101
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Hu WH, Eisenstein S, Parry L, Ramamoorthy S. Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study. Nutr J 2019; 18:33. [PMID: 31253199 PMCID: PMC6598281 DOI: 10.1186/s12937-019-0458-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 06/11/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Malnutrition with hypoalbuminemia (albumin < 35 g/L) is an important factor in predicting risks associated with colorectal cancer surgery. However, there is limited data about the effects of mild hypoalbuminemia with small decreases in albumin on postoperative complications. METHODS This is a retrospective study using the multi-institutional, nationally validated database of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) to investigate mild hypoalbuminemia and its association with postoperative mortality and morbidity by using a propensity score matching method. RESULTS In a group of 30,676 colorectal cancer patients who received surgery, 5230 had mild hypoalbuminemia (< 35 and > =30 g/L) and 21,310 had normal albumin levels (> = 35 g/L). Significant differences were noted in 21 clinical characteristics between the two groups. After 1:2 propensity score matching postoperative mortality was significantly associated with mild hypoalbuminemia (OR = 1.74; p < 0.001). There were significant associations between mild hypoalbuminemia and 11 postoperative morbidities including deep vein thrombosis, pulmonary embolism, superficial and deep surgical site infection, pneumonia, septic shock, ventilator> 48 h, blood transfusion, return to operating room, stroke and re-intubation. Mild hypoalbuminemia was also associated with overall complication (B = 0.064, p < 0.001) and length of total hospital stay (B = 2.236, p < 0.001). CONCLUSIONS In colorectal cancer, this is the first propensity score matching study of malnutrition with mild hypoalbuminemia which demonstrates that a mild decrease in serum albumin contributes significantly to poor postoperative outcome.
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Affiliation(s)
- Wan-Hsiang Hu
- Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Surgery, University of California, San Diego Health System, La Jolla, San Diego, CA, USA.,Department of Surgery and Rebecca and John Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, San Diego, CA, 92093, USA
| | - Samuel Eisenstein
- Department of Surgery, University of California, San Diego Health System, La Jolla, San Diego, CA, USA
| | - Lisa Parry
- Department of Surgery, University of California, San Diego Health System, La Jolla, San Diego, CA, USA
| | - Sonia Ramamoorthy
- Department of Surgery, University of California, San Diego Health System, La Jolla, San Diego, CA, USA. .,Department of Surgery and Rebecca and John Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, San Diego, CA, 92093, USA.
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102
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Controlling Nutritional Status (CONUT) Score Predicts Outcomes of Curative Resection for Gastric Cancer in the Elderly. World J Surg 2019; 43:1076-1084. [PMID: 30569221 DOI: 10.1007/s00268-018-04889-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preoperative nutritional status is considered to affect the short-term and long-term outcomes of cancer patients. The clinical value of the controlling nutritional status (CONUT) score in elderly patients undergoing gastrectomy for gastric cancer remains unknown. METHODS This study reviewed 211 elderly patients aged 75 years or over who underwent curative resection for gastric cancer from 2000 to 2015. Patients were grouped according to the preoperative CONUT score into those with normal nutrition (75 patients), light malnutrition (100 patients) and moderate or severe malnutrition (36 patients). The predictive value of the CONUT score for postoperative morbidity and survival was assessed. RESULTS Impaired nutrition was associated with cardiovascular disease (P = 0.012) and chronic kidney disease (P = 0.014), and worsened malnutrition was linked to advanced age (P = 0.004), decreased body mass index (P = 0.008) and advanced disease stage (P = 0.01). Multivariate analysis showed the CONUT score as an independent predictor of procedure-unrelated infectious morbidity (odds ratio, 2.36; 95% confidence interval [CI], 0.99-5.40; P = 0.046). Patients with a higher CONUT score had significantly shorter overall survival in both stage I and stage II/III gastric cancer (P = 0.044 and P = 0.007, respectively) and reduced cancer-specific survival in stage II/III (P = 0.003) The CONUT score was a strong predictors of overall survival (hazard ratio [HR], 2.12; 95% CI, 1.18-3.69; P = 0.012) and cancer-specific survival (HR, 3.75; 95% CI, 1.30-10.43; P = 0.015) independent of disease stage. CONCLUSIONS The preoperative CONUT score is a simple and promising predictor of postoperative procedure-unrelated infectious morbidity and prognosis in elderly gastric cancer patients.
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103
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Yu B, Park KB, Park JY, Lee SS, Kwon OK, Chung HY. Bioelectrical Impedance Analysis for Prediction of Early Complications after Gastrectomy in Elderly Patients with Gastric Cancer: the Phase Angle Measured Using Bioelectrical Impedance Analysis. J Gastric Cancer 2019; 19:278-289. [PMID: 31598371 PMCID: PMC6769372 DOI: 10.5230/jgc.2019.19.e22] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose Phase angle obtained using bioelectrical impedance analysis (BIA) provides a relatively precise assessment of the nutritional status of elderly patients. This study aimed to evaluate the significance of phase angle as a risk factor for complications after gastrectomy in elderly patients. Materials and Methods We evaluated 210 elderly patients (aged ≥65 years) who had undergone gastrectomy for gastric cancer between August 2016 and August 2017. The phase angle cutoff value was calculated using receiver operating characteristic curve analysis according to sex. A retrospective analysis regarding the correlation between early postoperative complications and well-known risk factors, including the phase angle, was performed. Results Multivariate analysis revealed that the presence of two or more comorbidities (odds ratio [OR], 3.675) and hypoalbuminemia (OR, 4.059) were independent risk factors for overall complications, and female sex (OR, 2.993) was independent risk factor for severe complications. A low phase angle (OR, 2.901 and 4.348, respectively) and total gastrectomy (OR, 4.718 and 3.473, respectively) were independent risk factors for both overall and severe complications. Conclusions Our findings show that preoperative low phase angle predicts the risk of overall and severe complications. Our findings suggest that BIA should be performed to assess the risk of postoperative complications in elderly patients with gastric cancer.
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Affiliation(s)
- Byunghyuk Yu
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ki Bum Park
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Yeon Park
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Soo Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Oh Kyoung Kwon
- Gastric Cancer Center, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Young Chung
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
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104
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Baird DLH, Simillis C, Pellino G, Kontovounisios C, Rasheed S, Tekkis PP. The obesity paradox in beyond total mesorectal excision surgery for locally advanced and recurrent rectal cancer. Updates Surg 2019; 71:313-321. [PMID: 30790208 PMCID: PMC6647851 DOI: 10.1007/s13304-019-00631-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/11/2019] [Indexed: 12/18/2022]
Abstract
The objective is to investigate preoperative body mass index (BMI) in patients receiving beyond total mesorectal excision (bTME) surgery. The primary end point is length of postoperative stay. Secondary end points are length of intensive care stay, postoperative morbidity and overall survival. BMI is the most commonly used anthropometric measurement of nutrition and studies have shown that overweight and obese patients can have improved surgical outcomes. Patients who underwent a bTME operation for locally advanced or recurrent rectal cancer were put into three BMI (kg/m2) groups of normal weight (18.5-24.9), overweight (25-29.9) and obese (≥ 30) for analysis. Included are 220 consecutive patients from a single centre. The overall length of stay, in days ± standard deviation (range), for normal weight, overweight and obese patients was 21.14 ± 16.4 (6-99), 15.24 ± 4.3 (7-32) and 19.10 ± 9.8 (8-62) respectively (p = 0.002). The mean ICU length of stay was 5.40 ± 9.1 (1-69), 3.37 ± 2.4 (0-19) and 3.60 ± 2.4 (1-14), respectively (p = 0.030). There was no significant difference between the three groups in terms of postoperative morbidity or overall survival. Patients with a normal weight BMI in this cohort have a significantly longer length of stay in ICU and in hospital than overweight or obese patients. This is seen with no significant difference in morbidity or overall survival.
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Affiliation(s)
- Daniel L H Baird
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | | | - Gianluca Pellino
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK
| | - Christos Kontovounisios
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK.
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK.
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.
| | - Shahnawaz Rasheed
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - Paris P Tekkis
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
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105
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Sathianathen NJ, Kwaan M, Lawrentschuk N, Weight CJ, Kim SP, Murphy DG, Moon DA, Konety BR. Adverse impact of malnutrition markers on major abdominopelvic cancer surgery. ANZ J Surg 2019; 89:509-514. [PMID: 30959573 DOI: 10.1111/ans.15129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/28/2018] [Accepted: 01/14/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Malnutrition has been associated with adverse postoperative outcomes in a range of procedures but none have evaluated the interaction between clinical indicators of malnutrition. We aimed to comparatively evaluate how combinations of nutritional parameters impact postoperative outcomes amongst patients undergoing major cancer operations. METHODS Major abdominopelvic cancer surgery cases (colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, nephrectomy, pancreatectomy, pneumonectomy and prostatectomy) were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2007-2016. Malnutrition was defined by the presence of the following parameters: body mass index <18.5 kg/m2 ; preoperative serum albumin <3.0 g/dL or more than 10% weight loss in the last 6 months. Malnourished cases were matched with cases with satisfactory nutritional status using propensity scores. The primary outcome was the incidence of Clavien III-IV complications. RESULTS Of the 30 207 cases included, 8.5% had at least one marker of malnutrition. The incidence of Clavien III-IV complications across all cases was 5.8%. In the matched cohort, malnourished cases had a higher rate of complications than those with adequate nutritional status (11.3% versus 9.6%, P = 0.018). A correlation was observed between the number of malnutrition markers possessed and the incidence of Clavien III-V complications. Cases with all three makers had the highest likelihood of experiencing a complication (odds ratio 5.47, 95% confidence interval 1.85-16.17). CONCLUSION Poor nutritional status confers an increased risk of major postoperative complications and being discharged to a facility in non-upper gastrointestinal cancer patients. There was a correlation between the number of malnutrition parameters and the risk of complications.
