Published online Apr 15, 2026. doi: 10.4251/wjgo.v18.i4.115485
Revised: December 5, 2025
Accepted: January 20, 2026
Published online: April 15, 2026
Processing time: 154 Days and 23.2 Hours
Colorectal cancer (CRC) surgery elicits a significant physiological stress response, characterized by increased catabolism and systemic immunosuppression, which collectively exacerbate pre-existing or postoperative malnutrition. This hyper
To investigate the effect of the PIPOST model combined with EEN on postoperative recovery in CRC patients.
A randomized controlled trial was conducted. A total of 120 patients undergoing CRC surgery were randomly assigned to a control group (n = 60) receiving conventional EEN or an observation group (n = 60) receiving PIPOST model-based EEN management. Nutritional indicators, immune function, gastrointestinal recovery, complications, and hospital stay were compared.
The observation group showed significantly higher levels of albumin, prealbumin, and transferrin at postoperative day 7 (P < 0.05). CD4+/CD8+ ratio and natural killer cell activity were also significantly higher in the observation group (P < 0.05). Time to first flatus and time to first defecation were shorter, overall complication rate was lower (16.7% vs 30.0%, P < 0.05), and hospital stay was significantly shortened in the observation group (P < 0.05).
EEN guided by the PIPOST model significantly improves postoperative nutritional status, immune function, and gastrointestinal recovery, and reduces complications and hospital stay in CRC patients.
Core Tip: This article demonstrates that implementing a structured PIPOST model for early enteral nutrition in post-colorectal cancer surgery patients significantly enhances recovery. Compared to conventional early enteral nutrition, the PIPOST-guided approach led to marked improvements in nutritional biomarkers (albumin, prealbumin, and transferrin), immune function (CD4+/CD8+ ratio and natural killer cell activity), and gastrointestinal recovery, while reducing complication rates and shortening hospital stays. This study provides evidence for a systematic and precise nutritional support framework in postoperative care.
- Citation: Chang XM, Cai BH, Zheng HB. Integration of the PIPOST model with early enteral nutrition to enhance postoperative rehabilitation in colorectal cancer patients. World J Gastrointest Oncol 2026; 18(4): 115485
- URL: https://www.wjgnet.com/1948-5204/full/v18/i4/115485.htm
- DOI: https://dx.doi.org/10.4251/wjgo.v18.i4.115485
Carrying the third-highest global incidence and the second-highest mortality burden among cancers, colorectal cancer (CRC) remains a pressing worldwide health challenge[1]. The Surveillance, Epidemiology, and End Results database documented over 150000 new CRC diagnosed in 2023, constituting 7.8% of all new cancer cases. About 70% of these malignancies are colon tumors, and the rest are rectal tumors. Men are not only more likely to develop colon cancer (53% of cases) but are also typically diagnosed at a younger age than women, with a mean age of 68 years vs 72 years[2]. Surgical resection remains the most important and potentially curative approach in clinical treatment of non-metastatic CRC at present[2]. However, surgery, as a stress event, triggers a series of complex physiological and pathological responses in the body, including hypercatabolic state, increased inflammatory response, suppressed immune function, and impaired intestinal barrier function, which together can easily lead to or aggravate postoperative malnutrition in patients[3]. The nutritional risks that arise after surgery due to tumors, loss of appetite, etc. are more prominent in the postoperative stage. If not intervened, they will significantly delay the patient’s recovery, increase the risk of complications, and even affect the prognosis of survival[3,4].
