalent

malignant gastrointestinal tumor in clinical

practice, and CRC patients all suffer from

varying degrees of malnutrition 1. Tumor

cachexia, the primary reason for malnutri-

tion in tumor patients, often results from

metabolic abnormalities and reduced food

intake, characterized by a negative ba-

lance between energy and protein metabo-

lism2,3. Malnutrition can attenuate patients’

immune systems and quality of life, elevate

surgery-related complications, and even en-

hance the mortality rate 4. The nutritional

metabolism of CRC patients has common

characteristics in most malignancies, such

as insulin resistance, lipid peroxidation,

accelerated protein conversion, and eleva-

ted acute phase protein synthesis, among

others5. On the other hand, gastrointestinal

dysfunction is a unique cause of malnutri-

tion in CRC patients 6. Thus, CRC patients

are more likely to suffer from malnutrition

and weakened immune function. Furthermo-

re, high metabolic status, prolonged fasting,

and impaired intestinal mucosal barrier and

immune function due to surgical treatment

further deteriorate the nutritional status of

CRC patients, thereby affecting postoperati-

ve recovery and reducing their quality of life

7,8. Thus, adequate and reasonable nutritio-

nal interventions during the perioperative

period have become a crucial component of

comprehensive treatment for CRC.

For patients who plan to undergo the-

rapeutic surgery but have preoperative mal-

nutrition or nutritional risks, enteral nutri-

tion (EN) support or combined enteral and

parenteral nutrition (PN) support treatment

is preferred 9,10. The therapeutic effect of nu-

trition support should be directly reflected

in improving postoperative gastrointestinal

function and elevation of the nutritional

status. In clinical practice, open surgery is

usually applied to treat CRC patients, whe-

reas surgery takes quite a long time and can

result in remarkable trauma to patients; pa-

tients often have to endure pain, especially

during bowel movements, which often makes

them hesitant to undergo surgery 11,12. Thus,

effective nutritional intervention remains

necessary to control postoperative pain.

This research aimed to clarify the clini-

cal impact of early EN on postoperative pain,

gastrointestinal function and nutritional

status of CRC patients, which may guide

postoperative nursing work for gastrointes-

tinal tumors.

MATERIALS AND METHODS

General data

Eighty rectal cancer patients under-

going surgery in our hospital from October

2021 to October 2023 were selected as re-

search subjects and divided into an expe-

rimental group (EG) and a control group

(CG) using a random number table method,

with 40 cases each. Inclusion criteria: 1)

Age ranging from 50-70 years old; 2) major

clinical manifestations including changes in

bowel habits and stool characteristics, abdo-

minal discomfort, abdominal masses, intes-

tinal obstruction, anemia, etc.; 3) diagnosed

as rectal cancer through colonoscopy and

histopathological examination, and all un-

derwent anterior resection of the rectum as

clinical therapy; 4) the patient’s condition

was stable, conscious, and had good com-

munication and expression abilities; 5) all

were informed of this research and signed

an informed consent. Exclusion criteria: 1)

Those with advanced rectal cancer, severe li-

ver and kidney dysfunction, and intestinal in-

flammation; 2) emergency surgery, conver-

sion to laparotomy, and inability to establish

pneumoperitoneum during surgery; 3) pa-

tients with blurred consciousness, cognitive

and communication barriers, mental illness;

and 4) female patients during pregnancy

and childbirth. This research received appro-

val from our hospital’s ethics committee.

42 Qin et al.

Investigación Clínica 66(1): 2025

METHODS

Both groups received conventional

nursing, including preoperative, intraopera-

tive, and postoperative nursing.

Preoperative nursing: (1) Preopera-

tive education: After patients were admit-

ted, nursing staff informed the patients of

the approximate stage and time of treat-

ment and explained the importance of early

postoperative activities. They were provided

timely guidance for different psychologi-

cal problems, patiently answered patients’

doubts about treatment, and helped patients

smoothly pass through the perioperative

period. (2) Preoperative intestinal prepara-

tion: A semi-liquid or low-residue diet was

administered one day before surgery. Then,

750 mL of glucose water was administered

to patients ten and two hours before surgery.

