Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) is a specialized cancer treatment for cancers that have spread to the lining of the abdominal cavity, known as the peritoneum. The procedure involves removing visible tumors from the abdominal cavity and then delivering a heated, highly concentrated chemotherapy solution to target any remaining cancer cells. Recovery after HIPEC surgery requires careful attention to various aspects of health, with diet playing a crucial role in the healing process. This article provides a comprehensive guide to dietary recommendations following HIPEC surgery, aiming to optimize recovery, minimize complications, and improve overall well-being.
Understanding HIPEC and Its Impact
HIPEC is often used for cancers that have spread to the peritoneum or cancers that start in the peritoneum. The combination of HIPEC and CRS can improve survival rates for many cancers, but it is typically reserved for people in good health whose cancer has not spread beyond the peritoneum.
The Procedure
During HIPEC, chemotherapy medicine is warmed to around 106 to 109 degrees Fahrenheit (41 to 43 degrees Celsius). Unlike traditional systemic chemotherapy, which circulates drugs throughout the body via the bloodstream, HIPEC is a more targeted approach. The procedure, combined with cytoreductive surgery, typically takes 6 to 12 hours, depending on the extent of cancer and surgical complexity.
Post-operative Care
After the procedure, patients usually stay in the hospital for a few days or longer, with full recovery potentially taking around 6 months to 1 year. Hospital providers monitor the patient's health status and administer antibiotics and pain medication as necessary. Although IV nutrition may be required initially, resuming eating solid foods is encouraged to restore bowel function as soon as possible.
The Importance of Nutrition in HIPEC Recovery
Addressing Malnutrition
Patients receiving HIPEC treatment are at risk for developing malnutrition due to tumor involvement and the risk of undernutrition if nutritional interventions are not timely or fall short of their goal. Malnutrition can lead to various health consequences, including increased length of stay (LOS) in the hospital and reduced survival rates.
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Nutritional Status and Outcomes
Studies have shown that baseline nutritional status is predictive of patient LOS and survival. Well-nourished patients tend to have shorter hospital stays and better survival rates compared to malnourished patients. Malnutrition has also been linked to increased postoperative infections.
Perioperative Nutrition
The role of perioperative nutrition in the treatment of patients undergoing CRS with HIPEC is significant. Nutrition screening, adequate protein provision (at least 1.2-2.0 g protein/kg/d), and the use of oral nutritional supplements are recommended for all patients. For those identified as malnourished, appropriate nutritional interventions, including enteral nutrition (EN) and parenteral nutrition (PN) preoperatively, are recommended as needed.
Pre-Surgery Dietary Preparation
Medical Evaluation and ERAS
Preparing for HIPEC surgery involves several steps, including a medical evaluation with blood work, cardiac assessments, and imaging scans to confirm fitness for surgery. Healthcare professionals may recommend an approach called Enhanced Recovery After Surgery (ERAS), which includes light exercise, a healthy diet, and stress management techniques. ERAS may also include help with quitting alcohol and smoking.
Diet and Fasting
Patients may need to follow a special diet or take a bowel-cleansing solution before surgery. Optimizing health before surgery is crucial for a successful outcome.
Post-Surgery Dietary Guidelines
Initial Post-operative Diet
Immediately after surgery, patients are typically given clear liquids. However, the next day, they may be encouraged to start on a diet of solid food to help restore bowel function.
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What to Eat to Heal Faster
Eating the right foods can significantly impact recovery speed. Focus on:
- Protein: Lean chicken, fish, eggs, lentils, and tofu are essential for muscle rebuilding.
- Easy-to-Digest Carbohydrates: White rice, mashed potatoes, and well-cooked pasta are gentle on the stomach and provide quick energy.
- Healthy Fats: Avocados, olive oil, and nut butters provide essential nutrients that support healing.
- Hydrating Foods: Cucumbers, watermelon, and soups keep you hydrated and aid digestion.
- Probiotics: Yogurt and kefir support gut health.
- Soft-Cooked Vegetables: Introduce fiber slowly to avoid bloating.
Foods to Avoid
Certain foods can hinder recovery and cause discomfort:
- Fried Foods: These are difficult for the stomach to digest.
- Sugary Foods: Candy, pastries, and sugary drinks can cause blood sugar spikes and energy crashes.
- Spicy Foods: Hot sauces, citrus fruits, and tomatoes can irritate the digestive system.
- Hard-to-Digest Foods: These can put unnecessary strain on the stomach.
- Carbonated Beverages: Bubbles can lead to painful bloating and gas.
- Dairy Products: Some individuals may temporarily struggle with digesting milk-based products.
- Processed Foods: Loaded with preservatives and additives, these can be tough on the stomach.
- Alcohol and Caffeine: These can irritate the gut and slow down the healing process.
Managing Common Post-operative Issues
- Prolonged Ileus: HIPEC is associated with a high incidence of prolonged ileus, requiring patients to remain nil per os (NPO) or nothing by mouth. In such cases, nutrition support is frequently required.
- Gastrointestinal Morbidity: The procedure carries a considerable risk of gastrointestinal complications, such as anastomotic leakage, fistulae, and perforations, which can further prolong inadequate oral or enteral intake.
Nutritional Support Strategies
Enteral Nutrition (EN) vs. Parenteral Nutrition (PN)
Early EN has been associated with a reduced incidence of postoperative ileus and decreased LOS for malnourished patients with gastrointestinal cancer. However, the benefits of early EN after CRS and HIPEC are not well-documented in the literature.
- Enteral Nutrition (EN): A retrospective study comparing EN and PN in patients undergoing CRS and HIPEC for pseudomyxoma peritonei showed that patients on EN had lower hospital LOS and complication rates, suggesting a benefit toward providing EN.
- Parenteral Nutrition (PN): While PN can provide necessary nutrients, it may be associated with higher complication rates compared to EN.
Calculating Nutritional Needs
Calculating nutritional needs can be challenging in cancer patients due to changes in resting energy expenditure. If resting energy expenditure cannot be measured, the general recommendation of 25-30 kcal/kg/d and 1.2-1.5 g protein/kg/d may underestimate nutritional needs after CRS with HIPEC.
Long-Term Dietary Adjustments
Adjusting to a New Normal
Life after HIPEC surgery involves adjusting to a new normal. This includes listening to your body, eating smaller meals, and being patient with yourself. If a food doesn’t sit well, allow more time for adjustment.
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Hydration
Drink water often throughout the day to stay hydrated.
High-Calorie, High-Protein Diet
Eat a high-calorie, high-protein diet to increase energy and aid healing. Small, frequent meals are recommended if you become full quickly or do not have an appetite.
Bowel Movements
Maintain regular bowel movements and avoid going more than three days without one.
Physical Activity and Recovery
Importance of Movement
Although rest is essential, moving around as much as possible is crucial to prevent complications such as blood clots.
Light Physical Activity
After surgery, people are typically encouraged to begin light physical activity, such as walking. As you get better, you can gradually increase physical activities for longer periods to restore strength and endurance.
Monitoring and Follow-Up
Regular Check-ups
It's important to attend all follow-up appointments after HIPEC surgery to help the care team catch any signs of cancer returning early.
Contacting Your Surgeon
Contact your surgeon with any questions or concerns. Staying close to home after hospitalization is advised.
The Role of a HIPEC Specialist
Finding the right doctor can make a significant difference in your recovery. Consult with a HIPEC specialist who can guide you through post-surgery care, including dietary recommendations tailored to your needs.
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