Therefore, nutritional support has become one of the key aspects of perioperative management for CRC. Traditionally, postoperative nutritional support is provided through the parenteral pathway (total parenteral nutrition). While effective for most patients, this approach is associated with complications including bloodstream infection, thrombosis, and liver damage. Furthermore, it is costly and, in severe cases, does not adequately maintain the structural and functional integrity of the intestinal mucosa[5]. Following the widespread implementation of the Enhanced Recovery After Surgery concept, early enteral nutrition (EEN) has received growing recognition as a core element. EEN is characterized by the commencement of enteral feeding within 24 hours to 48 hours after surgery[6]. International guidelines recommend starting EEN as early as the patient’s condition allows, usually within 24 hours to 48 hours of intensive care unit admission[7,8]. Studies have shown that, compared with delayed feeding or total parenteral nutrition, EEN can provide nutrient substrates earlier, stimulate gastrointestinal peristalsis, and maintain the intestinal mucosal barrier, thereby reducing the infection rate and complication rate and accelerating the recovery process of patients[3,4,9]. As a result, several international clinical nutrition guidelines, such as the ESPEN guidelines, strongly recommend initiating EEN as early as possible in postoperative patients with hemodynamic stability[4]. Evidence from recent randomized controlled trials indicates that postoperative EEN has been shown to lower postoperative morbidity (notably infectious ones), mortality, and duration of hospitalization, and does not increase the incidence of complications related to the digestive tract[9]. However, the traditional EEN implementation model lacks individualization, and the precision of nutritional support regimens is insufficient, which limits the clinical effect.
The PIPOST model[10] is a structured model for summarizing problems. Its six elements include the Population, Intervention, Professionals, Outcomes, Setting, and Type of evidence, to obtain as comprehensive, accurate, and reliable evidence as possible to support decision-making and practice guidance. At present, the model is less used in the EEN field. Therefore, this study intends to apply the PIPOST model to EEN management after CRC surgery, verify its effectiveness through a randomized controlled trial, explore the clinical effect of this combined intervention model, and support the implementation of this approach in clinical settings.
A consecutive series of 120 patients undergoing radical resection for CRC at our institution between January 2022 and December 2024 constituted the study cohort. Participants were allocated via computer-generated randomization to either a control group (n = 60) or an intervention group (n = 60). The allocation sequence was concealed using sequentially numbered, opaque, sealed envelopes. The control group included 34 males and 26 females, with a mean age of (63.12 ± 6.95) years, while the observation group comprised 32 males and 28 females, with a mean age of (62.35 ± 7.28) years. The data comparison between the two groups showed no statistically significant difference in baseline characteristics (P > 0.05), indicating that they were comparable (see Table 1 for details). Due to the nature of the nutritional interventions, blinding of patients and care providers was not feasible. However, outcome assessors and data analysts were blinded to the group assignments. The sample size was calculated using G*Power software (version 3.1). Based on a pilot study, we assumed an effect size (d) of 0.65 for the primary outcome [serum prealbumin (PA) level at day 7]. With an alpha error of 0.05 and a power (1 - β) of 0.80, a total sample size of 116 was required. We recruited 120 participants to account for potential dropouts.
| Gender (male/female) | Age (years) | |
| Control group (n = 60) | 34/26 | 63.12 ± 6.95 |
| Observation group (n = 60) | 32/28 | 62.35 ± 7.28 |
| t | 0.135 | 0.589 |
| P value | 0.714 | 0.557 |
Inclusion criteria: (1) Patients with pathologically confirmed CRC and undergoing curative-intent resection surgery; (2) 18 years to 75 years of age, regardless of gender; (3) No severe heart, liver, or kidney dysfunction; and (4) Providing written informed consent.
Exclusion criteria: (1) Coexisting with other malignancies; (2) Having an immune system disorder; (3) Those with severe mental illness or cognitive impairment; and (4) Severe preoperative malnutrition.
Control group: The control group received conventional EEN support. Enteral nutrition support through a gastric tube or nasogastric tube was initiated 24 hours after surgery at an initial dose of 250-500 mL/day and gradually increased to the target dose (25-30 kcal/kg/day) over 3-5 days. Enteral nutrition emulsion (Huarui Pharmaceutical Co., LTD) was selected as the nutritional preparation.
