Predictors for parenteral nutrition (PN) initiation and duration, and time to solid diet, following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC)

Abstract

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat peritoneal malignancy, and is associated with ileus and delayed nutrition after surgery¹. Consensus on parenteral nutrition (PN) protocols and best nutritional practices in this cohort is lacking^2-5. Aim(s): To evaluate data for potential predictors for PN initiation and other nutrition outcomes over a 13-month period at a single UK specialist centre, to guide individualised patient care following CRS with HIPEC. Method(s): A retrospective analysis of all patients (n=30) who underwent CRS with HIPEC at a specialist centre between February 2023-March 2024. The initiation and duration of PN, and time to solid diet were compared across CRS subcategories of organ resections and stoma formation. Data were analysed descriptively and statistically (significant at p<=0.05). Result(s): 24 of 30 patients (80%) were initiated on PN, with a mean PN duration of 14.4 days, and mean time to solid diet of 9.0 days. PN initiation was significantly likelier following small bowel (SB) resection (p=0.04) and peritonectomy (p=0.01). PN duration was significantly longer following SB resection (p<0.01), large bowel (LB) resection with SB resection (p=0.02), and stoma formation (p=0.01). Time to solid diet was significantly longer following gastrectomy (p<0.01) and stoma formation (p=0.05). No other significant associations were observed between CRS subcategories and nutritional outcomes (Table 1). [Formula presented] Conclusion(s): This analysis suggests several potential surgical predictors for PN need, PN duration, and time to solid diet following CRS with HIPEC. This may help guide individualised nutritional management of this high-risk group. References 1. Figueiroa S, Dourney A. Nutrition care for the patient undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Support Line (Chic) 2024; 46(1):2-10. 2. Reece L, Moran B, Ferrie S et al. A global analysis of nutrition support practices in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy. Clin Nutr ESPEN 2023; 57: 297-304. 3. Swain D, Yates A, Mohamed F et al. Do patients undergoing cytoreductive surgery and HIPEC for peritoneal malignancy need parenteral nutrition? Pleura Peritoneum 2018; 20180123. 4. Khan A, Beaumont A, Laing E et al. Parenteral nutrition after cytoreductive surgery for peritoneal malignancy: Should it be administered routinely? Clin Nutr ESPEN 2023; 57: 487-493. 5. Stibbard A, Brown M, Pons R et al. Factors affecting dietary progression post Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Clin Nutr ESPEN 2024: published online July 5. https://doi.org/10.1016/j.clnesp.2024.06.057 Copyright © 2025