Denutrition and postoperative infection in cancer patients.

Denutrition decreases immunological responses of non-cancer patients. the h ealing is altered whereas infectious complications increase. Now during hos pitalization, malnutrition prevails in cancer patients. The suppression of the adaptability to fasting which reduces the expenditure of energy at rest , an anormal metabolic response to nutrients' supply with the impossibility to compensate totally the metabolic deficits with the artificial nutrition alone, raise the fear of postoperative disorders, particularly an increase of the infectious risk. The key point is therefore to identify the cachexi a's degree owing to a simple, predictive and consensual index. This check-u p allows a postoperative complications' prevention by starting up a periope rative refeeding in high-risk subjects: that is to say all severe wasting p atients, the people booked for a severe surgical procedure, especially for oesophageal and gastric neoplasms. Actually, we consider that the quality o f the results depend more on the making up of the different nutritional sol utions dispensed than to strictly providing for cancer patients' wants, whi ch could be harmful in the postoperative period. Supplementation with antio xidant micronutrients or arginine, glutamine, ribonucleic acids and omega - 3 fatty acids would allow an immuno- modulation of the renutrition. But com plications strictly due to preoperative denutrition are still to be establi shed. (C) 2000 Editions scientifiques et medicales Elsevier SAS.