Observation group: The observation group was given EEN based on the PIPOST model as follows: (1) P: Detailed assessment of the enrolled patients, including age, gender, and “comprehensive assessment of nutritional risk and status in patients using Nutritional Risk Screening-2002[11] and the Patient Subjective Global Assessment Scale[12]”; (2) I: Development of individualized EEN programmes based on the assessment results. For example, oral nutritional support is preferred for those with good gastrointestinal tolerance; for those with poor tolerance, nasogastric tube feeding is adopted, and the tube is removed promptly when function recovers; (3) P: Establishment of a multidisciplinary team consisting of surgeons, dietitians, and nurses to develop a nutritional support program and conduct dynamic monitoring, and adjustment of the program in a timely manner based on the monitoring results; (4) O: Setting clear individualized goals such as serum protein levels, weight changes, and nutritional status; (5) S: Implemented in a standard ward setting, but with enhanced patrols and records; and (6) T: The intervention began 24 hours after the operation and continued until the patient could meet at least 60% of the energy requirement through oral feeding.
Monitoring indicators: (1) Biochemical nutritional indicators: Albumin (ALB), PA, and transferrin (TF) levels were measured before and 7 days after surgery to assess the biochemical nutrition of the patients; (2) Immune function indicators: The peripheral blood immune indicators of the patients, including CD4+/CD8+ ratio and natural killer (NK) cell activity, were detected before the operation and 7 days after the operation; (3) Indicators of recovery of gastrointestinal function: The time to first flatus and time to first defecation were recorded; (4) Complication indicators: Whether the patient had complications such as infection and incision dehiscence after the operation was recorded; and (5) Hospitalization indicators: The postoperative hospital stay of both groups of patients was recorded.
The clinical data obtained in this study were analyzed with SPSS 21.0. Count data, presented in the form of n (%), were tested using the χ2 test. For measurement data, the Shapiro-Wilk method was used to verify whether they conform to a normal distribution. Data that conform to a normal distribution are expressed in the form of mean ± SD, and the t-test was used for pairwise comparisons. P < 0.05 was considered statistically significant.
Table 2 demonstrates the levels of nutritional markers (ALB, PA, and TF) before and after surgery, indicating that patients in the observation group achieved significantly greater improvements in all the three nutritional parameters compared to the control group at postoperative day 7 (P < 0.05).
| Time | Control group (n = 60) | Observation group (n = 60) | t | P value | |
| ALB (g/L) | Preoperative | 34.26 ± 3.15 | 33.98 ± 3.22 | 0.475 | 0.636 |
| 7 days after surgery | 35.27 ± 3.24 | 38.67 ± 3.14 | 5.838 | < 0.05 | |
| PA (mg/L) | Preoperative | 242.37 ± 22.48 | 245.86 ± 30.56 | 0.712 | 0.478 |
| 7 days after surgery | 263.52 ± 36.18 | 292.54 ± 42.42 | 4.033 | < 0.05 | |
| TF (g/L) | Preoperative | 2.12 ± 0.35 | 2.15 ± 0.32 | 0.546 | 0.586 |
| 7 days after surgery | 2.31 ± 0.16 | 2.68 ± 0.29 | 8.552 | < 0.05 |
Table 3 presents the immune function profiles of the two groups, showing that the application of the PIPOST model was associated with significantly enhanced CD4+/CD8+ ratios and NK cell activity in the observation group compared to the control group at 7 days post-surgery (P < 0.05).
| Time | Control group (n = 60) | Observation group (n = 60) | t | P value | |
| CD4+/CD8+ ratio | Preoperative | 1.73 ± 0.14 | 1.78 ± 0.19 | 1.613 | 0.109 |
| 7 days after surgery | 1.85 ± 0.30 | 2.27 ± 0.23 | 8.637 | < 0.05 | |
| NK cell activity (%) | Preoperative | 22.39 ± 3.6 | 23.56 ± 4.1 | 1.657 | 0.100 |
| 7 days after surgery | 29.3 ± 4.8 | 38.7 ± 5.2 | 10.288 | < 0.05 |
Table 4 demonstrates the time to first flatus and time to first defecation of the two groups after surgery, indicating that the observation group had significantly shorter times to first flatus and first defecation than the control group (P < 0.05).