Fasting and water deprivation occurred six

and two hours before surgery, and no gastro-

intestinal decompression tube was placed.

Intraoperative nursing: The Dixon sur-

gery procedure (transabdominal radical re-

section of the rectum) was used as a surgical

method performed under general anesthe-

sia. An intraoperative insulation blanket was

used during surgery to prevent hypothermia.

Infusion and flushing liquids received appro-

priate warming.

Postoperative nursing: (1) Analgesia:

Postoperative patients received patient-con-

trolled intravenous analgesia (PCA) inter-

vention. The analgesic pump formula was:

Flurbiprofen axetil (150 mg) + Dezocine (50

mg) + Tropisetron (8 mg) + Dexmedetomi-

dine (60 ug) + normal saline (100 mL). The

analgesic pump speed was 1.2-1.5 mL/h,

with patient-controlled speed at around 1.5

mL/h, with a locking time of 15 min. When

the patient’s pain index was relatively high,

and PCA was inadequate to mitigate it, flur-

biprofen axetil could be added each time ad-

ditionally.

Nursing staff created an analgesic pump

usage card, and after patients returned to

the ward, provided a detailed introduction to

the working principle, usage method, and ad-

verse reactions of the analgesic pump to pa-

tients and their family members, improving

patients and their family members’ predict-

ability of adverse reactions and preventing

severe complications that might endanger

patients’ life safety. Nursing staff improved

acute pain work mode. All nursing staff regu-

larly inquired about and evaluated patients’

postoperative pain, responded promptly to

patients’ pain, provided timely feedback to

ensure that doctors administered expedi-

ent treatment and analgesic intervention,

and summarized clinical medication effects

to improve medication plans continuously.

(2) Tube management: antibiotics were ad-

ministered 2-3 days after surgery to shorten

the retention time of drainage tubes and

related catheters. According to wound heal-

ing, urinary catheters and nasogastric tubes

were removed within 24-48 hours after sur-

gery, and drainage tubes were removed on

the fifth day after surgery. (3) Postoperative

activities: 12 hours after surgery, patients

engaged in bed activities such as turning

over and sitting under a doctor’s or nurse’s

guidance. The next day after surgery, nurs-

ing staff encouraged and guided patients to

engage in getting-out-of-bed activities.

Nutrition intervention: The Experi-

mental Group (EG) received postoperative

early enteral nutrition (EN) based on a stan-

dard preoperative routine diet. In contrast,

the Control Group (CG) received standard

total parenteral nutrition (TPN) support

for seven days following surgery. The to-

tal liquid intake for both groups was 50

ml·kg⁻¹·d⁻¹, with energy provided at a rate

of 105 kJ·kg⁻¹·d⁻¹ and nitrogen intake at 0.2

g·kg⁻¹·d⁻¹. The nitrogen-to-calorie ratio was

1:552 kJ. Nutritional support was provided

as a “fully-integrated” solution administered

via peripheral veins. The EG received the

same caloric and nitrogen intake as the con-

trol group. 500 mL of Nutrison Fibre (NU-

TRICIA) was administered on the first day

after surgery. On the second day, the volume

increased to 1000 mL; from the third to the

Early enteral nutrition in surgical treatment of colorectal cancer patients 43

Vol. 66(1): 39 - 48, 2025

seventh day, 1500 mL of Nutrison Fibre was

given daily. Nutrison Fibre supplied 4180 kJ

of calories, 40 g of protein, and 6.4 g of ni-

trogen per 1000 mL, and it also contained

vitamins, dietary fiber, and microelements.

After recovery of gastrointestinal function,

the diet should gradually transition from liq-

uid or semi-liquid to general.

