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Background Postoperative complications and length of hospital stay (LOS) are major issues and affect hospital costs. Enhanced Recovery After Surgery (ERAS) protocols are effective in reducing morbidity and LOS after major surgery. We propose a nutritional protocol within ERAS programs in colorectal surgery, starting from preadmission. Methods We compared the ERAS + NutriCatt approach versus the ERAS standard program adopted in our center in the previous months. Complications, LOS, hospital readmission at 30 days, and late complications (at 90 days) were assessed and compared. A cost-effectiveness analysis was performed. Results A total of 114 patients were treated according to the ERAS program between April 2015 and January 2016; 105 were enrolled in the ERAS + NutriCatt protocol from February to September 2016; Patients' characteristics were similar in the two groups, except for American Society of Anesthesiologists score, which was significantly worse in the ERAS + NutriCatt cohort; preoperative diagnoses and surgical approaches were similar in the two periods. LOS was significantly inferior in the ERAS + NutriCatt protocol (4.9 ± 1.7 d; 95% confidence interval [CI] 4.60–5.28) compared with the standard ERAS program (6.1 ± 3.9 d, 95% CI 5.36–6.81) (P = 0.006), as were postoperative complications (36, 34.3% versus 55, 48.2%; P = 0.03). Complications within 90 d were 0 in ERAS + NutriCatt and 4 in the ERAS standard cohort. Cost-effectiveness analyses indicated savings in the ERAS + NutriCatt protocol. Conclusions Nutritional care, starting from the preadmission visit, is able to reduce LOS, postoperative and late complications, and costs, in addition to ERAS standard items in colorectal surgery.

Objective This study aimed to evaluate the safety and efficacy of a specified nutritional planning after a pancreatic fistula (PF) diagnosis (1). Methods and procedures Patients with clinical or laboratory diagnosis of PF after cytoreductive surgery (CRS) for ovarian cancer at the Fondazione Policlinico “A. Gemelli” – IRCCS in Rome, were enrolled in this study. Each patient started parenteral nutrition from the 1st postoperative day (POD) and a specific diet with increasing food texture and caloric intake (mean from 600 to 1500 kcal) was decided case-by-case, according to surgeon decision. Here we present the first data from the first ten patients enrolled. Data are presented as median (IQR). Results Ten patients [age: 63 (49-66), BMI: 24.2 (20.4-25.0)] were enrolled between January and June 2020. The median of starting oral nutrition was 4 days [median: 4 (3-8)]. Both the abdominal drainages output and amylases level were reduced in all patients. Conclusion Early oral feeding, with increasing food texture and calories, seems to be a safe and efficint procedure in nutritional management of PF, aiming to reduce PF output. Therefore, a personalized early refeeding should be encouraged, aiming to reduce the PF-related complications.

Objective This study aimed to determine changes in nutritional status and their impact on clinical outcomes in elderly patients undergoing surgery for colorectal cancer (CRC), treated with the NutriCatta protocol. Methods and procedures All patients undergoing surgery for CRC at the Fondazione Policlinico “A. Gemelli” – IRCCS were treated with the NutriCatta protocol, which consists of an implementation of the ERASa protocol with a nutritional prehabilitation. Bioimpedance analysis (BIA) was performed at prehospitalization (preH), hospital admission, and discharge. All data are expressed as mean±standard deviation and the Student's t-test for paired data was used to assess statistical differences. Results Between January 2016 and December 2019, 324 patients were enrolled, 100 of which over 75 years and 224 under 75 years (mean age ± SD respectively 67.8±11.9, 80.9±4.3, 61.9±9.2). In patients over 75 years the BIA-derived Phase Angle showed an improvement between preH and admission (4.65±0.79 vs 4.95±0.85, p The mean postoperative hospital stay (POS) was not different between over 75 years and under 75 years patients (5.5±3.1 and 5.0±3.5 days, p=0.21, respectively). Conclusion NutriCatta protocol was effective in improving nutritional status before surgery for CRC in patients over 75 years, obtaining the same POS as that of under 75 years patients, thus confirming the importance of a nutritional prehabilitation to prepare fragile subjects for major abdominal surgery.

This study aimed to determine changes in body composition among patients undergoing surgery for colorectal cancer, treated with the NutriCatt protocol. All patients undergoing surgery for colorectal cancer were enrolled and treated with the NutriCatt protocol at the Fondazione Policlinico “A. Gemelli” – IRCCS in Rome. This protocol consisted of an implementation of the nutritional items included in the ERAS protocol. At pre-hospitalization anthropometrical, demographical, body composition by bioimpedance analysis and clinical data were collected and each patient was given a personalized diet. At hospital admission - the day before the surgical intervention-body composition analysis was repeated. The Student's t-test for paired data was used to assess statistical differences. 315 patients (56.7% of male) were enrolled between January 2016 and December 2018. At hospital admission Free Fat Mass (FFM) and Muscular Mass did not change compared to pre-hospitalization measurements (FFM% 74.0±8.9 to 74.3±8.7, p=0.21; MM% 34.9±7.3 to 34.6±7.3; p=0.78), while there was an amelioration of Phase Angle (PA) (5.27±0.92 to 5.42±0.91; p=0.0001), Standardized Phase Angle (SPA) (0.1±1.1 to 0.4±1.2; p=0.0002) and Body Cell Mass Index (BCMI) (9.3±1.8 to 9.8±1.8; p=0.01). The NutriCatt protocol, which was shown to reduce the length of hospital stay, the post-surgical complications and the hospitalization costs, is able to improve PA, SPA and BCMI before surgical intervention. Larger studies are required to find the optimal strategies to prepare oncological patients to surgery, which often represents only the first step of their therapeutical program.