| Time to first flatus | Time to first defecation | |
| Control group (n = 60) | 6.29 ± 1.53 | 4.53 ± 1.33 |
| Observation group (n = 60) | 4.89 ± 1.03 | 3.65 ± 1.09 |
| t | 5.874 | 3.976 |
| P | < 0.05 | < 0.05 |
Table 5 demonstrates the complication rate of the two groups, indicating that the observation group had a lower complication rate than the control group (P < 0.05). Notably, the complications that did occur in the observation group were generally of lower severity and resolved more quickly with standard care.
| Infection | Incision dehiscence | Lung infection | Fever | Gastrointestinal complications | Urinary tract infection | Thrombosis | Incidence (%) | |
| Control group (n = 60) | 8 | 5 | 5 | 3 | 3 | 2 | 0 | 43.3 |
| Observation group (n = 60) | 3 | 2 | 5 | 1 | 1 | 1 | 0 | 21.7 |
| χ2 | - | - | - | - | - | - | - | 6.42 |
| P value | - | - | - | - | - | - | - | < 0.05 |
The length of hospital stay in the observation group was (7.89 ± 1.23) days, significantly shorter than that in the control group [(10.56 ± 1.56) days] (t = 10.428, P < 0.05).
CRC, a disease with a multifactorial etiology, is the third most common cancer in men and the second in women[13]. Diagnosis and treatment are significantly complex due to their different etiologies, clinical manifestations, and stages[2], and the risk increases with age[1]. In patients with CRC, due to metabolic abnormalities in the body and the tumor, the intake of nutrients fails to meet the body’s needs, often leading to preoperative malnutrition. During anesthesia and surgery, the body is under stress, experiencing high catabolism and negative nitrogen balance, which exacerbates postoperative malnutrition[3]. Therefore, in patients with CRC, postoperative nutritional support is considered particularly important. According to the Enhanced Recovery After Surgery protocol, EEN is widely used in clinical practice as a primary intervention, which helps postoperative recovery and is widely accepted as a method of nutritional therapy[14]. Studies indicate that postoperative EEN can promote the recovery of intestinal motility, and even if daily intake is below caloric requirements, it may still be beneficial. This may be because EEN has a local nutritional effect that can stimulate the proliferation of intestinal mucosal epithelial cells and promote the secretion of gastrointestinal hormones and the recovery of gastrointestinal function. Additionally, to prevent pulmonary infections, nasogastric tubes should be removed as early as possible[3]. In addition to promoting the recovery of gastrointestinal peristalsis, EEN can also reduce intestinal adhesions, improve incision healing, and lower complications[15]. However, the traditional EEN model is relatively monotonous, lacks individualized adjustment, and has insufficient precision in formulating nutritional support programs, which limits its clinical effect.
According to current research, healthcare institutions use EEN as an indicator for PIPOST. Studies show that during follow-up, the nutritional parameters, including ALB, PA, and TF, were significantly higher in the observation group than in the control group, indicating that PIPOST parameters contribute to the rational planning of nutritional support. Such parameters can also be used for reliable monitoring and help develop personalised plans according to PIPOST goals. Specifically, in the “P” section (populations needing nutrition), the plan requires careful assessment of patients' nutritional risk (Nutritional Risk Screening-2002) and nutritional status (Patient Subjective Global Assessment Scale)[11,12] for enrolled patients. This approach helps better understand each patient’s needs and assess individual risk levels, providing a basis for developing targeted plans.
