rpmjResearch'n Practical Medicine JournalResearch and Practical Medicine Journal2410-1893"QUASAR", LLC10.17709/2409-2231-2021-8-1-5rpmj-673Research ArticleОбзорыReviewДополнительное пероральное питание при раке желудка – обзор современной доказательной базыOral nutritional supplements for gastric cancer – the review of current evidencehttps://orcid.org/0000-0003-3752-3107ПотаповА. Л.PotapovA. L.

Потапов Александр Леонидович – д.м.н., заведующий отделом анестезиологии и реаниматологии

SPIN: 9189-4126, AuthorID: 717996

249036, г. Обнинск, ул. Королева, д. 4

Aleksandr L. Potapov – Dr. Sci. (Med.), head of the anesthesiology and resuscitation department

SPIN: 9189-4126, AuthorID: 717996

4 Korolev str., Obninsk 249036

alp8@yandex.ruhttps://orcid.org/0000-0001-8845-9913ХороненкоВ. Э.KhoronenkoV. E.

Хороненко Виктория Эдуардовна – д.м.н., доцент, заведующая отделом анестезиологии и реанимации

SPIN: 1971-6546, AuthorID: 467560

125284, г. Москва, 2-й Боткинский проезд, д. 3

Viktoriya E. Khoronenko – Dr. Sci. (Med.), associate lecturer, head of the anesthesiology and resuscitation department

SPIN: 1971-6546, AuthorID: 467560

3 2nd Botkinskiy travel, Moscow 125284

https://orcid.org/0000-0002-8509-4338ГамееваЕ. В.GameevaE. V.

Гамеева Елена Владимировна – к.м.н., заместитель директора по лечебной работе

SPIN: 9423-7155, AuthorID: 294656,

Scopus AuthorID: 6504612323, ResearcherID: AAD-3025-2020

125284, г. Москва, 2-й Боткинский проезд, д. 3

Elena V. Gameeva – Cand. Sci. (Med.), deputy director for medical work

SPIN: 9423-7155, AuthorID: 294656,

Scopus AuthorID: 6504612323, ResearcherID: AAD-3025-2020

3 2nd Botkinskiy travel, Moscow 125284

https://orcid.org/0000-0003-3258-0954ХайловаЖ. В.KhailovaZh. V.

Хайлова Жанна Владимировна – к.м.н., главный врач

249036, г. Обнинск, ул. Королева, д. 4

Zhanna V. Khailova – Cand. Sci. (Med.), head physician

4 Korolev str., Obninsk 249036

https://orcid.org/0000-0001-9565-301XДорожкинА. Д.DorozhkinA. D.

Дорожкин Артем Дмитриевич – врач анестезиолог-реаниматолог

SPIN: 3189-4950, AuthorID: 1037700

249036, г. Обнинск, ул. Королева, д. 4

Artem D. Dorozhkin – anesthesiologist-resuscitator

SPIN: 3189-4950, AuthorID: 1037700

4 Korolev str., Obninsk 249036

https://orcid.org/0000-0002-2136-1994СкоропадВ. Ю.ScoropadV. Yu.

Скоропад Виталий Юрьевич – д.м.н., ведущий научный сотрудник

SPIN: 2283-1111, AuthorID: 213297

249036, г. Обнинск, ул. Королева, д. 4

Vitaliy Yu. Skoropad – Dr. Sci. (Med.), senior researcher

SPIN: 2283-1111, AuthorID: 213297, Researcher ID: E-2200-2018

4 Korolev str., Obninsk 249036

МРНЦ им. А.Ф.Цыба – филиал ФГБУ «НМИЦ радиологии» Минздрава РоссииРоссияA.F.Tsyb Medical Radiological Research Center – Branch of the National Medical Research Radiological Center (A.F.Tsyb MRRC)Russian FederationМНИОИ им. П.А.Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава РоссииРоссияP.A.Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological CentreRussian Federation202110032021815361Copyright © Потапов А.Л., Хороненко В.Э., Гамеева Е.В., Хайлова Ж.В., Дорожкин А.Д., Скоропад В.Ю., 20212021Потапов А.Л., Хороненко В.Э., Гамеева Е.В., Хайлова Ж.В., Дорожкин А.Д., Скоропад В.Ю.Potapov A.L., Khoronenko V.E., Gameeva E.V., Khailova Z.V., Dorozhkin A.D., Scoropad V.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpmj.ru/rpmj/article/view/673