Observation indicators

1. Analgesic effect indicators: The average

additional amount of Flurbiprofen axe-

til in both groups was recorded.

2. Pain scores: The pain degree in both

groups at six, 12, 24, and 48 hours af-

ter surgery received evaluation with

the Visual Analog Pain Scale (VAS) 13.

Patients’ pain scores during rest and

activity (coughing, turning over, deep

breathing, etc.) were recorded, with

a score range of 0-10 points. A score

of 0-3 points indicated mild pain, 4-6

points indicated moderate pain, and

7-10 points indicated severe pain.

3. Gastrointestinal function recovery indi-

cators: The bowel sound recovery time,

first defecating time, first exhaust

time, and first getting-out-of-bed time

in both groups were recorded.

4. Adverse reactions: Both groups’ adver-

se reactions (majorly vomiting and nau-

sea) received recording.

5. Nutritional indicators: The total pro-

tein (TP) and serum albumin (ALB) le-

vels in both groups before surgery and

1, 3, and 7 days after surgery were mea-

sured with a colorimetric method.

STATISTICAL ANALYSIS

Statistical analysis of data of this re-

search was performed with the SPSS 27.0®

software. Counting data were expressed as

%, followed by the χ2 test for intergroup com-

parisons. Measurement data conforming to a

normal distribution were expressed as mean

± standard deviation ( ± SD), followed by

t-tests for intergroup comparisons. The dif-

ference was statistically significant when p

< 0.05.

RESULTS

Comparison of general data between both

groups

The CG included 25 (62.50%) males

and 15 (37.50%) females with a mean age

of 58.84 ± 4.47 years. Based on TNM sta-

ging, 17 (42.50%) cases were in stage I, 13

(32.50%) were in stage II, and 10 (25.00%)

were in stage III. The examination of co-

morbidities in CG patients showed that se-

ven (17.50%) patients had hypertension and

nine (22.50%) patients had diabetes. EG in-

cluded 22 (55.00%) males and 18 (45.00%)

females with a mean age of 59.24±4.40

years. Based on TNM staging, 18 (45.00%)

cases were in stage I, 14 (35.00%) were in

stage II, and eight (20.00%) were in stage III,

and the examination of co-morbidities in EG

patients showed that five (12.50%) patients

had hypertension and 10 (25.00%) patients

had diabetes. No statistical significance in

gender, age, TNM staging, and comorbidities

was found in the two groups (Table 1).

Table 1

General data in both groups.

Groups N

Gender [n (%)]

Age (years)

TNM staging [n (%)] Comorbidities [n (%)]

Male Female I II III Hypertension Diabetes

CG 40 25 (62.50) 15 (37.50) 58.84±4.47 17 (42.50) 13 (32.50) 10 (25.00) 7 (17.50) 9 (22.50)

EG 40 22 (55.00) 18 (45.00) 59.24±4.40 18 (45.00) 14 (35.00) 8 (20.00) 5 (12.50) 10 (25.00)

χ2/t 0.464 0.896 0.288 0.406

p 0.496 0.373 0.866 0.816

44 Qin et al.

Investigación Clínica 66(1): 2025

Comparison of analgesic effect indicators

between both groups

The average additional amount of Flur-

biprofen axetil in EG was lower than in the

CG, and there was a significant statisti-

cal difference between the two groups (p<

0.0001) (Fig.1).

Fig. 1. Analgesic effect indicators in both groups.

Note: EG versus CG, ****P<0.0001.

Comparison of pain scores between both

groups

At six hours and 12 hours after surgery,

VAS scores in the EG were inferior to those in

CG during the same period, indicating a sta-

tistical significance difference (p < 0.001).

At 24 h and 48 h after surgery, neither group

exhibited statistically different significance

in VAS scores (Fig. 2).

Fig. 2. Pain scores in both groups of patients.

Note: EG versus CG, ns=no significance.***p<0.001.