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Affiliation(s)
- Niranjan J Sathianathen
- Department of Surgery, The University of Melbourne and Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Victoria, Australia.,Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary Kwaan
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nathan Lawrentschuk
- Department of Surgery, The University of Melbourne and Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Simon P Kim
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Daniel A Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Badrinath R Konety
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
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106
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Nishiyama VKG, Albertini SM, Moraes CMZGD, Godoy MFD, Netinho JG. MALNUTRITION AND CLINICAL OUTCOMES IN SURGICAL PATIENTS WITH COLORECTAL DISEASE. ARQUIVOS DE GASTROENTEROLOGIA 2019; 55:397-402. [PMID: 30785525 DOI: 10.1590/s0004-2803.201800000-85] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Malnutrition is a frequent condition among hospitalized patients and a factor of increased risk of postoperative complication. OBJECTIVE This study aimed to evaluate the impact of malnutrition on phase angle (PA), body water distribution and clinical outcomes in surgical patients with colorectal disease. METHODS This retrospective study was performed in a tertiary hospital with 40 patients admitted electively. In the preoperative evaluation, global subjective assessment and bioelectrical impedance analysis were performed to determine nutritional status, PA, extracellular water (ECW), intracellular water (ICW) and total body water (TBW). In postoperative evaluation, the length of hospital stay and severe complications, according to Clavien-Dindo classification, were determined. The optimal PA cutoff for malnutrition screening was determined by ROC curve analysis. RESULTS Seventeen (42.5%) patients were diagnosed as malnourished and 23 (57.5%) as well-nourished according to global subjective assessment. Twelve (30.0%) patients developed severe complications. The malnourished group presented lower values of serum albumin (P=0.012), hematocrit (P=0.026) and PA (P=0.002); meanwhile, ECW/ICW (P=0.019) and ECW/TBW (P=0.047) were higher. Furthermore, 58.8% of malnourished patients developed severe postoperative complications compared to 8.7% of well-nourished. Malnutrition was independent predictor of severe postoperative complications (OR=15.00, IC: 2.63-85.68, P=0.002). The optimal PA cutoff obtained was 6.0º (AUC=0.82, P=0.001), yielding sensitivity, specificity, positive predictive value and negative predictive value of 76.5%, 87.0%, 81.3% and 83.4%, respectively. CONCLUSION Malnutrition was an independent predictive factor for severe complications in patients underwent to elective major coloproctological surgery. Besides that, malnutrition was associated with lower PA values and greater ratio of ECW. The PA provided great accuracy in nutritional screening, implying a useful marker of malnutrition.
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Affiliation(s)
| | - Silvia Maria Albertini
- Faculdade de Medicina de São José do Rio Preto, Disciplina de Nutricão, Departamento de Enfermagem Geral, São José do Rio Preto, SP, Brasil
| | | | - Moacir Fernandes de Godoy
- Faculdade de Medicina de São José do Rio Preto, Departamento de Cardiologia e Cirurgia Cardiovascular, São José do Rio Preto, SP, Brasil
| | - João Gomes Netinho
- Faculdade de Medicina de São José do Rio Preto, Disciplina de Coloproctologia, Departamento de Cirurgia, São José do Rio Preto, SP, Brasil
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107
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Faithfull S, Turner L, Poole K, Joy M, Manders R, Weprin J, Winters-Stone K, Saxton J. Prehabilitation for adults diagnosed with cancer: A systematic review of long-term physical function, nutrition and patient-reported outcomes. Eur J Cancer Care (Engl) 2019; 28:e13023. [PMID: 30859650 DOI: 10.1111/ecc.13023] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/21/2018] [Accepted: 01/17/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Prehabilitation is increasingly being used to mitigate treatment-related complications and enhance recovery. An individual's state of health at diagnosis, including obesity, physical fitness and comorbidities, are influencing factors for the occurrence of adverse effects. This review explores whether prehabilitation works in improving health outcomes at or beyond the initial 30 days post-treatment and considers the utility of prehabilitation before cancer treatment. METHODS A database search was conducted for articles published with prehabilitation as a pre-cancer treatment intervention between 2009 and 2017. Studies with no 30 days post-treatment data were excluded. Outcomes post-prehabilitation were extracted for physical function, nutrition and patient-reported outcomes. RESULTS Sixteen randomised controlled trials with a combined 2017 participants and six observational studies with 289 participants were included. Prehabilitation interventions provided multi-modality components including exercise, nutrition and psychoeducational aspects. Prehabilitation improved gait, cardiopulmonary function, urinary continence, lung function and mood 30 days post-treatment but was not consistent across studies. CONCLUSION When combined with rehabilitation, greater benefits were seen in 30-day gait and physical functioning compared to prehabilitation alone. Large-scale randomised studies are required to translate what is already known from feasibility studies to improve overall health and increase long-term cancer patient outcomes.
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Affiliation(s)
- Sara Faithfull
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Lauren Turner
- Frimley Health NHS Foundation Trust, Frimley, Surrey, UK
| | - Karen Poole
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Mark Joy
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Ralph Manders
- Exercise Physiology and Sports Science, University Surrey, Guildford, UK
| | - Jennifer Weprin
- School of Nursing, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kerri Winters-Stone
- School of Nursing, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - John Saxton
- Department of Sport Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
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108
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The Developing Story of Predictive Biomarkers in Colorectal Cancer. J Pers Med 2019; 9:jpm9010012. [PMID: 30736475 PMCID: PMC6463186 DOI: 10.3390/jpm9010012] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common malignancy worldwide. Surgery remains the most important treatment for non-metastatic CRC, and the administration of adjuvant chemotherapy depends mainly on the disease stage, which is still the strongest prognostic factor. A refined understanding of the genomics of CRC has recently been achieved thanks to the widespread use of next generation sequencing with potential future therapeutic implications. Microsatellite instability (MSI) has been suggested as a predictive marker for response to anti-programmed-cell-death protein 1 (PD-1) therapy in solid tumors, including CRC. It should be noted that not all cancers with MSI phenotype respond to anti-PD-1 immunotherapy, highlighting the urgent need for even better predictive biomarkers. Mitogen-Activated Protein Kinase (MAPK) pathway genes KRAS, NRAS, and BRAF represent important molecular targets and could serve as independent prognostic biomarkers in CRC, and identify those who potentially benefit from anti-epidermal growth factor receptor (EGFR) treatment. Emerging evidence has attributed a significant role to inflammatory markers including blood cell ratios in the prognosis and survival of CRC patients; these biomarkers can be easily assessed in routine blood exams and be used to identify high-risk patients or those more likely to benefit from chemotherapy, targeted therapies and potentially immunotherapy. Analysis of cell-free DNA (cfDNA), circulating tumor cells (CTC) and/or micro RNAs (miRNAs) could provide useful information for the early diagnosis of CRC, the identification of minimal residual disease and, the evaluation of the risk of recurrence in early CRC patients. Even the selection of patients suitable for the new targeted therapy is becoming possible with the use of predictive miRNA biomarkers. Finally, the development of treatment resistance with the emergence of chemo-resistance clones after treatment remains the most important challenge in the clinical practice. In this context it is crucial to identify potential biomarkers and therapeutic targets which could lead to development of new and more effective treatments.
