Revista do Colégio Brasileiro de Cirurgiões
https://revistadocbc.org.br/article/doi/10.1590/0100-6991e-2026001026
Revista do Colégio Brasileiro de Cirurgiões
Artigo Original

Implantação dos cuidados nutricionais perioperatórios do Projeto ACERTO em pacientes com câncer colorretal: factibilidade e benefícios

Implementation of perioperative nutritional care from the ACERTO Project in patients with colorectal cancer: feasibility and benefits

Eliani Frizon; Diana Borges Dock Nascimento; Fernanda Aparecida Matte da Costa; Rafael Teruel Berto; Sandra Mara Vendrametto; Pamela Luiza Tonello; José Eduardo de Aguilar-Nascimento

http://dx.doi.org/10.1590/0100-6991e-2026001026 RCBC, vol.53, e2026001026, 2026
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Resumo

Introdução: Pacientes com câncer são mais suscetíveis ao comprometimento do estado nutricional, especialmente quando submetidos a cirurgias. Minimizar a resposta metabólica e o catabolismo muscular associados ao trauma cirúrgico e acelerar a recuperação pós-operatória são objetivos dos protocolos de recuperação avançada como o Projeto Aceleração da Recuperação Total Pós-operatória (ACERTO). Neste contexto, o estudo objetivou implantar e avaliar a factibilidade e os benefícios dos cuidados nutricionais perioperatórios recomendadas pelo ACERTO em um hospital oncológico.

Método: Coorte retrospectiva desenvolvida com pacientes adultos e idosos com câncer colorretal submetidos a laparotomia realizadas entre 2018 e 2024. O estudo seguiu três fases: fase 1: dados pré-implantação do ACERTO; fase 2: implantação do Projeto ACERTO e fase 3: dados pós implantação do ACERTO. Os dados demográficos, clínicos, cirúrgicos, nutricionais e também os desfechos foram coletados nas fases 1 e 3 e submetidos à análises estatísticas para comparação entre as fases pré e pós-ACERTO.

Resultados: Foram analisados 275 prontuários de pacientes pré- implantação e 101 pós-implantação. Os pacientes pós-ACERTO eram mais velhos (p=0,014), apresentavam maior peso corporal (p=0,002), maior IMC (p=0,012) e mais risco nutricional pela NRS-2002 (p=0,015). Os cuidados nutricionais melhoraram após implantação ACERTO (p<0,05) e resultaram em redução fluidos intravenoso (IV) no pós-operatório (p<0,001). Aqueles que receberam menos fluidos IV complicaram menos (p=0,003). Também, após a implantação do ACERTO, os realimentados precocemente (≤ 36horas) tiveram menor tempo de hospitalização (p=0,006).

Conclusão: Os resultados mostraram que a implantação das diretrizes nutricionais do ACERTO no HCCU mostrou-se factível e com importantes benefícios aos pacientes.

Palavras-chave

Trauma; Cirurgia; Cuidados Nutricionais; Cuidados Perioeratórios; Câncer

Abstract

Introduction: Cancer patients are more susceptible to compromised nutritional status, especially when undergoing surgery. Minimizing the metabolic response and muscle catabolism associated with surgical trauma and accelerating postoperative recovery are objectives of advanced recovery protocols such as the Accelerated Postoperative Total Recovery Project (ACERTO). In this context, the study aimed to implement and evaluate the feasibility and benefits of perioperative nutritional care recommended by ACERTO in an oncology hospital.

Method: Retrospective cohort study developed with adult and elderly patients with colorectal cancer undergoing laparotomy performed between 2018 and 2024. The study followed three phases: phase 1: ACERTO’s pre-implementation data; phase 2: implementation of the ACERTO Project; and phase 3: ACERTO’s post-implementation data. Demographic, clinical, surgical, and nutritional data, as well as outcomes, were collected in phases 1 and 3 and subjected to statistical analyses for comparison between the pre- and post-ACERTO phases.

Results: 275 pre-implantation and 101 post-implantation patient records were analyzed. Post-ACERTO patients were older (p=0.014), had higher body weight (p=0.002), higher BMI (p=0.012), and higher nutritional risk according to the NRS-2002 (p=0.015). Nutritional care improved after ACERTO implementation (p<0.05) and resulted in reduced postoperative IV fluids (p<0.001). Those who received less IV fluids had fewer complications (p=0.003). Also, after ACERTO implementation, those who were re-fed early (≤ 36 hours) had shorter hospital stays (p=0.006).

Conclusion: The results showed that the implementation of the ACERTO nutritional guidelines at HCCU proved feasible and with important benefits for patients.

Keywords

Trauma; Surgery; Nutritional Care; Perioperative Care; Immunonutrients; Cancer

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