Figure 1.

Pragmatic algorithm for preoperative nutritional screening and perioperative nutrition in digestive surgery. The algorithm resumes perioperative care in terms of nutrition in major abdominal surgery. It is largely based on recent systematic reviews and guidelines on perioperative nutrition [26, 27] and enhanced recovery [32]. ^aMajor abdominal surgery includes colorectal, gastric, liver, pancreatic, and esophageal resection for benign and malignant disease by either laparotomy or laparoscopic approach, lasting usually >2 h. ^bMajor upper GI surgery indicating preoperative IN regardless of nutritional status include oesophageal, gastric and pancreatic resection for cancer [26]. ^cdefined as anticipated perioperative starving >7 days and oral intake <60% of recommended for >10 days [26]. NRS: Nutritional Risk Score; pre-OP: pre-operative, IN: immunonutrition, SEN: standard enteral nutrition (usually whole protein formula). *currently evaluated by (http://www.clinicaltrial.gov; trial # NCT005122).