Elsevier

Clinical Nutrition

Volume 27, Issue 3, June 2008, Pages 398-407
Clinical Nutrition

Original article
Is malnutrition still a risk factor of postoperative complications in gastric cancer surgery?

https://doi.org/10.1016/j.clnu.2008.03.002Get rights and content

Summary

Objective & aims

The present study aimed at retrospectively evaluating the incidence of mortality and major and minor postoperative complications in patients who underwent surgery for gastric cancer between 2000 and 2006 stratified according to the preoperative percentage weight loss, serum albumin levels and body mass index (BMI).

Methods

One hundred and ninety-six patients affected by gastric cancer admitted to the Division of Digestive Surgery of the Catholic University of Rome between January 2000 and December 2006 were considered eligible and were included in the study. According to the weight loss, patients were divided into three groups: (1) 0–5%; (2) 5.1–10%; (3) >10%. On the basis of serum albumin levels, were divided into three groups: (1) <3.0 g/dl; (2) 3.0–3.4 g/dl; (3) >3.5 g/dl. According to BMI, were divided into four groups: (1) <18.5 kg/m2; (2) 18.5–24.9 kg/m2; (3) 25.0–29.9 kg/m2; (4) >30.0 kg/m2. Postoperative complications and mortality were reported. Complications were classified by objective criteria as major or minor, and as infectious or non-infectious.

Results

The postoperative mortality was 0%. Major infectious complications occurred in 20 patients (10.2%), major non-infectious in 18 (9.2%), minor infectious in 21 (10.7%), whereas minor non-infectious complications were absent. The rate of major infectious, major non-infectious and minor infectious postoperative complications was similar in patients with absent or light weight loss (8.8%, 8.8%, 10.6%, respectively), mild weight loss (15.3%, 11.5%, 9.6%, respectively), or severe weight loss (6.4%, 6.4%, 12.9%, respectively). Similarly, the rate of postoperative complications did not differ between patients with serum albumin <3.0 g/dl (10.8%, 8.1%, 8.1%, respectively); between 3.0 and 3.4 (8.8%, 13.3%, 17.7%, respectively) or ≥3.5 g/dl (10.5%, 7.9%, 8,7%, respectively). According to BMI, the rate of postoperative complications was: 11.7%, 5.8%, and 5.8% for BMI <18.5 kg/m2; 9.4%, 8.2%, and 11.7% for BMI between 18.5 and 24.9 kg/m2; 10.7%, 10.7%, and 9.2% for BMI between 25 and 29.9 kg/m2; 10.3%, 10.3% and 13.7% for BMI >30 kg/m2. Then, we evaluated the postoperative morbidity only in patients who underwent total gastrectomy or distal subtotal gastrectomy associated with extended lymphadenectomy. In this group of patients, the rate of postoperative complications was comparable in patients with 0–5% (8.8%, 7.7%, 10%, respectively), 5.1–10% (14.6%, 9.7%, 9.7%, respectively), and >10% (7.1%, 7.1%, 14.3%, respectively) weight loss. Also stratifying the patients according to the serum albumin levels, the rate of postoperative complications did not differ significantly (serum albumin <3.0 g/dl: 14.8%, 11.1%, 14.8%, respectively; serum albumin between 3.0 and 3.4 g/dl: 6.2%, 12.5%, 15.6%, respectively; serum albumin ≥3.5 g/dl: 10.4%, 5.8%, 7.0%, respectively). According to BMI, the rate of postoperative complications was: 7.6%, 0%, and 7.6% for BMI <18.5 kg/m2; 9.5%, 9.5%, and 11.1% for BMI between 18.5 and 24.9 kg/m2; 12.5%, 8.3%, and 10.4% for BMI between 25 and 29.9 kg/m2; 9.5%, 9.5% and 9.5% for BMI >30 kg/m2.

Conclusion

The present study suggests that weight loss and hypoalbuminemia are not associated with an increased risk of mortality and morbidity in patients who underwent surgery for gastric cancer. This study may represent a stimulus for further studies aiming at evaluating the actual role of malnutrition in the development of postoperative complications in major abdominal surgery.

Introduction

Seventy years ago, Studley documented that in surgery for peptic ulcer postoperative complications were almost 10-fold higher in patients with weight loss greater than 20% compared to those without weight loss.1 Since then, a multitude of studies has clearly demonstrated that protein-calorie malnutrition is a significant risk factor of postoperative complications in major abdominal surgery.2, 3, 4, 5, 6, 7, 8, 9, 10

However, in the last three decades we have assisted in an impressive improvement of anesthetic and surgical techniques and in an amelioration of postoperative patient management that have led to a reduction of postoperative morbidity and mortality.11, 12 At the same time, some recent evidence suggests that overweight and obesity rather than malnutrition are significant risk factor of postoperative complications in major abdominal surgery.13, 14

In the light of these considerations and bearing in mind that correction of malnutrition requires a prolongation of hospital admission with consequent increase of the costs of health care, we thought that it was time to revisit the issue “malnutrition and postoperative complications”, investigating if malnutrition is still associated with an increased mortality and morbidity in gastric cancer surgery.

The present study aimed at retrospectively evaluating the incidence of mortality and major and minor postoperative complications in patients who underwent surgery for gastric cancer between 2000 and 2006 stratified according to the preoperative percentage weight loss, serum albumin levels and body mass index (BMI).

Section snippets

Patients

All patients affected by gastric cancer included in this prospectively collected, retrospective cohort study presented to the Division of Digestive Surgery of the Catholic University of Rome between January 2000 and December 2006. All patients underwent surgery and were considered eligible. All patients gave written informed consent and the local Ethics Committee approved the study.

Preoperative neoadjuvant chemo or radio-chemotherapy and/or hyperthermic intraoperative intraperitoneal

Results

During the period January 2000–December 2006 a total of 223 patients affected by gastric cancer underwent surgery at the Division of Digestive Surgery of the Catholic University of Rome and were inserted in a prospectively collected data base. Among these patients 11 received preoperative neoadjuvant chemo or radio-chemotherapy, 9 were treated with hyperthermic intraoperative intraperitoneal chemotherapy, and 7 received both procedures. All of these patients received pre and/or postoperative

Discussion

The present prospective study shows that the incidence of postoperative complications is similar in well-nourished and malnourished patients who underwent surgery for gastric cancer between 2000 and 2006. Indeed, we did not observe significant differences between well-nourished and malnourished patients either in the incidence of major infectious, major non-infectious, minor infectious or minor non-infectious postoperative complications. Also when limiting the analysis to the

Conflict of interest statement

The authors declare that they have no conflict of interest.

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