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Increased Rate of Serum Prealbumin Level after Preoperative Enteral Nutrition as an Indicator of Morbidity in Gastrectomy for Gastric Cancer with Outlet Obstruction

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Abstract

Background

Preoperative malnutrition is believed to contribute to increased postoperative complications. Preoperative serum prealbumin level was reported to be a predictor of nutritional status and postoperative complications after gastrointestinal surgery, including gastrectomy. Gastric outlet obstruction caused by gastric cancer leads to insufficient nutritional status. However, the impact of preoperative enteral nutrition using naso-jejunal feeding tubes for patients with gastric outlet obstruction is not fully understood.

Methods

From July 2010 to June 2020, 50 patients with gastric cancer-induced outlet obstruction who underwent gastrectomy following preoperative enteral nutrition via feeding tube were included. We investigated the relationship between changes in nutritional status after preoperative enteral nutrition and postoperative complications. Postoperative complications were defined as grade ≥II based on the Clavien–Dindo classification.

Results

The median period of preoperative enteral nutrition was 10 days. The median increase rate of the serum prealbumin level was 10.5% (interquartile range, 0.63–38.2%), and patients with an increase rate ≥ 10% were defined as the elevated group. Postoperative morbidity was significantly higher in the non-elevated group (P = 0.0031). Univariate and multivariate analyses showed that an increased rate of the serum prealbumin level was an independent risk factor of postoperative complications for patients with gastric outlet obstruction caused by gastric cancer (P = 0.0025 and P = 0.009, respectively).

Conclusions

Preoperative enteral nutrition improved the serum prealbumin level of patients with gastric cancer-induced outlet obstruction, and an increased rate of prealbumin can be an indicator of sufficient preoperative enteral nutrition and decreased postoperative morbidity.

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Acknowledgements

We would like to thank Preethi Ravindranathan for a critical reading of the manuscript. We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3–8-31 Ariake, Koto, Tokyo, 135–8550, Japan

    Daisuke Izumi, Satoshi Ida, Masaru Hayami, Rie Makuuchi, Koshi Kumagai, Manabu Ohashi, Masayuki Watanabe, Takeshi Sano & Souya Nunobe

  2. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Daisuke Izumi

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  1. Daisuke Izumi
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  2. Satoshi Ida
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Contributions

DI, SI, and SN contributed to study concept and design; DI, SI, RM, KK, MW, TS, and SN were specimen providers; DI, SI, MH, RM, KK, MW, TS, and SN contributed to acquisition of clinical data; DI, SI, and SN performed analysis and interpretation of data, statistical analysis, and drafting of the manuscript.

Corresponding author

Correspondence to Souya Nunobe.

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Conflict of interest

The authors declare no conflict of interests for this article.

Informed consent

The protocol for this research project has been approved by a suitably constituted Ethics Committee of the institution and it conforms to the provisions of the Declaration of Helsinki. Committee of the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Approval No. 2017–1029. All informed consent was obtained from the subjects or guardians.

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Izumi, D., Ida, S., Hayami, M. et al. Increased Rate of Serum Prealbumin Level after Preoperative Enteral Nutrition as an Indicator of Morbidity in Gastrectomy for Gastric Cancer with Outlet Obstruction. World J Surg 46, 624–630 (2022). https://doi.org/10.1007/s00268-021-06384-x

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  • DOI: https://doi.org/10.1007/s00268-021-06384-x

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