Comparison of gastrointestinal function

recovery indicators between both groups

The bowel sound recovery time, first

defecating time, first exhaust time, and first

getting-out-of-bed time in the EG were re-

duced relative to those in CG, indicating

a statistical significance difference (p<

0.0001) (Fig. 3).

Fig. 3. Gastrointestinal function recovery indica-

tors in both groups.

Note: EG versus CG .****p<0.0001.

Comparison of incidence of adverse

reactions between both groups

The incidence of adverse reactions

in EG was lower than in the CG, indicat-

ing a statistical significance difference (p<

0.043) (Table 2).

Comparison of nutritional indicators

between both groups

Before surgery and one day after sur-

gery, no statistically significant difference in

TP and ALB (borrowed protein) levels was ex-

hibited between both groups. At three days

and seven days after surgery, TP and ALB lev-

els in EG were elevated relative to those in

the CG during the same period, indicating

statistical significance (p<0.001) (Fig. 4).

6 h after surgery

12 h after surgery

24 h after surgery

48 h after surgery

Time period

VAS scores (points)

*** *** ns

CG EG CG EG

Early enteral nutrition in surgical treatment of colorectal cancer patients 45

Vol. 66(1): 39 - 48, 2025

DISCUSSION

CRC patients often have varying de-

grees of malnutrition or risk of malnutrition

before surgery. Currently, tumor cachexia,

the primary reason for malnutrition in tu-

mor patients, often results from metabolic

abnormalities and reduced food intake; its

primary feature is the negative balance be-

tween energy and protein metabolism. Re-

search has depicted that symptoms and signs

such as anorexia, emaciation, and weight

loss due to imbalanced nutritional needs

and intake by metabolic abnormalities and

reduced food intake in patients often cannot

be wholly reversed through individual nutri-

tional interventions 14.

CRC patients often experience abnor-

mal intestinal function 15. Before providing

nutrition support to patients, appropriate

nutrition support pathways should be se-

lected based on their intestinal function.

Nutrition support therapy majorly includes

EN and PN. PN is the major nutrition sup-

port pathway, which can keep the intestine

in a relatively static state of function and

provide timely supplement nutrients needed

by the body, which is beneficial for the re-

covery of damaged intestines 16,17. Neverthe-

less, long-term total PN support can lead to

intestinal mucosal atrophy, weakened muco-

sal barrier function, and translocation of in-

testinal microbiota, inducing complications

such as enterogenous infections 18. Thus, EN

is preferred for patients who require nutri-

tion support for therapy. EN support is in-

expensive and more in line with physiology,

which can stimulate secretion of digestive

Table 2. Incidence of adverse reactions in both groups.

Groups N Nausea Vomiting Others Total incidence of adverse reactions [n (%)]

CG 40 5 3 0 8 (20.00)

EG 40 1 1 0 2 (5.00)

χ2 / / / 4.114

p / / / 0.043

Fig. 4. Nutritional indicators in both groups.

Note: EG versus CG, ns=no significance, ***p<0.001.

46 Qin et al.

Investigación Clínica 66(1): 2025

fluids and gastrointestinal hormones, fa-

cilitate gastrointestinal peristalsis and gall-

bladder contraction, elevate intestinal blood

flow, maintain normal growth of mucosal

cells and gut microbiota, help maintain the

integrity of chemical, mechanical, and im-

mune barriers of the intestinal mucosa, and

reduce complications, which is conducive to

improving the overall state of patients 19,20.

Herein, the CG only received TPN after sur-

gery, while the EG received early EN before

and after surgery. The results depicted that

bowel sound recovery time, first defecating

time, first exhaust time, and first getting-

out-of-bed time in the EG were diminished

relative to those in the CG, indicating that

early EN probably can facilitate the recovery

of gastrointestinal function of patients and

further ameliorate their nutritional status,

which better meets the nutritional and gas-

trointestinal needs of CRC patients.

