Nutritional support of the surgical oncology patient.

Malnutrition is a common manifestation of cancer patients and has a significant negative impact on treatment and survival. The metabolic aberrations associated with tumor growth are complex, and nutritional repletion cannot always be accomplished with nutritional support. Ultimate survival depends upon the primary lesion. Oral nutrition should be used whenever patients can eat and are able to take in sufficient calories. Preoperative total parenteral nutrition (TPN) in well-nourished patients appears to be unwarranted at this time, but the efficacy of preoperative TPN in malnourished surgical patients is established. Patients undergoing radiotherapy and chemotherapy can also benefit from nutritional support when the appropriate patient population is selected. In patients who have a potentially treatable disease, their malnourished state should not be a contraindication to therapy, and every effort should be made to nutritionally support such patients.