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109
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Zhang S, Tan S, Jiang Y, Xi Q, Meng Q, Zhuang Q, Han Y, Sui X, Wu G. Sarcopenia as a predictor of poor surgical and oncologic outcomes after abdominal surgery for digestive tract cancer: A prospective cohort study. Clin Nutr 2018; 38:2881-2888. [PMID: 30630709 DOI: 10.1016/j.clnu.2018.12.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Sarcopenia has been widely recognized as an important predictor of poor outcomes in patients with cancer after surgery, but the controversy remains, and its impact on surgical and oncologic outcomes in patients after abdominal surgery for digestive tract cancer is poorly described. The aim of this study was to evaluate the prognostic impact of sarcopenia on surgical and oncologic outcomes in patients after abdominal surgery for digestive tract cancer. METHODS Six thousand four hundred and forty-seven consecutive patients who underwent abdominal surgery for digestive tract cancer in our institution were prospectively included. Sarcopenia was defined as skeletal muscle index below the lowest sex-specific quartile using computed tomography scan at L3 before surgery. The surgical and oncologic outcomes were recorded, and univariate and multivariate analyses were performed. RESULTS Sarcopenia was present in 1638 of 6447 patients (25.4%) with digestive tract cancer before surgery based on the diagnostic cut-off values (43.13 cm2/m2 for men and 37.81 cm2/m2 for women). The incidence of postoperative total and pulmonary complications, and 30-day readmission were significantly higher in sarcopenic group than in nonsarcopenic group (37.4% vs 12.9%, P < 0.001; 3.1% vs 2.1%, P = 0.026; 1.1% vs 0.4%, P = 0.003, respectively). The postoperative hospital stay was significantly longer in sarcopenic patients (9.42 ± 3.40 vs 8.51 ± 3.17 days, P < 0.001). There were significantly more patients receiving postoperative chemotherapy or radiotherapy in sarcopenic group than in nonsarcopenic group (73.1% vs 69.2%, P = 0.003; 10.6% vs 8.8%, P = 0.038, respectively), and patients with sarcopenia had significantly more chemotherapy modifications including delay, dose reduction, or termination (48.5% vs 44.2%, P = 0.018). In addition, during the follow-up period, sarcopenic patients had significantly lower rate of overall survival and disease-free survival than nonsarcopenic patients (53.9% vs 69.3%, P = 0.002; 36.8% vs 59.7%, P = 0.000, respectively). In multivariate analysis, sarcopenia was found to be a risk factor for postoperative complications [odds ratio (OR) = 5.418, 95% confidence interval (CI) = 2.986-9.828, P < 0.001], and was an unfavorable prognostic factor for poor overall survival [hazard ratio (HR) = 0.649, 95% CI = 0.426-0.991, P = 0.045] and disease-free survival (HR = 0.514, 95% CI = 0.348-0.757, P = 0.001). CONCLUSIONS Sarcopenia could be used as a strong and independent prognostic factor for poor surgical and oncologic outcomes in patients after abdominal surgery for digestive tract cancer. Identification of preoperative sarcopenia in digestive surgery for cancer and targeted approaches may improve its negative outcomes.
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Affiliation(s)
- Shuze Zhang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanjun Tan
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Jiang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiulei Xi
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qingyang Meng
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiulin Zhuang
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yusong Han
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiangyu Sui
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guohao Wu
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Ozturk E, van Iersel M, Stommel MM, Schoon Y, Ten Broek RR, van Goor H. Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care. World J Emerg Surg 2018; 13:48. [PMID: 30377439 PMCID: PMC6196030 DOI: 10.1186/s13017-018-0208-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022] Open
Abstract
Small bowel obstruction is one of the most frequent emergencies in general surgery, commonly affecting elderly patients. Morbidity and mortality from small bowel obstruction in elderly is high. Significant progress has been made in the diagnosis and management of bowel obstruction in recent years. But little is known whether this progress has benefitted outcomes in elderly patients, particularly those who are frail or have a malignancy as cause of the obstruction, and when considering quality of life and functioning as outcomes. In this review, we discuss the specific challenges and needs of elderly in diagnosis and treatment of small bowel obstruction. We address quality of life aspects and explore how the concept of geriatric assessment can be utilized to improve decision-making and outcomes for elderly patients with a small bowel obstruction.
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Affiliation(s)
- Ekin Ozturk
- 1Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marianne van Iersel
- 2Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martijn Mwj Stommel
- 1Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Yvonne Schoon
- 2Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands.,3Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard Rpg Ten Broek
- 1Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Harry van Goor
- 1Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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111
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Oh TK, Jo J, Oh AY. Perioperative Serum Calcium and Phosphorus Levels are Associated with Hospital Costs and Length of Stay after Major Abdominal Surgery. J Clin Med 2018; 7:jcm7100299. [PMID: 30249011 PMCID: PMC6210672 DOI: 10.3390/jcm7100299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 02/01/2023] Open
Abstract
This study aimed to identify an association between serum calcium (Ca) and phosphate (P) levels, tested during the pre- and postoperative period, with hospital costs and length of hospital stay (LOS) of patients who underwent major abdominal surgery. This retrospective cohort study analyzed the medical records of patients who underwent major abdominal surgery. A total of 3893 patients were included in the analysis, and multivariable linear regression analysis was performed. For a 1 mg/dL increase in preoperative Ca, total hospital costs decreased by 3997.9 dollars (coefficient: −3997.9, 95% confidence interval (CI): −4900.5, −30,953; p-value < 0.01), and for a 1 mg/dL increase in postoperative P, total hospital costs decreased by 702.5 dollars (coefficient: −702.5, 95% CI: −1274.5, −67.3; p-value = 0.03). Furthermore, for a 1 mg/dL increase in preoperative Ca, LOS decreased by 2.9 days (coefficient: −2.9, 95% CI: −3.7, −2.1; p-value < 0.01). For a 1 mg/dL increase in postoperative P, LOS decreased by 3.4 days (coefficient: −3.4, 95% CI: −4.2, −2.6; p-value < 0.01). This study suggested preoperative Ca and postoperative P could be useful indicators for the reduction of hospital costs and decrease in LOS from the perspective of enhanced recovery after surgery.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
| | - Jihoon Jo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul 03080, Korea.
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Sun F, Tan YA, Gao QF, Li SQ, Zhang J, Chen QG, Jiang YH, Zhang L, Ying HQ, Wang XZ. Circulating fibrinogen to pre-albumin ratio is a promising biomarker for diagnosis of colorectal cancer. J Clin Lab Anal 2018; 33:e22635. [PMID: 30047185 DOI: 10.1002/jcla.22635] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/15/2018] [Accepted: 07/09/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Inflammation and nutrition are closely associated with initiation and progression of colorectal cancer (CRC). This study aimed to investigate the diagnostic value of the FAR (FAR = 100*Fibrinogen/Albumin) and FPR (FPR = Fibrinogen/pre-Albumin) in CRC. METHODS Neutrophil-to-lymphocyte ratio (NLR), FPR, and FAR were calculated in 455 newly diagnosed CRC patients, 455 healthy individuals, and 455 benign controls with colorectal polyp. The diagnostic value of biomarker for CRC was evaluated by receiver operating characteristic curve (ROC). Logistic regression analysis was adopted to assess the risk factors for telling CRC apart from benign disease. Moreover, the combined biomarkers were used for discriminating between CRC and benign disease. RESULTS Neutrophil-to-lymphocyte ratio, FAR, and FPR were significantly higher in CRC patients compared with the benign or healthy controls (P < 0.05). ROC analysis showed that the diagnostic efficacy of FAR and FPR were better than NLR for CRC. Besides, FPR, NLR, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA199) were markedly associated with differentiation of benign disease and CRC in the logistic regression analysis. And the combination of FPR, CEA, and CA199 had the maximum area under the ROC curve (AUC) in separating CRC from benign disease (AUC = 0.845, Sensitivity = 67.9%, Specificity = 85.3%, Positive Predictive Value = 83.5%, Negative Predictive Value = 70.9%). CONCLUSIONS Fibrinogen/pre-Albumin could be a useful CRC diagnostic biomarker, and the combination of FPR, CEA, and CA199 could significantly improve the diagnostic efficacy in discriminating CRC from the benign colorectal disease.
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Affiliation(s)
- Fan Sun
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yu-Ao Tan
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Qiu-Fang Gao
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Shu-Qi Li
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jing Zhang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qing-Gen Chen
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yu-Huan Jiang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lei Zhang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hou-Qun Ying
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiao-Zhong Wang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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113
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Sun F, Peng HX, Gao QF, Li SQ, Zhang J, Chen QG, Jiang YH, Zhang L, Wang XZ, Ying HQ. Preoperative circulating FPR and CCF score are promising biomarkers for predicting clinical outcome of stage II-III colorectal cancer patients. Cancer Manag Res 2018; 10:2151-2161. [PMID: 30050325 PMCID: PMC6055907 DOI: 10.2147/cmar.s167398] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Inflammation and nutrition are considered as two important causes leading to the progression and poor survival of colorectal cancer (CRC). The objective of this study is to investigate the prognostic significance of preoperative albumin-to-fibrinogen ratio (AFR), fibrinogen-to-pre-albumin ratio (FPR), fibrinogen (Fib), albumin (Alb), and pre-albumin (pre-Alb) in CRC individuals. Materials and methods In this study, 3 years’ follow-up was carried out in 702 stage I–III resected CRC patients diagnosed between January 2008 and December 2013. The optimal cutoff points and prognostic values of AFR, FPR, Fib, Alb, pre-Alb, and a novel carcinoembryonic antigen (CEA)-carbohydrate antigen 19-9 (CA199)-FPR (CCF) score were assessed by X-tile software, Kaplan–Meier curve, and Cox regression model. We established the CRC prognostic nomogram, and its predictive efficacy was determined by Harrell’s concordance index (c-index). Results Our results showed that high FPR was obviously correlated with poor survival of CRC patients. The prognostic predictive efficacy of CCF score was superior to FPR, CEA, CA199, CEA-CA199 (CCI), and CEA-FPR (CFI) score. Moreover, stage II–III patients harboring high FPR or elevated CCF (score≥1) could benefit from adjuvant chemotherapy, rather than those with low FPR or CCF (score=0). Additionally, the c-index (0.728) of the nomogram containing CCF score was significantly higher than that (0.626) without it (p<0.01). Conclusion These findings illustrated that FPR and CCF score were promising biomarkers to predict the prognosis of CRC and to classify the stage II–III patients who could benefit from the adjuvant chemotherapy.