Second, at the “I” (intervention) level, flexible selection of feeding routes (oral priority or tube feeding) and adjustment of nutritional preparation types based on assessment results (such as gastrointestinal tolerance) ensure the feasibility and effectiveness of nutritional support. For example, for those with a faster recovery of gastrointestinal function, giving priority to oral nutritional support is more physiologically appropriate; for those with poor tolerance, nasogastric tube feeding is used to reduce the occurrence of intolerances such as diarrhea and bloating[16,17]. In addition, the emphasis on multi-disciplinary team collaboration at the “P” (professional) level ensures that the nutrition support program is developed and implemented by surgeons, dietitians, and nurses, achieving the integration and complementarity of expertise and enabling more timely detection and handling of problems that arise during feeding[10]. Dynamic monitoring, a core mechanism embedded within the "O" (outcome) and "T" (timeframe) components, allows for program adjustments based on patients’ real-time responses, ensuring the precision and adaptability of the intervention. PA has a short half-life (about 2 days), which reflects short-term nutritional support effects and protein synthesis status[18]. The significant improvement in its level particularly highlights the positive role of the PIPOST model in promoting postoperative protein synthesis. ALB is an indicator of the body’s long-term nutritional status and visceral protein reserves, and an improvement in its level suggests the sustained effectiveness of nutritional support[19]. Elevated TF levels also indirectly reflect improved protein nutritional status and benign changes in iron metabolism[20]. Therefore, the PIPOST model, through a systematic management process, ensures that EEN is not only implemented “early”, but also executed “precisely” and “effectively”, thus demonstrating a significant advantage in improving nutritional indicators.
The superiority of the PIPOST-based intervention likely stems from the synergistic integration of its six core elements, rather than any single component. The comprehensive “P” assessment allows for precise patient stratification. This informs a highly tailored “I”, ensuring that nutritional support matches individual metabolic needs and gastrointestinal tolerance. The “P” element, through multi-disciplinary team collaboration, facilitates the seamless execution and real-time adjustment of this plan. The predefined “O” provides clear targets for monitoring, while the structured “S” (setting) and “T” (time) elements ensure consistent, timely, and context-appropriate delivery of care. This integrated approach likely acts in concert to better preserve gut mucosal integrity, modulate the systemic inflammatory response, and promote anabolic recovery, thereby explaining the concurrent improvements across nutritional, immune, and functional domains.
From the perspective of health ecology theory, the PIPOST model constructs an “individual-intervention-professional” interaction system. The individual’s nutritional status and gastrointestinal tolerance (individual level) are dynamically monitored by the multidisciplinary team (professional environment), and interventions are adjusted in real time to adapt to the individual’s physiological changes. This positive feedback loop optimizes nutritional supply, reduces stress responses, and promotes immune function recovery, which is consistent with the theory’s emphasis on the interaction between individuals and their environment.
The suppression of immune function after surgery is an important factor that increases the risk of infection and affects recovery. Immune responses, particularly those involving CD4+/CD8+ and NK cells, are crucial in the body’s defense mechanisms. Evidence indicates that EEN contributes to immune system enhancement, suppression of inflammatory mediators, and overall improvement in surgical recovery[21]. The CD4+/CD8+ ratio serves as an indicator of immune balance, and its decline signifies a state of immunosuppression. Conversely, NK cells act as the body’s first line of defense by identifying and destroying tumors, fulfilling a critical function in both anti-tumor immunity and the clearance of virus-infected cells[22]. In this study, the levels of CD4+/CD8+ ratio and NK cells in the observation group were significantly elevated (P < 0.05), reflecting the reconstruction and enhancement of the patients’ immune system and a reduced risk of infection. On the one hand, it can be attributed to the fact that EEN under the guidance of the PIPOST model improved overall nutritional status more effectively, and on the other hand, it emphasizes that individualized protocols may better protect the intestinal barrier.
