Smart for Surgery℠

Most patients have much more control of their operation outcome than they think. What can you do to improve your outcome?

1.Eat Well

2.Quit Smoking

3.Quit alcohol

4.Walk a lot

5.See your family doctor

Eat Well

Proper nutrition plays a key role in both the prevention and treatment of many chronic diseases, including gastrointestinal conditions and cancer.

Despite excessive food availability in the USA, quality nutrition is difficult to obtain, and thus most of us suffer from some degree of nutritional imbalance. The most common include obesity, calcium and vitamin D deficits. Cancer patients are especially prone to malnutrition because of poor intestinal function, chemotherapy effect or direct parasitic effect of cancer on the body.

Nutrition and nutritional supplements remain target of pseudo-science, ‘guarantees’, and excessive marketing. This section of the website focuses on some special aspects - especially nutrition before surgery. Recommended links for other topics:

  1. Bullet nutrition during cancer treatment (NCI/NIH)

  2. Bulletdietary guideline for Americans (NLM)

  3. BulletAmerican Cancer Society guidelines for nutrition (ACS)

Nutrition Before Surgery: Research in past decades documented, that substantial improvements in surgical outcomes can be obtained by changes in nutrition. Plethora of terms awaits anyone exploring this arena, like prebiotic, probiotics, synbiotics, organics, immunonutrition, etc. Recommendations:

  1. Bulleteat diet high in protein

  2. Bulletdrink plenty of water. Sport drinks (such as Gatorade) are great. Stimulation drinks (such as Monster) are bad before surgery.

  3. Bulletspecial nutrition prior to surgery improves healing and decrease risk of infections. It should be taken 5-10 days prior to operation. Both poorly nourished and well-nourished people benefit from it. Most data are available on Impact nutrition, available in most healthcare supply stores, but usually not in food stores. Ensure, Boost, Carnation and similar are also a good choice (can be purchased in any food store or pharmacy)

Nutrition After Surgery:

  1. Bulletdischarge instruction are provided in the hospital

  2. Bulletagain, eat diet high in protein

  3. BulletBoost, Ensure and Impact nutritional products are optional

  4. Bulletavoid excess dairy products for the first week - it is usually difficult to digest it so early. Add yoghurt and milk products gradually.

  5. Bulletdo not force your food (no overeating)

  6. Bulletif you cannot drink or eat anything for half a day, your should call your doctor’s office

  7. Bulletit may take 6-12 weeks to get energy back

Quit Smoking

Smoking increases the risk of any operation. Any decrease in smoking, even for as little as 4 weeks before operation lowers your risk closer to normal. Problems commonly linked to smoking and surgery:

  1. BulletMakes it harder to breath.

  2. BulletLung infections are more common.

  3. BulletYour are more likely to have wound infection and/or hernia

  4. BulletHigher risk of heart attach and stroke

  5. BulletNicotine replacements (patch, chewing gum) remain associated with poor healing.

Stop smoking. Get help here.

Quit Alcohol

Alcohol damages your liver and makes you prone for delirium. It interacts with anesthesia and pain medications. Overuse and abuse of alcohol is more common than one thinks. If you drink any amount regularly, get screened by your family doctor. Get help here.

Walk a lot. Exercise.

  1. Bulletphysical fitness remains one of the strongest predictors of recover from surgery or any cancer treatment. Even walking, if done daily, is very beneficial. Walking at least for 1 mile is recommended.

  2. Bulletexcessive training - marathon, triathlon, etc - is discouraged one week prior to surgery

  3. Bulletwe can refer you to special program to make you fit for surgery and to improve your strength after surgery.

Activity After Surgery

  1. Bulletwalking, even climbing stairs is encouraged with no limits. It is normal to be tired after operations and be low on energy. Take extra naps and more rest during daytime after operation.

  2. Bulletdo not return to work too early.

  3. Bulletdo NOT drive car until your are fit for it. Please remember that you may need to react in emergency situation. If incision limits you enough so you have troubles to look around and perform usual or emergency maneuvers, do not drive. This usually resolves when you are off pain medications.

  4. Bulletwe can refer you to physical therapist or a specialized program assisting in enhanced recovery.

See your family/primary doctor

Your family doctor or internist can screen you for diabetes, high blood pressure, sleep apnea, undiagnosed heart conditions, etc. They can adjust your medication to ‘optimize’ your body long before the operation.

Scientific Background

Frailty is common, even among individuals with normal or above-normal weight and/or body-mass index (BMI). It is frequently encountered among cancer patients, especially among those with diet difficulties. Frailty has been shown to profoundly shorten long-term survival and outcome of any cancer-directed treatment. Studies suggest worse outcome of frail individuals after surgery (Englesbe 2010, Peng 2010, Peng 2012), and worse outcome with chemotherapy as well (Galvao 2010, Antoun 2010).

Even modest 12-week exercise increases endurance, strength, and quality of life (Galvao 2010), as was documented in a formal prospective controlled randomized trial among chemotherapy patients. The Cochrane review (Cramp & Byron-Daniel 2012) also suggested positive benefit of aerobic exercise/walking among patients with solid tumors in 56 reviewed high-quality studies. Progressive walking after major pancreatic surgery was also documented to improve fatigue and quality of life (Yeo JACS 2012).