Postoperative Nutritional Status is Predictive of the Survival Outcomes in Patients Undergoing Resection of Stage III Colorectal Cancer

Hiramatsu, Kosuke; Shindoh, Junichi; Hanaoka, Yutaka; Toda, Shigeo; Ueno, Masashi; Matoba, Shuichiro; Kuroyanagi, Hiroya

doi:10.1007/s00268-021-06202-4

Cited by 8 publications

(7 citation statements)

References 41 publications

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“…we observed a significant increase in the prevalence of malnutrition from hospital admission to discharge. Preoperative CONUT score has previously been correlated with a higher mortality rate [ 22 ]. although not with increased length of stay.…”

Section: Discussionmentioning

confidence: 99%

Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort

et al. 2022

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Background: Malnutrition increases worse outcomes during hospital admission for elective colorectal cancer (CRC) surgery in older adults. Methods: This work was designed an observational, monocentric, case-control study nested in a cohort of patients undergoing elective surgery for CRC disease at the Hospital Universitario de la Ribera (HULR) (Alzira, Valencia, Spain) between 2011 and 2019. The study considered patients with a CONUT score in the range of moderate to severe malnutrition (>4 points), with control patients with normal nutritional situations or mild malnutrition. Results: Moderate-to-severe malnutrition cases presented a greater length of stay (LOS), a higher incidence of adverse events (both medical and surgical complications), a higher incidence of surgical-wound infection, a greater need for blood transfusion, and a greater amount of transfused packed red blood cells. During hospitalization, the percentage of patients without nutritional risk decreased from 46 to 9%, and an increase in mild, moderate, and severe risk was observed. Patients with severe nutritional risk at hospital admission had significantly increased mortality at 365 days after discharge (HR: 2.96 (95% CI 1.14–7.70, p = 0.002)). After adjusting for sex, age, and Charlson index score, patients with severe nutritional risk at admission maintained a higher mortality risk (HR: 3.08 (95% CI 1.10–8.63, p = 0.032)). Conclusion: Malnutrition prevalence is high in older adults undergoing CRC elective surgery. Furthermore, this prevalence increases during hospital admission. Malnutrition is linked to worse outcomes, such as LOS, surgical and clinical complications, and mortality. For this reason, nutritional interventions are very important in the perioperative period

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Section: Discussionmentioning

confidence: 99%

Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort

et al. 2022

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“…Previous studies have reported that malnutrition prevalence has been widely reported to reach 15–40% in patients with cancer at the time of diagnosis, and up to 80–90% in advanced cases of the disease ( 8 ). The prevalence of malnutrition in CRC patients also ranged from 45 to 60% ( 9 ) and these rates significantly increased followed by radical surgery ( 10 ). In addition, immune dysfunction or immunosuppression caused by surgery acted as the main inducement of post-operative complications.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of Glutamine on Immune Function and Post-Operative Complications of Patients With Colorectal Cancer

et al. 2021

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The aim of this meta-analysis was to evaluate the clinical significance of glutamine in the management of patients with colorectal cancer (CRC) after radical operation. Electronic databases, including PubMed, EMBASE, MEDLINE, Cochrane Library, Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), VIP medicine information system (VIP), and Wanfang electronic databases were comprehensively searched from inception to 30, July 2021. Prospective randomized trials with glutamine vs. routine nutrition or blank therapy were selected. The immune function related indicators (including IgA, IgG, IgM, CD4+, CD8+, and the ratio of CD4+/CD8+), post-operative complications [including surgical site infection (SSI), anastomotic leakage, and length of hospital stay (LOS)], and corresponding 95% confidence intervals (CIs) were assessed in the pooled analysis. Subsequently, the heterogeneity between studies, sensitivity, publication bias, and meta-regression analysis were performed. Consequently, 31 studies which contained 2,201 patients (1,108 in the glutamine group and 1,093 in the control group) were included. Results of pooled analysis indicated that glutamine significantly improved the humoral immune function indicators [including IgA (SMD = 1.15, 95% CI: 0.72–1.58), IgM (SMD = 0.68, 95% CI: 0.48–0.89), and IgG (SMD = 1.10, 95% CI: 0.70–1.50)], and the T cell immune function indicators [including CD4+ (SMD = 0.76, 95% CI: 0.53–0.99) and the ratio of CD4+/CD8+ (SMD = 0.92, 95% CI: 0.57–1.28)]. Meanwhile, the content of CD8+ was decreased significantly (SMD = −0.50, 95% CI: −0.91 to −0.10) followed by glutamine intervention. Pooled analysis of SSI (RR = 0.48, 95% CI: 0.30–0.75), anastomotic leakage (RR = 0.23, 95% CI: 0.09–0.61), and LOS (SMD = −1.13, 95% CI: −1.68 to −0.58) were decreased significantly in glutamine group compared with control group. Metaregression analysis revealed that the covariate of small-sample effects influenced the robustness and reliability of IgG outcome potentially. Findings of the present work demonstrated that glutamine ought to be applied as an effective immunenutrition therapy in the treatment of patients with CRC after radical surgery. The present meta-analysis has been registered in PROSPERO (no. CRD42021243327).Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO, Identifier: CRD42021243327.

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“…In a recent study, tumor resection was found to alter the nutritional state of patients, and postoperative nutritional status in the non-cancer-bearing state more accurately predicted outcomes in patients with Stage III CRC. 28,29 Further studies will be needed to verify these important findings. Third, potential confounders such as KRAS, BRAF, and MSI status were not included in the analyses.…”

Section: Discussionmentioning

confidence: 98%

Impact of malnutrition on cancer recurrence, colorectal cancer‐specific death, and non‐colorectal cancer‐related death in patients with colorectal cancer who underwent curative surgery

Nakamura,

Kawase,

Kawabata

et al. 2023

Journal of Surgical Oncology

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AimThis study aimed to examine how malnutrition, as reflected by the Geriatric Nutritional Risk Index (GNRI), is associated with colorectal cancer (CRC) recurrence and cause of death.MethodsConsecutive stage I‐III CRC patients (n = 601) were divided into two groups using GNRI 98 as the cutoff. The relationship of GNRI with overall survival (OS) and recurrence‐free survival (RFS) was evaluated, followed by competing risk analysis to determine prognostic factors of non‐CRC‐related death, and hazard function analysis to examine changes in the risk of recurrence and death.ResultsMedian body mass index was lower in the low GNRI group than in the high GNRI group (19.8 vs. 23.5; p < 0.001). After adjusting for known prognostic factors, a low GNRI was independently associated with reduced OS/RFS, and was a significant predictor of non‐CRC‐related death. The risk of recurrence was higher and peaked earlier in the low GNRI group than in the high GNRI group, although after 3 years, both groups had a similar risk. Meanwhile, the low GNRI group had a higher risk of non‐CRC‐related death over the course of 5 years.ConclusionIt is important to consider preoperative nutritional status along with the cancer stage when developing strategies to improve outcomes for CRC patients.

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Postoperative Nutritional Status is Predictive of the Survival Outcomes in Patients Undergoing Resection of Stage III Colorectal Cancer

Cited by 8 publications

References 41 publications

Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort

Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort

Meta-analysis of Glutamine on Immune Function and Post-Operative Complications of Patients With Colorectal Cancer

Impact of malnutrition on cancer recurrence, colorectal cancer‐specific death, and non‐colorectal cancer‐related death in patients with colorectal cancer who underwent curative surgery

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