Postoperative Hypoproteinemia in Cancer Patients Following Extensive Abdominal Surgery Despite Parenteral Nutritional Support

Abstract

Determination of the predictors of hypoproteinemia among cancer patients following extensive surgery may enhance their nutritional management and clinical outcome. This study evaluated the predictive factors of postoperative hypoproteinemia among cancer patients following extensive abdominal surgery. An age- and gender-matched case-control study (n = 115) was conducted among cancer patients undergoing extensive (cases; n = 81) and moderate (controls; n = 34) abdominal surgery. Case patients received total parenteral nutrition (TPN), including 3 units of fresh frozen plasma and 200 mL 5% human albumin solution, for 8 postoperative days (POD). Case patients had lower mean total serum protein (TSP) levels throughout POD 8 (F value = 13.81; P = 0.001). Despite TPN, cases had greatest mean (±SD) TSP percent change on POD 1 (-24.6% ± 13.0, vs. -12.6% ± 9.2; P < 0.0001) and did not regain preoperative levels (POD 8: -14.3% ± 12.5 vs. 6.9% ± 13.4; P = 0.006). The likelihood of hypoproteinemia in this group was greatest on POD 3 (OR = 30.57; 95% CI 5.44-171.83). Multivariate regression analyses indicated that the determinants of postoperative hypoproteinemia were age [Adjusted OR (AOR) = 1.04; 95% CI 1.00-1.08), preoperative TSP (AOR = 0.46; 95% CI 0.23-0.92), and extensive surgery (AOR = 2.65; 95% CI 1.01-6.95). Tailored nutritional support, regarding extent of surgery, preoperative TSP, and patient age are needed to deter the occurrence of postoperative hypoproteinemia and consequent adverse surgical outcome among cancer patients.

Effect of Early Peripheral Parenteral Nutrition Support in an Enhanced Recovery Program for Colorectal Cancer Surgery: A Randomized Open Trial

“…Fasting, reduced protein-calorie intake, and increased catabolic activity triggered by the stress of surgery are reflected in the decrease in analytical parameters such as urea and serum proteins. This decrease seems to be directly related to the degree of surgical stress to which the patient is subjected [26,27]. In our study, we only observed differences in glucose, urea, and zinc postoperative laboratory parameters between the PPN and FT groups in the short-term follow-up.…”

How Do Surgical Stress and Low Perioperative Serum Protein and Albumin Impact Upon Short Term Morbidity and Mortality in Gastric Cancer Surgery?

“…It leads to increased postoperative morbidity, being the main cause of mortality after intestinal resections. Identification of predisposing factors is paramount in the prevention of anastomotic leakage [ 6 ] We only found studies analyzing the connection between albumin and surgical complications such as anastomotic leakage in colorectal cancer surgery [ 7 , 8 ] and only preoperatively, while few other studies debated the problem of postoperative low total serum protein values in abdominal cancer surgery [ 9 ] and an unfavorable outcome.…”

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

“…Eligibility for study participation was assessed upon hospital admission and one day prior to surgery (Critselis et al 2011). Eligible participants were aged between 18 and 85 years old with a primary or recurrent carcinoma of the lower gastrointestinal and/or urogenital tract.…”