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Affiliation(s)
- Fan Sun
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China, ;
| | - Hong-Xin Peng
- Department of Clinical Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu, China
| | - Qiu-Fang Gao
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China, ;
| | - Shu-Qi Li
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China, ;
| | - Jing Zhang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China, ;
| | - Qing-Gen Chen
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China, ;
| | - Yu-Huan Jiang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China, ;
| | - Lei Zhang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China, ;
| | - Xiao-Zhong Wang
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China, ;
| | - Hou-Qun Ying
- Department of Clinical Laboratory, Jiangxi Province Key Laboratory of Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China, ;
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Clark LN, Helm MC, Higgins R, Lak K, Kastenmeier A, Kindel T, Goldblatt M, Gould JC. The impact of preoperative anemia and malnutrition on outcomes in paraesophageal hernia repair. Surg Endosc 2018; 32:4666-4672. [PMID: 29934871 DOI: 10.1007/s00464-018-6311-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/18/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with a paraesophageal hernia may experience gastroesophageal reflux symptoms and/or obstructive symptoms such as dysphagia. Some patients with large and complex paraesophageal hernias unintentionally lose a significant amount of weight secondary to difficulty eating. A subset of patients will develop Cameron's erosions in the hernia, which contribute to anemia. Given the heterogeneous nature of patients who ultimately undergo paraesophageal hernia repair, we sought to determine if patients with anemia or malnutrition suffered from increased morbidity or mortality. METHODS The American College of Surgeons National Surgical Quality Improvement Program datasets from 2011 to 2015 were queried to identify patients undergoing paraesophageal hernia repair. Malnutrition was defined as preoperative albumin < 3.5 g/dL. Preoperative anemia was defined as hematocrit less than 36% for females and 39% for males. Thirty-day postoperative outcomes were assessed. RESULTS A total of 15,105 patients underwent paraesophageal hernia repair in the study interval. Of these patients, 7943 (52.6%) had a recorded preoperative albumin and 13.9% of these patients were malnourished. There were 13,139 (87%) patients with a documented preoperative hematocrit and 23.1% met criteria for anemia. Both anemia and malnutrition were associated with higher rates of complications, readmissions, reoperations, and mortality. This was confirmed on logistic regression. The average postoperative length of stay was longer in the malnourished (6.1 vs. 3.1 days when not malnourished, p < 0.0001) and anemic (4.1 vs. 2.8 days without anemia, p < 0.0001). CONCLUSION Malnutrition and anemia are associated with increased morbidity and mortality in patients undergoing paraesophageal hernia repair, as well as a longer length of stay. This information can be used for risk assessment and perhaps preoperative optimization of these risk factors when clinically appropriate.
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Affiliation(s)
- Lindsey N Clark
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA
| | - Melissa C Helm
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA
| | - Rana Higgins
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA
| | - Kathleen Lak
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA
| | - Andrew Kastenmeier
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA
| | - Tammy Kindel
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA
| | - Matthew Goldblatt
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA
| | - Jon C Gould
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, HUB for Collaborative Medicine, 6th floor, Milwaukee, WI, 53226, USA.
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Jankowski M, Las-Jankowska M, Sousak M, Zegarski W. Contemporary enteral and parenteral nutrition before surgery for gastrointestinal cancers: a literature review. World J Surg Oncol 2018; 16:94. [PMID: 29769085 PMCID: PMC5956927 DOI: 10.1186/s12957-018-1393-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/03/2018] [Indexed: 12/15/2022] Open
Abstract
Background Gastrointestinal cancers are among the most recognised oncological diseases in well-developed countries. Tumours located in the digestive tract may cause the fast occurrence of malnutrition. Main text The perioperative period is a special time for systemic metabolism. Thanks to published guidelines, early universal control nutritional status before treatment, patients may have a chance to get suitable nutritional intervention. Although the first line of the intervention—nutritional consultation as well as the fortification of a diet and oral nutritional support (ONS)—is not debatable, in a case of inability of undergoing an oral feeding, the choice of the way of administration in patients before a surgery may represent a serious clinical obstacle. Conclusions Although there is broad agreement in the staging, classification, and role of surgery and nutritional status for outcomes of treatment of gastrointestinal cancers, there the way of nutritional intervention in patients with gastrointestinal cancer are still discussed.
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Affiliation(s)
- Michal Jankowski
- Surgical Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Oncology Centre, Bydgoszcz, 2 Romanowskiej Str, 85-796, Bydgoszcz, Poland. .,Department of Surgical Oncology, Oncology Center - Prof Franciszek Lukaszczyk Memorial Hospital, Romanowskiej, Bydgoszcz, Poland.
| | - Manuela Las-Jankowska
- Surgical Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Oncology Centre, Bydgoszcz, 2 Romanowskiej Str, 85-796, Bydgoszcz, Poland.,Department of Clinical Oncology, Oncology Center - Prof Franciszek Lukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Massaoud Sousak
- Department of General Surgery, Paluki Health Centre, Znin, Poland
| | - Wojciech Zegarski
- Surgical Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Oncology Centre, Bydgoszcz, 2 Romanowskiej Str, 85-796, Bydgoszcz, Poland.,Department of Surgical Oncology, Oncology Center - Prof Franciszek Lukaszczyk Memorial Hospital, Romanowskiej, Bydgoszcz, Poland
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Shen J, Wen T, Li C, Yan L, Li B, Yang J. The Prognostic Prediction Role of Preoperative Serum Albumin Level in Patients with Intahepatic Cholangiocarcinoma Following Hepatectomy. Dig Dis 2018; 36:306-313. [PMID: 29672305 DOI: 10.1159/000487479] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is little information regarding the role of preoperative serum albumin (ALB) in intrahepatic cholangiocarcinoma (ICC) patients who underwent liver resection. METHODS Clinicopathological characteristics and survival rate of 91 ICC patients who underwent surgery between 2009 and 2013 were included in this study. The optimal cut-off for ALB were determined by plotting the receiver operating characteristics curves of ALB in predicting overall survival (OS) and utilizing the Youden index. Long-term outcome was calculated by Kaplan-meire method. RESULTS The pathological characteristics were similar in both groups. The 1- and 3-year disease-free survival (DFS) rates between the high ALB group and the lower ALB group were 62.7 vs. 25.5% and 27.0 vs. 11.1% respectively (p < 0.001). The 1- and 3-year OS rates between the high ALB group and the lower ALB group were 78.4 vs. 57.5% and 42.6 vs. 6.7% respectively (p < 0.001). The ALB level as continuous variable in multivariate analysis remained a favorable factor for DFS and OS (p < 0.05). Furthermore, ALB could distinguish the prognoses in non-cirrhotic patients. Multivariate analysis showed other pathological risk factors like lymph node involvement, positive surgical margin, satellite lesions, and carbohydrate antigen 19-9 were associated with DFS and OS (p < 0.05 for all). CONCLUSIONS A higher preoperative serum ALB level is associated with better long-term survival in ICC patients.
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Effect of Malnutrition on Radical Nephroureterectomy Morbidity and Mortality: Opportunity for Preoperative Optimization. Clin Genitourin Cancer 2018; 16:e807-e815. [PMID: 29550201 DOI: 10.1016/j.clgc.2018.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/01/2018] [Accepted: 02/18/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Nutritional status has been increasingly recognized as an important predictor of prognosis and surgical outcomes for cancer patients. We evaluated the effect of preoperative malnutrition on the development of surgical complications and mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS Using data from the American College of Surgeons National Surgical Quality Improvement Program, we evaluated the association of poor nutritional status with 30-day postoperative complications and overall mortality after RNU from 2005 to 2015. The preoperative variables suggestive of poor nutritional status included hypoalbuminemia (< 3.5 g/dL), weight loss within 6 months before surgery (> 10%), and a low body mass index. RESULTS A total of 1200 patients were identified who had undergone RNU for UTUC. The overall complication rate was 20.5% (n = 246), and mortality rate was 1.75% (n = 21). On univariate analysis, patients who experienced a postoperative complication were more likely to have hypoalbuminemia (25.0% vs. 11.4%; P < .001) and weight loss (3.7% vs. 1.0%; P = .003). After controlling for baseline characteristics and comorbidities, hypoalbuminemia was found to be a significant independent predictor of postoperative complications (odds ratio, 2.09; 95% confidence interval, 1.29-3.38; P = .003). Hypoalbuminemia was also a significant independent predictor of mortality (odds ratio, 4.31; 95% confidence interval, 1.45-12.79; P = .008) on multivariable regression analysis. CONCLUSION Our results have shown that hypoalbuminemia is a significant predictor of surgical complications and mortality after RNU for UTUC. This finding supports the importance of patients' preoperative nutritional status in this population and suggests that effective nutritional interventions in the preoperative setting could improve patient outcomes.