Surgery is a major treatment for non-

terminal stage CRC, and comprehensive

treatments such as surgery and psychologi-

cal elements can lead to a high metabolic

stress state in the body after surgery, which

can further worsen malnutrition. Research

has demonstrated that tumor patients with

preoperative malnutrition have remarkably

higher incidence and mortality rates of post-

operative complications relative to those

with good nutritional status 21,22. Serum pro-

tein levels are the most commonly applied

indicators reflecting the nutritional status

of patients, including TP and ALB. In this re-

gard, no statistically significant differences

in TP and ALB levels were observed between

both groups before and one day after sur-

gery. Three and seven days after surgery, TP

and ALB levels in EG were elevated relative

to those in the CG during the same period,

indicating that early EN probably can facili-

tate visceral protein synthesis and enhance

the overall nutritional status of patients.

Postoperative pain, as a complication

of surgery, has always been a hot research

topic that needs urgently to be solved in

clinical, surgical patients after surgery, and

also a vital factor affecting the degree of

postoperative recovery and psychological

stress state of patients 23. Common Western

medicine pain relief methods after surgery

include epidural analgesia, patient-con-

trolled analgesia, and oral opioid analge-

sics, among others. Herein, both groups

received PCA intervention, and in addition,

Nutrison Fibre was chosen for the EG as an

alternative diet for early nutritional inter-

vention. The results showed that the aver-

age additional amount of flurbiprofen axetil

in the EG was lower relative to those in CG.

Within 24 hours after surgery, VAS scores

in the EG were lower than those in the CG

during the same period. No statistically sig-

nificant difference in VAS scores was shown

between both groups 24 hours later, indi-

cating that early EN probably reduces the

additional amounts of analgesics and miti-

gates patients’ pain levels. Moreover, the

incidence of adverse reactions in the EG

was reduced relative to that in the CG, indi-

cating that early EN probably can attenuate

adverse gastrointestinal events in patients,

improve the safety of postoperative use of

analgesic pumps, and thereby enhance the

prognosis of patients.

In conclusion, early EN can improve pa-

tients’ postoperative gastrointestinal func-

tion and nutritional status, mitigate post-

operative pain, and facilitate postoperative

recovery with high safety, which is worthy of

further clinical promotion.

Limitation

The subjective method using the nutri-

tional screens (GLIM, MUST, NSR) was im-

possible due to the time limit.

Conflict of interest

The authors declare no conflict of inter-

est.

Source of funding

None.

Early enteral nutrition in surgical treatment of colorectal cancer patients 47

Vol. 66(1): 39 - 48, 2025

Contribution of authors

All authors have been contributed

equally to this research article.

Authors´ ORCID

• Yue Qin: 0000-0002-5650-0149

• Ping Yuan: 0000-0002-6135-5660

• Lingling Tao: 0000-0002-2928-0902

REFERENCES

1. Wu T, Xu H, Li W, Zhou F, Guo Z, Wang K,

Weng M, Zhou C, Liu M, Lin Y, Li S, He Y,

Yao Q, Shi H, Song C; Investigation on Nu-

trition Status and its Clinical Outcome of

Common Cancers (INSCOC) Group. The

potential of machine learning models to

identify malnutrition diagnosed by GLIM

combined with NRS-2002 in colorectal

cancer patients without weight loss infor-

mation. Clin Nutr 2024; 43(5):1151-1161.

doi: 10.1016/j.clnu.2024.04.001.

2. Loyala JV, Down B, Wong E, Tan B.

Treatment of Cachexia in Gastric Cancer:

Exploring the Use of Anti-Inflammatory

Natural Products and Their Derivatives.

Nutrients 2024 ;16(8):1246. doi: 10.3390/

nu16081246.

3. Malta FAPS, Gonçalves DC. A triple-

masked, two-center, randomized parallel

clinical trial to assess the superiority of

eight weeks of grape seed flour supple-

mentation against placebo for weight loss

attenuation during perioperative period

in patients with cachexia associated with

colorectal cancer: a study protocol. Front

Endocrinol (Lausanne) 2024;14:1146479.

doi: 10.3389/fendo.2023.1146479.

