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Clin Nutr. 2017 Jun;36(3):623-650. doi: 10.1016/j.clnu.2017.02.013. Epub 2017 Mar 7.

ESPEN guideline: Clinical nutrition in surgery.

Author information

Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Delitzscher Straße 141, 04129 Leipzig, Germany. Electronic address:
San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. Electronic address:
Department of Anesthesia of McGill University, School of Nutrition, Montreal General Hospital, Montreal, Canada. Electronic address:
Department of Surgery & Palliative Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan. Electronic address:
Service de chirurgie viscérale, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Electronic address:
General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, 15 Tyniecka Street, 32-050 Skawina, Krakau, Poland. Electronic address:
Dipartimento di Medicina Clinica, Universita "La Sapienza" Roma, UOD Coordinamento Attività Nutrizione Clinica, Viale dell'Università, 00185 Roma, Italy. Electronic address:
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. Electronic address:
Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK. Electronic address:
Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L223A, Portland, OR 97239, USA. Electronic address:
Department of Gastroenterology, School of Medicine, LIM-35, University of Sao Paulo, Ganep - Human Nutrition, Sao Paulo, Brazil. Electronic address:
Institut für Ernährungsmedizin (180), Universität Hohenheim, 70593 Stuttgart, Germany. Electronic address:
Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva 49100, Israel. Electronic address:


Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include: • integration of nutrition into the overall management of the patient • avoidance of long periods of preoperative fasting • re-establishment of oral feeding as early as possible after surgery • start of nutritional therapy early, as soon as a nutritional risk becomes apparent • metabolic control e.g. of blood glucose • reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function • minimized time on paralytic agents for ventilator management in the postoperative period • early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice.


ERAS; Enteral nutrition; Parenteral nutrition; Perioperative nutrition; Prehabilitation; Surgery

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