Delayed recovery of gastrointestinal function may lead to increased patient discomfort, prolonged hospitalization, and higher treatment costs[23]. The findings demonstrated significantly shorter times to first flatus and first defecation in the observation group compared to the control group, suggesting that the PIPOST model effectively promotes gastrointestinal function recovery. The mechanisms may include: (1) Individualized assessment ensured the timing and approach of EEN initiation, avoiding intolerances caused by forced feeding due to gastrointestinal dysfunction in patients; and (2) The selection of appropriate enteral nutrition preparations and progressive infusion regimens promoted the secretion of gastrointestinal hormones.
Postoperative complications are a major factor affecting the prognosis of patients and the consumption of medical resources, and are associated with poor long-term prognosis[24]. In this research, the observation group exhibited a significantly lower total complication rate compared to the control group. This result was closely associated with improved nutritional status, enhanced immune competence, and decreased infection risk due to the protection of intestinal barrier function. Good nutritional status enhances tissue repair ability and anti-infection ability. Improved immune function reduces the risk of infectious complications such as lung infections and incision infections. Early recovery of gastrointestinal function reduces the occurrence of related complications such as intestinal paralysis and intestinal obstruction, and may also indirectly reduce the risk of deep vein thrombosis caused by long-term bedridden conditions. More importantly, the structured implementation framework provided by the PIPOST model can identify and address potential problems (such as feeding intolerances and electrolyte imbalances) at an early stage, thereby preventing many complications caused by management negligence or untimely response[7]. Hospital length of stay is an important indicator of recovery speed. The significant reduction in hospital stay in the observation group was a comprehensive reflection of the above indicators. Faster recovery means less hospitalization expenses and less psychological burden for patients.
However, there are still some limitations to this study. First, as a single-center investigation with a relatively limited sample size, it may lead to bias, and extrapolation needs to be validated in future multi-center, large-sample studies. Second, this study focused mainly on short-term rehabilitation indicators and did not follow up on long-term prognosis of patients, such as survival rate and standard of living. The long-term effects of the PIPOST model combined with EEN still need to be further observed. Furthermore, differences in compliance between caregivers and individual patients during the intervention may have an impact on the outcome, and blinding of outcome measures may be considered in the future to reduce measurement bias.
To sum up, this study shows that applying the PIPOST model to EEN intervention in patients after CRC surgery can construct a systematic, individualized, and standardized nutritional support system. Through precise assessment, multidisciplinary collaboration, and goal-oriented and continuous optimization, the system can significantly improve short-term rehabilitation outcomes for patients, including improvements in nutritional status, immune function, and gastrointestinal recovery, as well as a reduction in complications. This provides compelling evidence for integrating the implementation of scientific theoretical tools into clinical practice and is worthy of broader application.
| 1. | Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209-249. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 76817] [Cited by in RCA: 68838] [Article Influence: 13767.6] [Reference Citation Analysis (8)] |
| 2. | Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73:233-254. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 2171] [Cited by in RCA: 1892] [Article Influence: 630.7] [Reference Citation Analysis (0)] |
