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Preoperative identification of the surgical cancer patient in need of postoperative supportive total parenteral nutrition

In the absence of specific therapy, nutrition was the mainstay of medicine in ancient times. Because of the current emphasis on modern treatment modalities in the fight against cancer, the provision of adequate nutrition is frequently overlooked. Because of the inconsistent results obtained from randomized trials of total parenteral nutrition (TPN) in cancer patients undergoing chemotherapy and radiation therapy, ambivalence about the usefulness of TPN as an adjunct to cancer therapy (particularly as it pertains to surgical patients) is further confused by the lack of appropriate criteria for the use of TPN postoperatively. The incidence of malnutrition in relation to certain cancer types is high. Malnutrition is associated with a higher incidence of both postoperative complications and mortality when compared to the well nourished patient. Consequently, preoperative criteria were developed to identify that group of cancer patients requiring abdominal operation who are at high risk and in whom planned nutritional support should be initiated postoperatively. Use of these criteria provides a rational basis for the use of TPN postoperatively.