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Liu X, Qiu H, Huang Y, Xu D, Li W, Li Y, Chen Y, Zhou Z, Sun X. Impact of preoperative anemia on outcomes in patients undergoing curative resection for gastric cancer: a single-institution retrospective analysis of 2163 Chinese patients. Cancer Med 2018; 7:360-369. [PMID: 29341506 PMCID: PMC5806112 DOI: 10.1002/cam4.1309] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 12/15/2022] Open
Abstract
We sought to evaluate whether preoperative anemia was an important determinant of survival in gastric cancer (GC). A single institution cohort of 2163 GC patients who underwent curative resection were retrospectively analyzed. Anemia was defined as a preoperative hemoglobin level <120 g/L in males and <110 g/L in females. Overall survival (OS) was analyzed using the Kaplan-Meier method, and a multivariate Cox proportional hazards model was performed to identify the independent prognostic factor. Anemic patients had a poorer OS compared with nonanemic patients after resection for tumor-nodes-metastasis (TNM) stage III tumors (5-year OS rate: 32.2% vs. 45.7%, P < 0.001) but not stage I (P = 0.480) or stage II (P = 0.917) tumors. Multivariate analysis revealed that preoperative anemia was an independent prognostic factor in TNM stage III (hazard ratio [HR], 1.771; 95% CI, 1.040-3.015; P = 0.035). In a stage-stratified analysis, preoperative anemia was still independently associated with OS in TNM stages IIIa through IIIc (P < 0.001, P = 0.075, and P = 0.012, respectively), though the association was only marginal in stage IIIb. Of note, preoperative mild anemia had a similar prognostic value in TNM stage III GC. Furthermore, preoperative anemia was significantly associated with more perioperative transfusions, postoperative complications and several nutritional-based indices, including the prognostic nutritional index (PNI), preoperative weight loss and performance status (all P < 0.05). Preoperative anemia, even mild anemia, was an important predictor of postoperative survival for TNM stage III GC.
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Affiliation(s)
- Xuechao Liu
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Haibo Qiu
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Yuying Huang
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Dazhi Xu
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Wei Li
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Yuanfang Li
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Yingbo Chen
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Zhiwei Zhou
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xiaowei Sun
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
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van der Werf A, Arthey K, Hiesmayr M, Sulz I, Schindler K, Laviano A, Langius J, de van der Schueren M. The determinants of reduced dietary intake in hospitalised colorectal cancer patients. Support Care Cancer 2018; 26:2039-2047. [PMID: 29352452 PMCID: PMC5919993 DOI: 10.1007/s00520-018-4044-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/03/2018] [Indexed: 12/03/2022]
Abstract
Purpose Patients with colorectal cancer (CRC) often experience malnutrition and weight loss, largely resulting from reduced dietary intake. The aim of this study was to identify determinants of reduced dietary intake in order to facilitate early recognition of malnutrition and optimise nutritional treatment. Methods Data from nutritionDay, an international 1-day survey investigating patient, disease and food profiles, were used. To identify determinants of dietary intake, defined as normal vs. reduced in the last week, univariate and multivariate logistic regressions were performed. Results Of 1131 hospitalised CRC patients, 54% reported reduced dietary intake. Patient- and disease-related characteristics significantly associated with reduced dietary intake were female gender (odds ratio (OR) 1.38), cancer stage III (OR 1.52) or IV (OR 1.70) vs. I, performance status 2 (OR 1.56), 3 (OR 2.37) or 4 (OR 4.15) vs. 0, duration since hospital admission of ≥ 4 days (OR 4–7 days, 1.91; 8–21 days, 1.97; > 21 days, 1.92) vs. < 4 days, and unintentional weight loss (OR 2.56). Additionally, higher symptom scores of pain, weakness, depression, tiredness and lack of appetite were associated with reduced intake. Conclusions Patient- and disease-related determinants for reduced dietary intake were being female, higher cancer stage, worse performance status, duration since hospital admission ≥ 4 days and unintentional weight loss. Furthermore, multiple symptoms were associated with a reduced dietary intake. Future trials should assess whether early recognition of patients at risk of malnutrition and the combination of treating symptoms and dietary advice result in improved intake and treatment-related outcomes.
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Affiliation(s)
- Anne van der Werf
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands. .,Department of Medical Oncology, Internal Medicine, VU University Medical Center, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands.
| | - Katherine Arthey
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands
| | - Michael Hiesmayr
- Division Cardiac-, Thoracic-, Vascular Anaesthesia and Intensive Care, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Isabella Sulz
- Institute for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Karin Schindler
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Alessandro Laviano
- Department of Clinical Medicine, Sapienza University, Viale dell'Università 37, 00185, Rome, Italy
| | - Jacqueline Langius
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands
| | - Marian de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands
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Souza BUD, Souza NCS, Martucci RB, Rodrigues VD, Pinho NBD, Gonzalez MC, Avesani CM. Factors Associated with Sarcopenia in Patients with Colorectal Cancer. Nutr Cancer 2018; 70:176-183. [PMID: 29351494 DOI: 10.1080/01635581.2018.1412480] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction; Sarcopenia are frequently observed in cancer patients and was associated with poor prognosis. Objectives; to determine the association of nutritional status, body composition, and clinic parameters with sarcopenia in patients with colorectal cancer (CRC). Methods; We conducted a cross-sectional study of 197 patients with CRC. The sarcopenia elements, including lumbar skeletal muscle index (SMI), handgrip strength, and gait speed were measured. The SMI was assessed by computed tomography at third lumbar vertebra. Phase angle (PA), serum albumin (SAlb), muscle attenuation (MA), and the scored patient-generated subjective global assessment (PG-SGA) were also evaluated. Univariate and multivariate analysis of factors associated with sarcopenia were performed. Results; Sarcopenia was present in 29 of 195 patients (15%) and was significantly correlated with advance age, lower body mass index (BMI), SAlb, PA, MA, higher PG-SGA score, and malnutrition (PG-SGA B). In univariate analysis, age, BMI, SAlb, PA, MA, PG-SGA score, and malnutrition (PG-SGA B) were associated with sarcopenia. Multivariable analysis revealed that BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia. Conclusion; BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia in patients with CRC.
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Affiliation(s)
- Bianca Umbelino de Souza
- a Nutrition and Dietetic Service, Cancer Hospital Unit I, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA) , Rio de Janeiro , Brazil
| | - Nilian Carla Silva Souza
- a Nutrition and Dietetic Service, Cancer Hospital Unit I, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA) , Rio de Janeiro , Brazil.,c Nutrition Institute, Rio de Janeiro State University (UERJ) , Rio de Janeiro , Brazil
| | - Renata Brum Martucci
- a Nutrition and Dietetic Service, Cancer Hospital Unit I, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA) , Rio de Janeiro , Brazil.,c Nutrition Institute, Rio de Janeiro State University (UERJ) , Rio de Janeiro , Brazil
| | - Viviane Dias Rodrigues
- a Nutrition and Dietetic Service, Cancer Hospital Unit I, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA) , Rio de Janeiro , Brazil
| | - Nivaldo Barroso de Pinho
- a Nutrition and Dietetic Service, Cancer Hospital Unit I, Brazilian National Cancer Institute José Alencar Gomes da Silva (INCA) , Rio de Janeiro , Brazil
| | - Maria Cristina Gonzalez
- b Post-graduate Program on Health and Behavior, Catholic University of Pelotas (UCPEL), Pelotas , Rio Grande do Sul , Brazil
| | - Carla Maria Avesani
- c Nutrition Institute, Rio de Janeiro State University (UERJ) , Rio de Janeiro , Brazil
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Luo Z, Wang J, Zhang Z, Li H, Huang L, Qiao Y, Wang D, Huang J, Guo L, Liu J, Liu Y, Zhang Y. Efficacy of Early Enteral Immunonutrition on Immune Function and Clinical Outcome for Postoperative Patients With Gastrointestinal Cancer. JPEN J Parenter Enteral Nutr 2017; 42:758-765. [PMID: 28666095 DOI: 10.1177/0148607117715439] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nutrition support is crucial for patients with gastrointestinal (GI) cancer after the operation. However, the controversy over the application of parenteral nutrition (PN) and early enteral immunonutrition (EEIN) has no determinate conclusion. MATERIALS AND METHODS We compared the effects of PN and EEIN on the postoperative nutrition condition, immune status, inflammation level, long-term survival, and quality of life of the patients with GI cancer. Seventy-eight patients were randomly divided into the PN group (n = 44) or EEIN group (n = 34). After an 8-day nutrition treatment, clinical and immunological parameters were evaluated. RESULTS The EEIN group had a significantly shorter hospital stay and higher body mass index level on postoperative day 30 than those in the PN group (P < .05). However, total hospital cost and incidences of short-term postoperative complications had no significant difference (P > .05). The percentages of CD4+ , natural killer, and natural killer T lymphocyte cells and the ratio of CD4+ /CD8+ in peripheral blood were significantly increased. Compared with the PN group, the EEIN group had a higher expression of activated cell surface markers such as CD27 and CD28. In addition, the secretion of interleukin (IL)-2 and interferon-γ was significantly higher, and the secretion of tumor necrosis factor-α and IL-10 was lower. Complication-free survival in the EEIN group were longer than those in the PN group (P = .04). CONCLUSION EEIN is superior to PN in improving nutrition status, enhancing immune function, and elevating quality of life.
