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

Abstract

Postoperative hypoalbuminemia is associated with adverse outcomes, particularly in cancer patients. The risk and predictors of hypoalbuminemia in cancer patients following extensive abdominal surgery (EAS), despite total parenteral nutrition (TPN) support, were evaluated. A prospective cohort study (n = 115) was conducted in patients with gastrointestinal and/or urogenital malignancies following extensive (n = 81) or moderate (n = 34) abdominal surgery (mean age ± standard deviation: 66.0 ± 11.7 years). EAS patients received daily TPN, including 200 mL of 5% human albumin solution. Serum albumin (SA) levels and hypoalbuminemia (SA < 3.5 g/dL) were assessed daily. EAS patients had an elevated risk of hypoalbuminemia during the first postoperative week [relative risk (RR): 3.12; 95% confidence interval (95% CI): 1.64-5.91]. Postoperative hypoalbuminemia was associated with surgery duration (RR: 1.76; 95% CI: 1.32-2.36), preoperative SA (RR: 0.24; 95% CI: 0.11-0.55), blood (RR: 1.46; 95% CI: 1.04-2.04) and Ringer's lactated solution (RR: 1.52; 95% CI: 1.12-2.07) volumes transfused intra-operatively. Therefore, despite TPN, cancer patients who underwent EAS had an elevated risk of postoperative hypoalbuminemia. Additional tailored nutritional support among this group is necessary to deter adverse clinical outcomes.

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.…”

Hepaticojejunostomy leak after pancreaticoduodenectomy

“…But these intraoperative associated factors are not different between the two groups. 9 In this study a total of 204 patients had dilated common hepatic ducts preoperatively, defined as the diameter more than 1cm, measured at the level of 1cm below the bifurcation on CT or MRI scans. And the dilation can reduce the risk of HJ-leak, because the large diameter biliary duct can make the anastomoses technically easier.…”

Early post-operative serum albumin level predicts survival after curative nephrectomy for kidney cancer: a retrospective study

“…Some researchers have concluded that early post-operative hypoalbuminemia is associated with the pre-operative serum albumin level, age, and extent of surgery [ 12 ], while other studies have shown that post-operative hypoalbuminemia may lead to unfavorable short-term prognoses, such as acute kidney injury [ 13 , 14 ], unbalanced substance metabolism [ 15 – 17 ], and surgical site infections [ 18 , 19 ]. Such findings suggest that albumin has a role in immune-inflammatory reactions [ 11 , 20 ].…”