Abstract
Background
Preoperative nutritional status may predict short- and long-term outcomes of patients with cancer.
Objective
The aim of this study was to clarify the impact of preoperative nutritional status on outcomes of elderly patients who have undergone gastrectomy for gastric cancer (GC).
Methods
A review examining 147 patients treated for GC by gastrectomy at our institution between January 2004 and December 2011 was conducted. Onodera’s prognostic nutritional index (PNI) was invoked, using an optimal cutpoint to stratify patients by high (PNI > 43.8; n = 84) or low (PNI ≤ 43.8; n = 63) nutritional status. Clinicopathologic features and short- and long-term outcomes, including the cause of death, were compared.
Results
In multivariate analysis, low PNI was identified as an independent correlate of poor 5-year overall survival (OS). In subgroup analysis, 5-year OS rates for patients with stage 1 GC were significantly worse in the low PNI (vs. high PNI) patient subset, which also posed a significantly higher risk of death from other disease; however, 5-year cancer-specific survival and PNI were unrelated. Deaths from recurrence in both groups were statistically similar, and morbidity rates did not differ significantly by group.
Conclusions
PNI is useful in predicting long-term outcomes of elderly patients surgically treated for GC, helping to identify those at high risk of death from other disease. In an effort to improve patient outcomes, nutritional status and oncologic staging merit attention.
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References
Takeshita H, Ichikawa D, Komatsu S, et al. Surgical outcomes of gastrectomy for elderly patients with gastric cancer. World J Surg. 2013;37(12):2891–8.
Oki E, Sakaguchi Y, Ohgaki K, et al. Totally laparoscopic distal gastrectomy for elderly patients with gastric cancer. Fukuoka Igaku Zasshi. 2013;104(9):290–8.
Kim MG, Kim HS, Kim BS, Kwon SJ. The impact of old age on surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. Surg Endosc. 2013;27(11):3990–7.
Gretschel S, Estevez-Schwarz L, Hunerbein M, Schneider U, Schlag PM. Gastric cancer surgery in elderly patients. World J Surg. 2006;30(8):1468–74.
Sakurai K, Ohira M, Tamura T, et al. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol. 2016;23(2):525–33.
Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients [in Japanese]. Nippon Geka Gakkai Zasshi 1984;85:1001–5.
Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268–74.
Watanabe M, Iwatsuki M, Iwagami S, Ishimoto T, Baba Y, Baba H. Prognostic nutritional index predicts outcomes of gastrectomy in the elderly. World J Surg. 2012;36(7):1632–9.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma 2010. 14th ed. Tokyo: Kanehara; 2010.
Sakurai K, Muguruma K, Nagahara H, et al. The outcome of surgical treatment for elderly patients with gastric carcinoma. J Surg Oncol. 2015;111(7):848–54.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.
Bachmann J, Muller T, Schroder A, et al. Influence of an elevated nutrition risk score (NRS) on survival in patients following gastrectomy for gastric cancer. Med Oncol. 2015;32(7):204.
Lee HH, Park JM, Song KY, Choi MG, Park CH. Survival impact of postoperative body mass index in gastric cancer patients undergoing gastrectomy. Eur J Cancer. 2016;52:129–37.
Hoover HC Jr, Ryan JA, Anderson EJ, Fischer JE. Nutritional benefits of immediate postoperative jejunal feeding of an elemental diet. Am J Surg. 1980;139(1):153–9.
Bowrey DJ, Baker M, Halliday V, et al. A randomised controlled trial of six weeks of home enteral nutrition versus standard care after oesophagectomy or total gastrectomy for cancer: report on a pilot and feasibility study. Trials. 2015;16:531.
Pacelli F, Bossola M, Rosa F, Tortorelli AP, Papa V, Doglietto GB. Is malnutrition still a risk factor of postoperative complications in gastric cancer surgery? Clin Nutr. 2008;27(3):398–407.
Yamada T, Hayashi T, Cho H, et al. Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer. 2012;15(1):34–41.
Zhou H, Yi W, Zhang J, et al. Short- and long-term outcomes of LigaSure versus conventional surgery for curative gastric cancer resection: a matched pair analysis. Gastric Cancer. 2015;18(4):843–9.
Conflict of Interest
Katsunobu Sakurai, Tatsuro Tamura, Takahiro Toyokawa, Ryosuke Amano, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Kiyoshi Maeda, Masaichi Ohira, and Kosei Hirakawa declare no conflicts of interest.
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Sakurai, K., Tamura, T., Toyokawa, T. et al. Low Preoperative Prognostic Nutritional Index Predicts Poor Survival Post-gastrectomy in Elderly Patients with Gastric Cancer. Ann Surg Oncol 23, 3669–3676 (2016). https://doi.org/10.1245/s10434-016-5272-6
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DOI: https://doi.org/10.1245/s10434-016-5272-6