Concentrated albumin infusion as an aid to postoperative recovery after pelvic exenteration

Risk and predictive factors of hypoalbuminemia in cancer patients following extensive abdominal surgery despite total parenteral nutritional support

“…Specifically, SA levels remained 11.8% lower on POD 7 in cancer patients following EAS. This contrasts previous reports indicating that total serum protein levels normalize during the first few PODs (Fiorica et al 1991), even among cancer patients not administered TPN (Tashiro et al 1999;Usharani et al 2004). Furthermore, the RR of postoperative hypoalbuminemia during the first postoperative week was increased by approximately threefold among patients following extensive, as compared to moderate, abdominal surgery.…”

“…SA levels are often reduced immediately following abdominal interventions (Orr et al 1983;Tashiro et al 1999;Hallay et al 2002), including those limited in extent and duration (Kudsk et al 2003;Montagnana et al 2009), secondary to the transudation of proteins into the peritoneal cavity or development of postoperative ileus. Moreover, reduction of SA levels has also been reported among patients receiving TPN, including HAS (Fiorica et al 1991) and/or colloid (Vogt et al 1999) solutions. However, the present findings further indicated that despite TPN administration, mean SA levels were significantly lower in cancer patients following extensive, as compared to moderate, abdominal surgery throughout the first four PODs.…”

“…Despite the plethora of evidence regarding the relationship between hypoalbuminemia and adverse postoperative outcome, limited studies exist regarding the aetiological role of the extent of surgery upon observed SA levels (Haupt et al 1999;Nicholson (Orr et al 1983;Fiorica et al 1991). Since postoperative hypoalbuminemia may present with both varying intensity and duration, impeding tissue repair and recovery, it is often deterred with the administration of total parenteral and/or enteral nutritional support, including amino acid enriched solutions, HAS and FFP transfusions.…”

“…Statistical analyses were conducted with SAS version 9.1 (SAS Institute, Cary, North Carolina, USA). The study sample size was calculated based on 90% power, 95% confidence intervals (95% CIs) and expected odds of 2.41 (Fiorica et al 1991).…”

“…However, to date, prospective studies aimed at assessing the risk and predictive factors of postoperative hypoalbuminemia in cancer patients following EAS, despite TPN support, are limited (Orr et al 1983;Fiorica et al 1991;Kudsk et al 2003). Such evidence may contribute to the determination of the magnitude of SA depletion incurred and the resulting necessity for repletion with TPN administration, thus deterring adverse outcomes in cancer patients undergoing abdominal surgery (Machado et al 2008).…”