Postoperative Medical Nutrition Therapy in Patient With Ascending Colon Adenocarcinoma With Severe Malnutrition: A Case Report

OBJECTIVES: Colorectal cancer is one of the cancers with the highest cause of death in the world. Indonesia as a developing country is also reported an increased incidence of colorectal cancer together with the increase in the economy, industrialization, and westernization lifestyle. Due to the inflammatory process, colorectal cancer patients are in a hypermetabolic state leading to increased nutritional requirements and failure to meet these requirements will result in malnutrition. Colorectal cancer with severe malnutrition requires special nutrition therapy, tailored to each patient based on their nutritional status and clinical condition. METHODS: A 36 year old male patient with severe malnutrition (subjective global assessment score C) diagnosed with post exploratory laparotomy, adhesiolysis, segmentectomy, end ileostomy due to adenocarcinoma of the ascending colon. Oral intake is decreased due to loss of appetite and abdominal pain. The patient shows pallor conjunctiva, loss of subcutaneous fat, and wasting of the extremities. Laboratory findings were anemia (10.4 g/dL), leukocytosis (20,100 mm(3)), total lymphocyte count (582.9/µL), hypoalbuminemia (1.8 gr/dL), hyponatremia (132 mmol/L), elevated enzymes transaminases (SGOT 232 U/L, SGPT 88 U/L). RESULTS: Medical nutrition therapy was initially given 450 kcal and gradually increased to 2300 kcal, protein 1–1.8 g/kilogram ideal body weight/day using a high protein formula and Branched Chain Amino Acid (BCAA) parenteral nutrition. We administered supplementations which were zinc, vitamin A, B, C, D, curcuma, and snakehead fish extract. The patient was discharged after 12 days with clinical and functional improvement assessed with handgrip strength dynamometer from 11.4 to 16.3 kg. Laboratory improvement were leukocytes 10,000 mm(3), total lymphocyte count 1,310/µL, albumin 2.7 gr/dL, sodium 133 mmo/L, SGOT 40 U/L, SGPT 31 U/L. CONCLUSIONS: Malnourished colorectal cancer patient had a higher risk of poor clinical outcome. Specific nutritional therapy is needed to reduce inflammation or hypermetabolic, and to treat postoperative complications, proper monitoring and nutritional education results in a good outcome for patient. FUNDING SOURCES: Institutions from Department of Nutrition, Faculty of Medicine, Hasanuddin University.