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Affiliation(s)
- Zhenzhen Luo
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Junxia Wang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhen Zhang
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hong Li
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lan Huang
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yamin Qiao
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Dan Wang
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jingjing Huang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Luwei Guo
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jinbo Liu
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanhua Liu
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yi Zhang
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China.,Key Laboratory for Tumor Immunology and Biotherapy of Henan Province, Zhengzhou, Henan, China.,Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Chemotherapy-Related Toxicity, Nutritional Status and Quality of Life in Precachectic Oncologic Patients with, or without, High Protein Nutritional Support. A Prospective, Randomized Study. Nutrients 2017; 9:nu9101108. [PMID: 29019951 PMCID: PMC5691724 DOI: 10.3390/nu9101108] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/01/2017] [Accepted: 10/09/2017] [Indexed: 02/08/2023] Open
Abstract
Background: Cancer disease is usually associated with impaired nutritional status, which is one of the factors contributing to deterioration of the results of surgery, chemotherapy or radiotherapy. Objectives: The aim of the study was to determine whether nutritional support with high protein (ONS) in adult oncologic patients in the first step of cancer cachexia—asymptomatic precachexia, has an influence on the toxicity of systemic therapy. However, secondary endpoints were established: to determine whether high protein ONS influences the nutritional status, the quality of life, and the performance status. Materials and Methods: A total of 114 persons aged 40–84 years old with colorectal cancer were examined. Based on the randomization, 47 patients were qualified to the interventional group (ONS group) and 48 to Control group. To evaluate the nutritional status NRS-2002 (Nutritional Risk Screening), SGA (Subjective Global Assessment), SCRINIO (SCReenIng the Nutritional status In Oncology) Working Group classification, VAS (Visual Analog Scale) for appetite was used. FAACT (Functional Assessment of Anorexia/Cachexia Therapy) questionnaire was used for assessment of the quality of life. The health status of patients was evaluated based on the Karnofsky Performance Scale. Anthropometric measurements were done. Results: Severe complications of chemotherapy, which caused the end of treatment, a slight complication of the gastrointestinal tract such as diarrhea grade 2 according to ECOG (Eastern Cooperative Oncology Group) score regardless of the studied group, were observed. There were no statistical differences in the number and severity of the observed complications, i.e., neutropenia, leucopenia, thrombocytopenia, anemia, abdominal pain, nausea and vomiting, and diarrhea. During the follow-up the significant changes of SGA, VAS, albumin and prealbumin were observed between groups. In the ONS group an improvement in nutritional status was noticed (increased appetite VAS, p = 0.05; increased points in SGA, p = 0.015, and increased levels of albumin and prealbumin, p = 0.05). In Control group nutritional status was stable during observation. The performance status and quality of life were stable in both groups. No statistical differences between groups (ONS vs. Control) in the numbers for disqualification, resignation, delay in treatment, or dose reduction were observed. Conclusions: Results of the study did not indicate that nutritional support in precachectic oncologic patients influenced the toxicity of systemic therapy. High protein nutritional support improved nutritional status assessed by SGA, VAS for appetite, albumin, and prealbumin. The performance status and quality of life were stable throughout the observation and were not changed under the supplementation.
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Hardt J, Pilz L, Magdeburg J, Kienle P, Post S, Magdeburg R. Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection. Int J Colorectal Dis 2017; 32:1439-1446. [PMID: 28823064 DOI: 10.1007/s00384-017-2884-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE This study investigated the association of preoperative hypoalbuminemia and postoperative complications after elective resection for rectal cancer. METHODS From September 2009 to December 2014, all patients who underwent elective rectal resection for adenocarcinoma of the rectum were identified using a prospective colorectal cancer database. Hypoalbuminemia was defined as a serum albumin < 35 g/L. Characteristics and outcomes of hypoalbuminemic patients were compared to those of patients with normal albumin levels. Potential risk factors for postoperative major morbidity, defined as Clavien-Dindo ≥ grade 3, were analyzed by both univariate and multivariate analyses. RESULTS Three hundred seventy patients met the inclusion criteria. Hypoalbuminemic patients (67/370 (18%)) were significantly older and had more advanced tumor stages and more comorbidities (more ASA III, higher percentage of diabetics). Furthermore, they were more likely to undergo abdominoperineal resection instead of low anterior resection and less likely to be operated laparoscopically. On univariate analysis, a higher BMI, advanced tumor stages, diabetes, open procedures, pre- and postoperative hypoalbuminemia, a higher decrease in albumin (∆ preop-postop), and conversion were significantly associated with postoperative high-grade morbidity. On multivariate analysis, diabetes, advanced tumor stages, a higher decrease in the albumin level, as well as preoperative hypoalbuminemia turned out to be independent risk factors for postoperative high-grade morbidity. CONCLUSIONS Hypoalbuminemia is an independent risk factor for postoperative high-grade morbidity. As a low-cost and easy accessible test, serum albumin should be used as a prognostic tool to detect patients at risk for adverse outcomes after resection for rectal cancer.
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Affiliation(s)
- J Hardt
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
| | - L Pilz
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J Magdeburg
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
| | - S Post
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
| | - R Magdeburg
- Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany
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Maurício SF, Xiao J, Prado CM, Gonzalez MC, Correia MITD. Different nutritional assessment tools as predictors of postoperative complications in patients undergoing colorectal cancer resection. Clin Nutr 2017; 37:1505-1511. [PMID: 28918167 DOI: 10.1016/j.clnu.2017.08.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/21/2017] [Accepted: 08/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Malnutrition in patients with colorectal cancer contributes to increased postoperative complications. The aim of the study was to evaluate the prognostic value of several nutritional assessment parameters: body mass index versus percentage of weight loss grading system (BMI/%WL); Patient-Generated Subjective Global Assessment (PG-SGA); standardized phase angle (SPA) by BIA; muscle strength by handgrip strength; muscle mass by computerized tomography; and the combination of muscle mass and strength in patients undergoing resection surgery. METHODS Patients diagnosed with cancer of the colon or rectum, who were over 18 years old and were scheduled to undergo surgical treatment were invited to participate. Postoperative complications were assessed from the first day post-surgery until discharge. Complications classified as Grade II or above according to the Clavien-Dindo classification were considered. Chi-square test or Fisher's exact test, bivariate analysis, Poisson regression and receiver operator characteristic (ROC) curve were utilized and p < 0.05 was considered significant. RESULTS 84 patients were evaluated, with 28 (33.3%) presenting with Grade II postoperative complications. SPA showed no association with postoperative complications (p = 0.199). In multivariate analysis, low skeletal muscle mass showed a relative risk (RR) of 1.80 (CI: 1.02-3.17), BMI/%WL equal or higher than grade 3 had a RR of 1.90 (95% CI: 1.22-3.39). PG-SGA classified as malnutrition showed a RR of 2.08 (95% CI: 1.06-4.06); and low muscle mass plus low muscle strength showed a RR 2.13 (95% CI: 1.23-3.69). Low strength alone was not associated with postoperative complications after controlling for confounding factors (p = 0.16; 95% CI: 0.83-2.77). Low muscle mass in combination with low strength showed the highest predictive power for postoperative complications (AUC: 0.68; CI: 0.56-0.80). CONCLUSIONS BMI/%WL > grade 3, PG-SGA defined malnutrition, low muscle mass and low muscle mass plus low strength were independent risk factors for complications controlling for confounding factors. However, low muscle mass in combination with low muscle strength were the strongest variables associated with complications. CLINICAL TRIALS IDENTIFICATION NUMBER NCT02901132 (www.clinicaltrials.gov).
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Affiliation(s)
- Sílvia Fernandes Maurício
- Post-graduate Program on Surgery and Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Jingjie Xiao
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Maria Cristina Gonzalez
- Post-graduate Program on Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
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Berkelmans GH, van Workum F, Weijs TJ, Nieuwenhuijzen GA, Ruurda JP, Kouwenhoven EA, van Det MJ, Rosman C, van Hillegersberg R, Luyer MD. The feeding route after esophagectomy: a review of literature. J Thorac Dis 2017; 9:S785-S791. [PMID: 28815075 DOI: 10.21037/jtd.2017.03.152] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Enhanced recovery programs effectively optimize perioperative care and reduce postoperative morbidity. In esophagectomy, several components of the ERAS program are successfully introduced. However, timing and type of postoperative feeding remain a matter of debate. Adequate nutritional support is essential in patients undergoing an esophagectomy. These patients often present with weight loss and their eating pattern is strongly altered by the procedure and reconstruction. Total parenteral nutrition (TPN) is associated with severe septic complications and enteral nutrition (EN) does not increase major complications. Therefore, early EN after esophagectomy is favored over TPN. However, with enteral feeding tubes minor complications occur frequently (13-38%) and in some cases this can hamper recovery. Based on experience in other types of upper gastro-intestinal surgery, early start of oral feeding could improve time to functional recovery after surgery. The total length of stay was significantly shorter in four prospective studies (6-12 vs. 8-13 days). However, large randomized controlled trials are lacking and the potential benefit of early oral feeding after esophageal surgery remains elusive. EN is nowadays the optimal feeding route after esophagectomy. TPN should only be used in specific cases in which EN is contraindicated. Early initiation of oral intake is promising and could improve postoperative recovery. However, further research is needed to substantiate these results.
