Original articleIs malnutrition still a risk factor of postoperative complications in gastric cancer 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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