4. Sowerbutts AM, Burden S, Sremanako-

va J, French C, Knight SR, Harrison EM.

Preoperative nutrition therapy in people un-

dergoing gastrointestinal surgery. Cochra-

ne Database Syst Rev 2024;4(4):CD008879.

doi: 10.1002/14651858.CD008879.pub3.

5. Yang M, Zhang Q, Ge YZ, Tang M, Zhang

X, Song MM, Ruan GT, Zhang XW, Zhang

KP, Shi HP. Association between insulin re-

sistance related indicators with the prog-

nosis of patients with colorectal cancer.

Cancer Epidemiol. 2023 Dec;87:102478.

doi: 10.1016/j.canep.2023.102478.

6. Lai Y, Masatoshi H, Ma Y, Guo Y, Zhang

B. Role of Vitamin K in Intestinal Health.

Front Immunol 2022;12:791565. doi: 10.

3389/fimmu.2021.791565.

7. Yu S, Wang X, Li Z, Jin D, Yu M, Li J, Li

Y, Liu X, Zhang Q, Liu Y, Liu R, Wang X,

Fang B, Zhang C, Wang R, Ren F. Solo-

bacterium moorei promotes the progres-

sion of adenomatous polyps by causing

inflammation and disrupting the intestinal

barrier. J Transl Med 2024;22(1):169. doi:

10.1186/s12967-024-04977-3.

8. Wu N, Feng YQ, Lyu N, Wang D, Yu WD,

Hu YF. Fusobacterium nucleatum pro-

motes colon cancer progression by chang-

ing the mucosal microbiota and colon

transcriptome in a mouse model. World

J Gastroenterol. 2022;28(18):1981-1995.

doi: 10.3748/wjg.v28.i18.1981.

9. Loon MM, Goshe M, Rashid M, Sheh-

ryar A, Rehman A, Abdallah S, Baluch

SK, Ahmed A, Batat H, Quinn M. Im-

pact of Preoperative Nutritional Support

on Surgical Outcomes in Gastrointestinal

Surgeries: A Systematic Review. Cureus

2024;16(3):e56416. doi: 10.7759/cureus.

56416.

10. Wang C, Yang D. Effect of different pre-

operative nutritional treatments on

postoperative recovery and clinical out-

comes in patients with gastric cancer

and early gastric outlet obstruction. On-

col Lett 2024;27(5):214. doi: 10.3892/

ol.2024.14348.

11. Sun XJ, Feng TC, Wang YM, Wang F,

Zhao JB, Liu X, Li FL. The effect of the

enhanced recovery after surgery protocol

and the reduced use of opioids on posto-

perative outcomes in elderly patients with

colorectal cancer. Eur Rev Med Pharma-

col Sci 2023; 27(20):10053-10060. doi:

10.26355/eurrev_202310_34185.

12. Qi L, Shi H, Zhang Y, Zhang X, Jia H, Tian

H. The effect of acupuncture on recovery

after colorectal cancer resection: A sys-

tematic review meta-analysis of randomi-

48 Qin et al.

Investigación Clínica 66(1): 2025

zed controlled trials. Medicine (Baltimo-

re) 2023;102(35):e34678. doi: 10.1097/

MD.0000000000034678.

13. Lu DH, Xu XX, Zhou R, Wang C, Lan LT,

Yang XY, Feng X. Ultrasound-guided ste-

llate ganglion block benefits the posto-

perative recovery of patients undergoing

laparoscopic colorectal surgery: a single-

center, double-blinded, randomized con-

trolled clinical trial. BMC Anesthesiol

2024;24(1):137. doi: 10.1186/s12871-024

-02518-5.