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Affiliation(s)
- Gijs H Berkelmans
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Frans van Workum
- Department of Surgery, University Medical Center Radboud, Nijmegen, The Netherlands
| | - Teus J Weijs
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marc J van Det
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Camiel Rosman
- Department of Surgery, University Medical Center Radboud, Nijmegen, The Netherlands
| | | | - Misha D Luyer
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Nutritional status assessment in colorectal cancer patients qualified to systemic treatment. Contemp Oncol (Pozn) 2017; 21:157-161. [PMID: 28947886 PMCID: PMC5611506 DOI: 10.5114/wo.2017.68625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/23/2017] [Indexed: 01/06/2023] Open
Abstract
Aim of the study Cancer is usually associated with impaired nutritional status, which is one of the factors contributing to the deterioration of the results of surgery, chemotherapy, or radiotherapy. The aim of this study was the assessment of the nutritional status of patients with CRC qualified to chemotherapy. Material and methods Seventy-five persons aged 40–86 years with colorectal cancer were examined. To evaluate the nutritional status NRS 2002, SGA, SCRINIO Working Group classification, VAS scale for appetite, and FAACT questionnaire were used. The health status of patients was evaluated based on the Karnofsky Performance Scale. Anthropometric measurements were made. Results The results indicate that 75% of patients present pre-cachexia status based on SCRINIO Working Group classification. According to both NRS-2002 and SGA, 73.3% of patients were moderately malnourished and 2.7% were severely malnourished. 37.0% of patients had moderate appetite and 6.0% (n = 5) had poor appetite. The Karnofsky score indicates the state of normal activity, and minor signs and symptoms of the disease among most of the patients. A statistically significant positive correlation was found between the VAS and the Karnofsky score (R = 0,4; p < 0.05). The FACCT average score (78.5) indicates a reduction in the quality of life of the patients in all aspects of functioning. Conclusions Evaluation of the baseline nutritional status of patients with CRC should be a part of routine clinical practice. Because of the high incidence of confirmed pre-cachexia, this group of patients also requires early adequate nutrition intervention.
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Leong KJ, Chapman MAS. Current data about the benefit of prehabilitation for colorectal cancer patients undergoing surgery are not sufficient to alter the NHS cancer waiting targets. Colorectal Dis 2017; 19:522-524. [PMID: 28498541 DOI: 10.1111/codi.13723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/24/2017] [Indexed: 02/08/2023]
Affiliation(s)
- K J Leong
- Good Hope Hospital, Sutton Coldfield, UK
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Bendersky V, Sun Z, Adam MA, Rushing C, Kim J, Youngwirth L, Turner M, Migaly J, Mantyh CR. Determining the Optimal Quantitative Threshold for Preoperative Albumin Level Before Elective Colorectal Surgery. J Gastrointest Surg 2017; 21:692-699. [PMID: 28138809 DOI: 10.1007/s11605-017-3370-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/12/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hypoalbuminemia is associated with adverse surgical outcomes. A minimum threshold and the impact of incrementally decreasing albumin remain undefined for colorectal surgery patients. STUDY DESIGN The 2011-2013 National Surgical Quality Improvement Program (NSQIP) dataset was queried for patients undergoing elective colorectal surgery. Multivariable regression analyses with restricted cubic splines (RCS) were used to examine the adjusted association between preoperative serum albumin level and the incidence of complications and to establish an optimal threshold. RCS allows for flexible evaluation in multivariable models without having to assume a specific relationship a priori. RESULTS Sixteen thousand one hundred forty-five patients met study criteria. RCS analysis demonstrated an inflection point at serum albumin level of 3.9 mg/dL. Patients with preoperative albumin <3.9 mg/dL vs. albumin ≥3.9 mg/dL had a higher likelihood of experiencing a major complication (odds ratio (OR) = 1.18, confidence interval (CI) 1.07-1.30, p = 0.0007) or any complications (OR 1.18, CI 1.08-1.29, p = 0.0002,) and had a lengthened hospital stay (p < 0.001). CONCLUSIONS This study objectively determines that a threshold preoperative serum albumin of ≥3.9 mg/dL is associated with improved outcomes in elective colorectal surgery patients. Each 0.5 mg/dL decrease in albumin was progressively associated with increased risk for complications. Identifying a minimum albumin threshold has implications in perioperative optimization of patients undergoing colorectal surgery.
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Affiliation(s)
| | - Zhifei Sun
- Department of Surgery, Duke University, Durham, NC, USA
| | | | - Christel Rushing
- Duke Department of Biostatics and Bioinformatics, Durham, NC, USA
| | - Jina Kim
- Department of Surgery, Duke University, Durham, NC, USA
| | | | - Megan Turner
- Department of Surgery, Duke University, Durham, NC, USA
| | - John Migaly
- Department of Surgery, Duke University, Durham, NC, USA
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Preoperative hypoalbuminemia is associated with poor clinical outcomes after open and endovascular abdominal aortic aneurysm repair. J Vasc Surg 2017; 66:53-63.e1. [PMID: 28216349 DOI: 10.1016/j.jvs.2016.10.110] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/25/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The effect of preoperative malnutrition on outcomes in patients undergoing major vascular surgery is unclear. We investigated the effects of preoperative hypoalbuminemia, a marker for malnutrition, on outcomes after open abdominal aortic aneurysm repair (OAR) and endovascular abdominal aortic aneurysm repair (EVAR). METHODS Patients undergoing OAR or EVAR were identified in the 2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program database and stratified into three groups: normal albumin (serum albumin >3.5 g/dL), moderate hypoalbuminemia (2.8-3.5 g/dL), and severe hypoalbuminemia (<2.8 g/dL). Multivariable analyses were performed to assess the association of preoperative hypoalbuminemia with 30-day morbidity and mortality. RESULTS We identified 15,002 patients with a recorded preoperative serum albumin who underwent OAR (n = 4956) or EVAR (n = 10,046). Patients in both cohorts with hypoalbuminemia had a higher burden of comorbidity. In OAR patients, multivariable analyses demonstrated that moderate hypoalbuminemia was associated with an increased risk of 30-day mortality (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.02-1.70) and postoperative length of stay (LOS; means ratio [MR], 1.10; 95% CI, 1.04-1.16), whereas severe hypoalbuminemia was associated with increased 30-day mortality (OR, 1.92; 95% CI, 1.37-2.70), reoperation ≤30 days (OR, 1.80; 95% CI, 1.32-2.48), pulmonary complications (OR, 1.40; 95% CI, 1.06-1.86), and postoperative LOS (MR, 1.33; 95% CI, 1.21-1.45). In EVAR patients, moderate hypoalbuminemia was associated with an increased risk of 30-day mortality (OR, 1.90; 95% CI, 1.38-2.62), pulmonary complications (OR, 1.61; 95% CI, 1.26-2.04), reoperation ≤30 days (OR, 1.39; 95% CI, 1.12-1.74), and postoperative LOS (MR, 1.23; 95% CI, 1.18-1.29), whereas severe hypoalbuminemia was associated with increased 30-day mortality (OR, 2.98; 95% CI, 1.96-4.53), pulmonary complications (OR, 1.88; 95% CI, 1.32-2.67), reoperation ≤30 days (OR, 1.54; 95% CI, 1.08-2.19), and postoperative LOS (MR, 1.52; 95% CI, 1.40-1.65). CONCLUSIONS Preoperative hypoalbuminemia is associated with increased postoperative morbidity and mortality in a severity-dependent manner among patients undergoing OAR or EVAR. Evaluation and optimization of nutritional status should be performed preoperatively in this high-risk population.
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Aldebeyan S, Nooh A, Aoude A, Weber MH, Harvey EJ. Hypoalbuminaemia-a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures. Injury 2017; 48:436-440. [PMID: 28040258 DOI: 10.1016/j.injury.2016.12.016] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/12/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Our aim was to determine the effect of hypoalbuminaemia as a marker of malnutrition on the 30-day postoperative complication rate and mortality in patients receiving surgical treatment for hip fractures using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS We analyzed all patients admitted with hip fractures receiving surgical treatment from 2011 to 2013. Patients were dichotomized based on their albumin levels; hypoalbuminaemia (albumin <3.5g/dL), and nonhypoalbuminaemia (albumin >3.5g/dL). Patient demographics, postoperative complications, and length of stay were analysed. Logistic regression analysis was conducted to assess the ability of albumin level for predicting postoperative complications, length of stay, and mortality. RESULTS A total of 10,117 patients with hip fractures were identified with 5414 patients with normal albumin levels, and 4703 with low albumin. Multivariate analysis showed that when controlling for comorbidities; hypoalbuminaemia alone was a predictor of postoperative complications (death, unplanned intubation, being on a ventilator >48h, sepsis, and blood transfusion), and increased length of stay (6.90±7.23 versus 8.44±8.70, CI 0.64-1.20, P<0.001). CONCLUSION Hypoalbuminaemia alone can predict postoperative outcomes in patients with hip fractures. Furthermore, patients with hypoalbuminaemia had a longer hospital length of stay. Further studies are needed to assess whether nutritional support can improve postoperative complications in patients with hypoalbuminaemia.
