Grade of esophageal cancer and nutritional status impact on postsurgery outcomes

Abstract

-Context -Undernutrition is a well known underlying cause in both disease onset and outcome. Objective -To associate disease severity with pre surgical nutritional status, the main postsurgical complications, and mortality in esophagus cancer patients. Method -Retrospective data from 100 patients (38-81 years old, 85% males) who had undergone esophagectomy (G1/n = 25) or gastro/jejunostomy (G2/n = 75) between 1995 and 2004. Data included clinical, endoscopic, histological (TNM-UICC), dietary, anthropometric, blood chemistry, and postsurgical (>30 days) complications and mortality. Surgical groups were compared by Student's test and existing associations between variables by either c 2 or Fisher exact tests with P = 0.05. Results -The studied sample was predominantly male (85%), white (80%), smokers and alcoholics (95%), dysphagics (95%) mostly presenting body weight loss before cancer diagnosis (78%). TNM III and IV predominated over I and II, associated (P≤0.005) with higher body mass index and hypoalbuminemia (<3.5 mg/dL) frequency. Esophagic obstructions (n = 77) were associated (P = 0.002) with lower body mass index (kg/m 2 ). Postsurgical complications were more common in G1 (69.2%) than G2, predominantly with infections in G2 (80%) and pleura-pulmonary in G1 (61%). Body mass index and lower lymphocyte counts were associated with early infections and postsurgical complications in G2. Plasma albumin levels were lower in this group than G1, and were associated with postsurgical complications and mortality whereas lower lymphocyte counts was associated with mortality in G1. Conclusions -Disease severity (or late diagnosis) is associated with poor nutritional status and palliative surgery which lead to more complicated postsurgery outcome and mortality. Early diagnosis and nutritional intervention are the recommended actions.

O índice de risco nutricional (nutritional risk index) é preditor de complicação pós-operatória em operações do aparelho digestivo ou parede abdominal?

“…Many studies have demonstrated lower mortality in patients with lower body weight loss, despite in some cases, as in a study with surgical patients with esophagus cancer, this was not observed 21 . Considering that to calculate the Nutritional Risk Index both serum albumin and body weight loss are needed, the Nutritional Risk Index result might overestimate malnutrition, because, albumin level might be related with disease severity and body weight loss estimation depends on subjective usual body weight value informed by the patient.…”

“…Mortality is higher in subjects with lower serum albumin level 21 . Gregg 15 assessed several mortality predictors and found that serum albumin had a positive association with mortality in patients submitted to cystectomy 21 .…”

“…Pablo 23 and Almeida 1 found a low correlation between Subjective Global Assessment and Nutritional Risk Index. 21,23 In the same study, Almeida 1 suggested that the Nutritional Risk Index has a lower sensitivity and specificity to assess malnutrition risk as compared to Subjective Global Assessment. Some postoperative complications are related to the wound healing process.…”

“…Gregg 15 assessed several mortality predictors and found that serum albumin had a positive association with mortality in patients submitted to cystectomy 21 . Another study showed no association between mortality and low serum albumin level to patients submitted for surgery for esophageal cancer tratament 21 .The present study found a significant association between low serum albumin and noninfectious complications.…”

“…Garth 14 , Marin 21 and Pacelli 24 also suggested that BMI assessed in hospital admission was not correlated to postoperative complications. Regardless which method is used to assess malnutrition, studies have shown that higher hospital length of stay is associated to impaired nutritional status and the probability of malnourished patients stay in hospital fifteen days or more is three times higher as compared to nourished subjects.…”