14. Jakobsen DD, Brader L, Bruun JM. Effect

of a higher protein diet and lifestyle camp

intervention on childhood obesity (The

COPE study): results from a nonrandomi-

zed controlled trail with 52-weeks follow-

up. Eur J Nutr 2024. doi: 10.1007/s00394-

024-03420-z.

15. Wu Z, Xiao C, Long J, Huang W, You F,

Li X. Mitochondrial dynamics and colo-

rectal cancer biology: mechanisms and

potential targets. Cell Commun Signal

2024 ;22(1):91. doi: 10.1186/s12964-024-

01490-4.

16. Tong Y, Sun J, Xin W, Chen L, Kong S,

Mi X, Feng Y, Jin W, Wu Y, Ding H, Fang

L. Pharmacist-led standardization of total

parenteral nutrition improves postoperati-

ve nutritional status in colorectal cancer

patients. Ann Transl Med 2022;10(6):339.

doi: 10.21037/atm-22-1172.

17. López-Rodríguez-Arias F, Sánchez-Gui-

llén L, Lillo-García C, Aranaz-Ostáriz V,

Alcaide MJ, Soler-Silva Á, Soriano-Iriga-

ray L, Barber X, Arroyo A. Assessment

of Body Composition as an Indicator of

Early Peripheral Parenteral Nutrition The-

rapy in Patients Undergoing Colorectal

Cancer Surgery in an Enhanced Recovery

Program. Nutrients 2021;13(9):3245. doi:

10.3390/nu13093245.

18. Kirupananthan D, Bertolo RF, Brunton

JA. Lysine Dipeptide Enhances Gut Struc-

ture and Whole-Body Protein Synthesis

in Neonatal Piglets with Intestinal Atro-

phy. J Nutr 2022 ;152(8):1843-1850. doi:

10.1093/jn/nxac095.

19. Dijk S, Jarman M, Zhang Z, Lawley M,

Ahmad M, Suarez R, Rossi L, Chen M,

Wu J, Carroll MW, Otley A, Sherlock

M, Mack DR, Jacobson K, deBruyn JC,

El-Matary W, Deslandres C, Rashid M,

Church PC, Walters TD, Huynh HQ, Su-

rette MG, Griffiths AM, Wine E; Cana-

dian Children IBD Network. Pre-Diagnosis

Diet Predicts Response to Exclusive En-

teral Nutrition and Correlates with Mi-

crobiome in Pediatric Crohn Disease. Nu-

trients 2024;16(7):1033. doi: 10.3390/

nu16071033.

20. Bar-Yoseph H, Metcalfe-Roach A, Cirstea

M, Finlay BB. Microbiome changes under

enteral deprivation are dynamic and de-

pendent on intestinal location. JPEN J Pa-

renter Enteral Nutr 2024;48(4):502-511.

doi: 10.1002/jpen.2624.

21. Hou TY, Lin YH, Liu YW, Liu YY, Li WF,

Kuo MC, Huang SW, Ye h ChH, Lin YCh,

Yin ShM. The impact of preoperative nutri-

tional status on postoperative outcomes:

an insight from Geriatric Nutritional Risk

Index in elderly pancreaticoduodenectomy

patients. BMC Surg 2024; 24: 100. https://

doi.org/10.1186/s12893-024-02397-0

22. Herzog I, Panchal D, Sikder S, Park JB,

Mendiratta D, Mansukhani PA, Lee ES.

Malnutrition in Head and Neck Free Flap

Reconstruction as a Predictor of Adverse

Outcomes. Ann Plast Surg 2024;92(4S

Suppl 2):S251-S254. doi: 10.1097/SAP.000

0000000003868.

23. Acharya R, Blackwell S, Simoes J, Harris

B, Booth L, Bhangu A, Glasbey J. Non-

pharmacological interventions to impro-

ve sleep quality and quantity for hospi-

talized adult patients-co-produced study

with surgical patient partners: systematic

review. BJS Open 2024;8(2):zrae018. doi:

10.1093/bjsopen/zrae018.