| 3. | Chen F, Dou Y, Wei W, Duan H, Liu C. Effects of modular nursing model for typical issues on enteral nutrition status, immune function, and quality of life in colon cancer patients. Heliyon. 2024;10:e23208. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in RCA: 1] [Reference Citation Analysis (0)] |
| 4. | Li K, Wang D, Zhang X, Yang J, Chen X. Efficacy of early enteral nutrition versus total parenteral nutrition for patients with gastric cancer complicated with diabetes mellitus: A systematic review and meta-analysis. Nutr Diet. 2022;79:129-139. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 4] [Cited by in RCA: 17] [Article Influence: 4.3] [Reference Citation Analysis (0)] |
| 5. | Uwumiro F, Olaomi OA, Tobalesi O, Okpujie V, Abesin O, Ekata E, Ezerioha P, Umoudoh UA, Olapade Z, Asobara E. Enteral Nutrition Versus Parenteral Nutrition on Outcomes in Acute Pancreatitis: Insights From the Nationwide Inpatient Sample. Cureus. 2023;15:e44957. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 1] [Reference Citation Analysis (0)] |
| 6. | Yanamaladoddi V, D'Cunha H, Charley E, Kumar V, Sohal A, Youssef W. Early enteral nutrition in critically-ill patients. World J Crit Care Med. 2025;14:102834. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in RCA: 2] [Reference Citation Analysis (0)] |
| 7. | Hadi V, Amiri Khosroshahi R, Imani H, Jahangirfard B, Majari K, Kiany F, Hadi S. Impact of early versus delayed enteral nutrition on ICU outcomes: a comparative study on mortality, ventilator dependence, and length of stay. Eur J Med Res. 2025;30:315. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in RCA: 5] [Reference Citation Analysis (0)] |
| 8. | Senecal JB, Lakhanpal T, Mbuagbaw L, Giannidis T, Khazaneh PT, Rochwerg B, Oczkowski SJW, Cook DJ, Tsang JLY, Pinto-Sanchez MI, Sharif S, Armstrong D, Ovtcharenko N, Janisse N, Millen T, Lamontagne F, Dionne JC. The effect of enteral nutrition strategy and non-invasive ventilation on diarrhea and nutritional goals in the critically ill: A protocol for a multicentre retrospective cohort study (ENND GOALS). PLoS One. 2025;20:e0322122. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in RCA: 1] [Reference Citation Analysis (0)] |
| 9. | Preiser JC, Arabi YM, Berger MM, Casaer M, McClave S, Montejo-González JC, Peake S, Reintam Blaser A, Van den Berghe G, van Zanten A, Wernerman J, Wischmeyer P. A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice. Crit Care. 2021;25:424. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 4] [Cited by in RCA: 76] [Article Influence: 15.2] [Reference Citation Analysis (0)] |
| 10. | Wu D, Dai J, Sheng Y, Lin Y, Ye H, Wang D, Lu L, Yan B. Evidence summary on pain management in thoracoscopic lung cancer surgery. Asia Pac J Oncol Nurs. 2025;12:100693. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 2] [Reference Citation Analysis (0)] |
| 11. | İleri İ, Özsürekci C, Halil MG, Gündoğan K. NRS-2002 and mNUTRIC score: Could we predict mortality of hematological malignancy patients in the ICU? Nutr Clin Pract. 2022;37:1199-1205. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 5] [Reference Citation Analysis (0)] |
| 12. | Sakaguchi T, Maeda K, Takeuchi T, Tsuchida M, Ishida Y, Kawamura K, Amano K, Mori N. A comparative evaluation of the Global Leadership Initiative on Malnutrition vs the Patient-Generated Subjective Global Assessment in assessing nutrition status in patients diagnosed with terminal cancer: A retrospective study. Nutr Clin Pract. 2025;. [RCA] [PubMed] [DOI] [Full Text] [Reference Citation Analysis (0)] |
| 13. | Li J, Ma X, Chakravarti D, Shalapour S, DePinho RA. Genetic and biological hallmarks of colorectal cancer. Genes Dev. 2021;35:787-820. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 461] [Cited by in RCA: 396] [Article Influence: 79.2] [Reference Citation Analysis (0)] |