Проведен анализ современной доказательной базы, касающейся применения дополнительного перорального питания (ДПП) при раке желудка (РЖ). Использованы базы научной информации elibrary.ru и PubMed. Сделан акцент на рандомизированные клинические исследования и мета‑анализы. Назначение ДПП показано всем пациентам, планирующимся на хирургическое лечение по поводу РЖ. Его применение позволяет повысить потребление белка и энергии, улучшить качество жизни, показатели нутритивного статуса (альбумин, лимфоциты крови) и состояние иммунитета. У пациентов с тяжелой недостаточностью питания (НП) ДПП позволяет существенно снизить количество клинически значимых послеоперационных осложнений. Применение данного вида лечебного питания в первые 5 суток после операции является безопасным и не сопровождается увеличением частоты несостоятельности анастомозов. После гастрэктомии (ГЭ) его назначение сокращает время восстановления моторной функции кишечника и сроки госпитализации пациентов. После субтотальной резекции желудка (СРЖ) возможно увеличение частоты нарушений эвакуации из верхних отделов желудочно‑кишечного тракта. При исходно тяжелой НП следует рассмотреть возможность начала раннего энтерального питания. После выписки из стационара ДПП позволяет замедлить прогрессирование мальнутриции, улучшить переносимость адъювантной химиотерапии и повысить качество жизни. В наибольшей мере указанные эффекты выражены после ГЭ и у пациентов с исходно выраженным риском НП (NRS‑2002 ≥ 3). Однозначных преимуществ какого‑либо определенного вида смеси при проведении ДПП у пациентов РЖ нет. При выборе конкретного продукта следует отдавать предпочтение формулам с оптимальным соотношением азота: небелковые килокалории, осмолярностью, наиболее близкой к физиологической и индивидуально подобранными органолептическими свойствами. Следует рекомендовать потребление пациентом не менее 200–250 мл смеси в сутки, а в раннем послеоперационном периоде ориентироваться не на целевой объем, а на признаки переносимости.

The analysis of the current evidence base concerning the use of oral nutritional supplements (ONS) in gastric cancer (GC) has been made. Databases of scientific information eLIBRARY.ru and PubMed were used. Emphasis is placed on randomized clinical trials and meta‑analyses. The application of ONS is suggested for all patients who undergo to surgical treatment for GC. Its use allows increasing protein and energy consumption, improving the quality of life, some parameters of nutritional status and immunity (albumin, blood lymphocytes etc.). In patients with severe malnutrition (SM) ONS can significantly reduce the incidence of clinically important postoperative complications. The use of this type of medical nutrition in the first 5 days after surgery is safe and does not increase the rate of anastomotic leak. After gastrectomy (GE) its administration reduces the time of recovery of bowel motor function and the duration of hospitalization. After distal GE delay of gastric emptying may occur. In patients with SM, early start of enteral nutrition should be considered. After discharge from the hospital ONS can decelerate the progression of malnutrition, improve the tolerance of adjuvant chemotherapy and improve the quality of life. These effects are most clear after GE and in patients with a high risk of malnutrition (NRS‑2002 ≥ 3). There are no evident advantages of any particular type of ONS in patients with GC. When choosing a specific product, preference should be given to formulas with optimal nitrogen: non‑protein kilocalories ratio, osmolarity closest to physiological and individually selected organoleptic properties. It is recommended that the patient consume at least 200–250 ml of the mixture per day, and in the early postoperative period focus have to be made not on the target volume, but on signs of tolerability.

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The authors declare that there are no conflicts of interest present.