Pulmonary Dysfunction Function and Poor Nutritional Status are Risk Factors for Remote Infections Following Surgery for Colorectal Cancer

Abstract

Objective:We evaluated the preoperative patient status including nutrition, immunity, and inflammation as a predictive factor of remote infection (RI) in colorectal cancer surgery. Subjects and Methods:A total of 351 patients who underwent colorectal cancer resection were retrospectively analyzed. Factors correlated with RI incidence were identified by logistic analysis and stepwise selection.Results: RI occurred in 27 patients, with an incidence of 7.7%. In univariate logistic analysis, a significantly high incidence of RI was associated with excessive blood loss (>423 mL), long duration of surgery (>279 minutes), ileus, pulmonary dysfunction, performance status (PS)"1, American Society of Anesthesiologists (ASA) classification>2, prognostic nutritional index (PNI)!40, and controlling nutritional status (CONUT)"2 , modified Glasgow Prognostic Score (mGPS) (Score 2). In multivariate analysis, pulmonary dysfunction (odds ratio=2.83; 95% CI: 1.14 6.97; p=0.02) and PNI!40 (odds ratio=3.87; 95% CI: 1.45 10.31; p=0.006) were independent risk factors of RI incidence.Conclusion: RI is caused by poor nutrition, immune system dysfunction and pulmonary dysfunction. (J Nippon Med Sch 2018; 85: 208 214)

Prognostic significance of the controlling nutritional status (CONUT) score in patients with colorectal cancer: A systematic review and meta-analysis

“…A systematic search of the literature resulted in 247 abstracts. After screening the abstracts, 9 full-text manuscripts were assessed for eligibility and included in the present study [9][10][11][14][15][16][17][18][19], as represented in Table 1. All included studies were single-center retrospective series.…”

“…All included studies were single-center retrospective series. Eight studies included patients undergoing surgery for CRC [9][10][11][14][15][16][17][18], and one included patients receiving chemotherapy for CRC [19]. The Newcastle-Ottawa quality assessment scale evaluated all the included studies as high-quality with a total score ≥6, as shown in Supplementary Table 2.…”

“…The effect of the CONUT score on short-term outcomes including complications after CRC surgery remains controversial due to differently reported results. Two studies reported the association between the CONUT score and complications in multivariable analyses [10,18], in contrast no association between the CONUT score and postoperative infectious diseases was shown [14,15]. Recent meta-analyses have indicated that patients with higher CONUT score had an increased risk of complications as well as mortality after gastroenterological and hepatopancreatobiliary surgery [6][7][8].…”

“…Five studies reported data on postoperative complications including overall complications in two studies [9,18], major complications in one study [10], and infectious complications in two studies [14,15].…”

“…Ahiko et al [18] revealed that only the CONUT score was related to the incidence of overall complications in the multivariable analyses (OR 1.93, 95% CI = 1.15-3.20, P = 0.013). Sagawa et al [14,15] reported two articles using the same cohort to identify risk factors for surgical site infections and remote infections after CRC surgery. The results demonstrated that the CONUT score was not associated with surgical site infections and remote infections in multivariable analyses.…”