| 14. | Hasanloei MAV, Rahimlou M, Eivazloo A, Sane S, Ayremlou P, Hashemi R. Effect of Oral Versus Intramuscular Vitamin D Replacement on Oxidative Stress and Outcomes in Traumatic Mechanical Ventilated Patients Admitted to Intensive Care Unit. Nutr Clin Pract. 2020;35:548-558. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 12] [Cited by in RCA: 38] [Article Influence: 5.4] [Reference Citation Analysis (0)] |
| 15. | Braungart S, Siminas S. Early Enteral Nutrition Following Gastrointestinal Surgery in Children: A Systematic Review of the Literature. Ann Surg. 2020;272:377-383. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 9] [Cited by in RCA: 4] [Article Influence: 0.7] [Reference Citation Analysis (0)] |
| 16. | Weimann A, Bezmarevic M, Braga M, Correia MITD, Funk-Debleds P, Gianotti L, Gillis C, Hübner M, Inciong JFB, Jahit MS, Klek S, Kori T, Laviano A, Ljungqvist O, Lobo DN, Segurola CL, Montroni I, Reddy BR, Saur NM, Schweinlin A, Shi HP, Takeuchi H, Waitzberg DL, Wallengren O, Wischmeyer PE, Ysebaert D, Bischoff SC. ESPEN guideline on clinical nutrition in surgery - Update 2025. Clin Nutr. 2025;53:222-261. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 40] [Cited by in RCA: 23] [Article Influence: 23.0] [Reference Citation Analysis (0)] |
| 17. | Chauhan D, Varma S, Dani M, Fertleman MB, Koizia LJ. Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced. Curr Gerontol Geriatr Res. 2021;2021:6650675. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 1] [Cited by in RCA: 16] [Article Influence: 3.2] [Reference Citation Analysis (0)] |
| 18. | Sanguinetti C, Minniti M, Susini V, Caponi L, Panichella G, Castiglione V, Aimo A, Emdin M, Vergaro G, Franzini M. The Journey of Human Transthyretin: Synthesis, Structure Stability, and Catabolism. Biomedicines. 2022;10:1906. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 1] [Cited by in RCA: 61] [Article Influence: 15.3] [Reference Citation Analysis (0)] |
| 19. | Boesiger F, Poggioli A, Netzhammer C, Bretscher C, Kaegi-Braun N, Tribolet P, Wunderle C, Kutz A, Lobo DN, Stanga Z, Mueller B, Schuetz P. Changes in serum albumin concentrations over 7 days in medical inpatients with and without nutritional support. A secondary post-hoc analysis of a randomized clinical trial. Eur J Clin Nutr. 2023;77:989-997. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 19] [Reference Citation Analysis (0)] |
| 20. | Lu S, Khan MA, Setua S, O'Boyle Q, Thangaraju K, Cabrales P, Swindle DC, Irwin DC, Buehler PW, Palmer AF. Transferrin Purification, Biophysical Characterization, and Lung Biodistribution in Sickle Cell Disease Mice. Biotechnol Bioeng. 2025;122:2709-2723. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in RCA: 1] [Reference Citation Analysis (0)] |
| 21. | Wang F, Gao Y. Efficacy of early enteral nutrition support on the nutritional status of patients after gallstone surgery. PLoS One. 2025;20:e0314659. [RCA] [PubMed] [DOI] [Full Text] [Reference Citation Analysis (0)] |
| 22. | Shi X, Zhao H, Yu J, Cai P, Zhou S, Yang N, Li D. Changes in PD-1 expression on T lymphocyte subsets and related immune indicators before and after definitive chemoradiotherapy for esophageal squamous cell carcinoma. Ann Med. 2025;57:2445190. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 4] [Reference Citation Analysis (0)] |
| 23. | Zhao CY, Shi WH, Wen ZQ, Jin YM, Shang YB, Zheng L, Li J, Chen XM. An Evidence-Based Medical Review on Promoting Gastrointestinal Function Recovery After Colorectal Cancer Surgery. J Multidiscip Healthc. 2024;17:1343-1362. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 3] [Cited by in RCA: 4] [Article Influence: 2.0] [Reference Citation Analysis (0)] |
| 24. | Ortiz-López D, Marchena-Gómez J, Nogués-Ramía E, Sosa-Quesada Y, Arencibia-Pérez B, Artiles-Armas M, Roque-Castellano C. Utility of a new prognostic score based on the Comprehensive Complication Index (CCI®) in patients operated on for colorectal cancer (S-CRC-PC score). Surg Oncol. 2022;42:101780. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 6] [Reference Citation Analysis (0)] |