Nutritional Status as a Risk Factor in Esophageal Surgery

Abstract

Background: Nutritional condition is one of the factors determining postoperative outcome in esophageal surgery. This study explored the relation between preoperative nutritional status and postoperative infectious complications. Methods: From a prospective database, 400 patients who underwent esophageal resection for malignancy were selected. Preoperative nutritional status was assessed by body mass index, prognostic nutritional index (PNI), nutritional risk index (NRI) and weight loss. The association between nutritional parameters and postoperative complications and mortality, gender, age and hospitalization was assessed. Results: PNI and NRI differed between the patients with and without postoperative infectious complications (p = 0.031 and p = 0.009, respectively). However, receiver operating characteristic curves showed that PNI and NRI have a low predictive value for such complications. Also, no associations were found between nutritional parameters and in-hospital mortality. Although mean nutritional parameters were significantly lower, i.e. worse, in patients with neoadjuvant treatment as compared to no such treatment, the incidence of complications did not significantly differ between these treatment groups. Although PNI and NRI correlated negatively with age, no association was found between age and infectious complications. Multivariate analysis of various factors showed the male gender to be the only significant risk factor for development of infectious complications. Discussion: Preoperative nutritional status established by PNI, NRI, body mass index and weight loss has limited value in predicting complications following esophageal resection.

Nutritional Management of Esophageal Cancer Patients

“…These results are in accordance with later studies, indicating that nutritional status preoperatively, expressed as PNI, was significantly related with the occurrence of severe complications and was a predictive factor for long-term survival [25,26]. Nevertheless, Han-Geurts et al showed that PNI was not associated with postoperative infectious complications in patients who underwent esophageal resection for malignancy [27]. NRS-2002 is recommended by the European Society for Clinical Nutrition and Metabolism as a standard tool for the assessment of surgical patients [28], but it is not tailored to esophageal cancer patients, thus limiting its prognostic value in this population.…”

“…NRI is another tool used for the assessment of malnutrition based on serum albumin concentration and weight loss. Ιncreased nutritional risk, derived from NRI, is associated with reduced survival in esophageal cancer patients treated with definitive chemoradiotherapy [10,33], but is not associated with postoperative infectious complications in patients treated with esophagectomy [27]. The Geriatric Nutritional Risk Index (GNRI) is a new index recently introduced for the assessment of nutritional status of elderly patients.…”

Quality-of-care indicators for oesophageal cancer surgery: A review

“…The relationship between the preoperative nutritional status and the outcome of surgery in patients with oesophageal carcinoma has shown conflicting results [58][59][60][61] . In one study, underweight patients who underwent major intra-abdominal surgery, e.g., oesophagectomy, had a five-fold increased risk of postoperative mortality 59 .…”

“…Though, other studies including exclusively oesophageal cancer patients have not confirmed this 58;60 . In four studies, complication rates for obese patients equalled those for non-obese patients [58][59][60][61] .…”

Review of nutritional status and dietetic interventions in patients suffering from upper-gastrointestinal cancers

“…Nutritional status is a predictive factor in post-operative outcomes (2) . Neo-adjuvant chemotherapy followed by surgery is the treatment of choice for the majority of these patients (3) .…”