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Affiliation(s)
- Sultan Aldebeyan
- Division of Orthopaedics, McGill University Health Center, Montreal, Canada; National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Anas Nooh
- Division of Orthopaedics, McGill University Health Center, Montreal, Canada; Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Aoude
- Division of Orthopaedics, McGill University Health Center, Montreal, Canada
| | - Michael H Weber
- Division of Orthopaedics, McGill University Health Center, Montreal, Canada
| | - Edward J Harvey
- Division of Orthopaedics, McGill University Health Center, Montreal, Canada
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Optimal Nutrition and Hydration Through the Surgical Treatment Trajectory. Semin Oncol Nurs 2017; 33:61-73. [PMID: 28062328 DOI: 10.1016/j.soncn.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To review oncology nurses role of informational continuity in regards to nutrition and hydration to ensure continuity of care from one care center to another. DATA SOURCES Peer-reviewed literature, PubMed, CINAHL, EMBASE, and web-based resources. CONCLUSION Optimal nutrition and hydration during cancer treatment and survivorship requires assessment and preplanning of needs. Oncology nurses play a vital role in preparing patients and caregivers for optimal nutrition during the surgical treatment trajectory. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses should emphasize nutrition planning during the surgical treatment trajectory to enhance survivorship and quality of life of the cancer patient. Educational resources exist for both nursing and cancer patients.
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Shin R, Lee SM, Sohn B, Lee DW, Song I, Chai YJ, Lee HW, Ahn HS, Jung IM, Chung JK, Heo SC. Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation. Ann Coloproctol 2016; 32:221-227. [PMID: 28119865 PMCID: PMC5256250 DOI: 10.3393/ac.2016.32.6.221] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/23/2016] [Indexed: 02/07/2023] Open
Abstract
Purpose An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation. Methods We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated. Results The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels. Conclusion Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.
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Affiliation(s)
- Rumi Shin
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang Mok Lee
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Beonghoon Sohn
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dong Woon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Inho Song
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hae Won Lee
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hye Seong Ahn
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - In Mok Jung
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung Kee Chung
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seung Chul Heo
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Luigi De M, Brice P, David O, Olivier F, Giovanni di G, Patrick R, Christine B, Pablo OD. Preoperative inflammation increases the risk of infection after elective colorectal surgery: results from a prospective cohort. Int J Colorectal Dis 2016; 31:1611-7. [PMID: 27357511 PMCID: PMC5517619 DOI: 10.1007/s00384-016-2620-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Septic complications after colorectal surgery are frequent and sometimes life threatening. It is well known that inflammation impairs the healing process. It has been suggested that preoperative ongoing inflammation could increase the risk of postoperative infections. This study aimed to elucidate the role of preoperative inflammation on postoperative infectious complications and to understand if, through biological markers, it is possible to identify preoperatively patients at higher risk of infection. METHODS A prospective, observational study was conducted in three centers from November 2011 to April 2014. Consecutive patients undergoing elective colorectal surgery with anastomosis were included. Any ongoing infection was an exclusion criterion. C-reactive protein, albumin, prealbumin, and procalcitonin plasma levels were measured preoperatively. Postoperative infections were recorded according to the definitions of the Centers for Diseases Control. The areas under the receiver operating characteristic curve were analyzed and compared to assess the accuracy of each preoperative marker. RESULTS Four-hundred and seventy two patients were analyzed. Infectious complications occurred in 118 patients (25 %) and mortality in 6 patients (1.3 %). In the univariate analysis, preoperative C-reactive protein and albuminemia were found significantly associated with postoperative infectious complications (P = 0.008 and P = 0.0002, respectively). Areas under the ROC curve for preoperative C-reactive protein and albuminemia were 0.57and 0.62, respectively. CONCLUSIONS This study confirms the association between preoperative inflammatory activity, hypoalbuminemia, and the onset of infections after surgery. Trials aiming to decrease the inflammatory activity before surgery in order to prevent postoperative complications are warranted.
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Affiliation(s)
- Magistris Luigi De
- Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon)
Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand - CHU Dijon - 14 rue Paul Gaffarel - 21079 Dijon
| | - Paquette Brice
- Service de Chirurgie Digestive [CHU Besançon]
Centre Hospitalier Régional Universitaire [Besançon] - Université de Franche-Comté - Place Saint Jacques 25000 Besançon
| | - Orry David
- CRLCC - CGFL, Centre Régional de Lutte Contre le Cancer - Centre Georges-François Leclerc
1 rue du Professeur Marion, 21000 Dijon
| | - Facy Olivier
- Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon)
Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand - CHU Dijon - 14 rue Paul Gaffarel - 21079 Dijon,Chimiothérapie et Réponse Immunitaire Anti-Tumorale (U866, Cancer, équipe 1)
Université de Bourgogne - Institut National de la Santé et de la Recherche Médicale - U866Université de Bourgogne - 21000 Dijon
| | - Giacomo Giovanni di
- Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon)
Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand - CHU Dijon - 14 rue Paul Gaffarel - 21079 Dijon
| | - Rat Patrick
- Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon)
Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand - CHU Dijon - 14 rue Paul Gaffarel - 21079 Dijon,Chimiothérapie et Réponse Immunitaire Anti-Tumorale (U866, Cancer, équipe 1)
Université de Bourgogne - Institut National de la Santé et de la Recherche Médicale - U866Université de Bourgogne - 21000 Dijon
| | - Binquet Christine
- Chimiothérapie et Réponse Immunitaire Anti-Tumorale (U866, Cancer, équipe 1)
Université de Bourgogne - Institut National de la Santé et de la Recherche Médicale - U866Université de Bourgogne - 21000 Dijon,CIC-EC, Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques
Université de Bourgogne - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand - Institut National de la Santé et de la Recherche Médicale - Faculté de MédecineBP 87900 - 7 boulvard Jeanne d'Arc - 21079 Dijon Cedex
| | - Ortega-Deballon Pablo
- Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon)
Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand - CHU Dijon - 14 rue Paul Gaffarel - 21079 Dijon,Chimiothérapie et Réponse Immunitaire Anti-Tumorale (U866, Cancer, équipe 1)
Université de Bourgogne - Institut National de la Santé et de la Recherche Médicale - U866Université de Bourgogne - 21000 Dijon,* Correspondence should be addressed to Ortega-Deballon Pablo
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Hu WH, Chen HH, Lee KC, Liu L, Eisenstein S, Parry L, Cosman B, Ramamoorthy S. Assessment of the Addition of Hypoalbuminemia to ACS-NSQIP Surgical Risk Calculator in Colorectal Cancer. Medicine (Baltimore) 2016; 95:e2999. [PMID: 26962812 PMCID: PMC4998893 DOI: 10.1097/md.0000000000002999] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to evaluate the benefit of adding hypoalbuminemia to the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Surgical Risk Calculator when predicting postoperative outcomes in colorectal cancer patients.The ACS-NSQIP Surgical Risk Calculator offers qualified risk evaluation in surgical decision-making and informed patient consent. To date, malnutrition defined as hypoalbuminemia, an important independent surgical risk factor in colorectal cancer, is not included.This is a retrospective, multi-institutional study of ACS-NSQIP patients (n = 18,532) who received colorectal surgery from 2009 to 2012. Models were constructed for predicting postoperative mortality and morbidity using the risk factors of the ACS-NSQIP Surgical Risk Calculator before and after adding hypoalbuminemia as a risk factor. The 2 models' performance was then compared using c-statistics and Brier scores. The ACS-NSQIP database in 2008 was used for validation of the created models.The prevalence of hypoalbuminemia (27.8%) is higher in colorectal cancer, when compared with other most common cancers. In univariate analyses, hypoalbuminemia was significantly associated with postoperative mortality and morbidity in colorectal cancer patients. In multivariate logistic regression analyses, 15 postoperative complications, including mortality and serious morbidities, were significantly predicted by hypoalbuminemia. Most of the models with hypoalbuminemia showed better performance and validation in predicting postoperative complications than those without hypoalbuminemia.In colorectal cancer, hypoalbuminemia, with levels below 3.5 g/dL, serves as an excellent assessment tool and preoperative predictor of postoperative outcomes. When combined with hypoalbuminemia as a risk factor, the ACS-NSQIP Surgical Risk Calculator offers more accurate information and estimation of surgical risks to patients and surgeons when choosing treatment options.
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Affiliation(s)
- Wan-Hsiang Hu
- From the Department of Surgery (W-HH, SE, LP, BC, SR) and Rebecca and John Moores Cancer Center (W-HH, SE, LP, SR), University of California San Diego Health System, La Jolla, CA; Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (W-HH, H-HC, K-CL); Department of Surgery, Veteran's Administration San Diego Healthcare System, La Jolla (BC); and Division of Biostatistics and Bioinformatics, School of Medicine, University of California, San Diego (LL), CA
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