World Journal of Surgery

, Volume 36, Issue 7, pp 1632–1639 | Cite as

Prognostic Nutritional Index Predicts Outcomes of Gastrectomy in the Elderly

  • Masayuki Watanabe
  • Masaaki Iwatsuki
  • Shiro Iwagami
  • Takatsugu Ishimoto
  • Yoshifumi Baba
  • Hideo Baba
Article

Abstract

Background

Owing to the increased life expectancy, elderly patients with gastric cancer is also increasing. Onodera’s prognostic nutritional index (PNI) is an assessment tool for nutritional status of surgical patients and possibly predicts prognosis of the patients. The aim of the present study is to clarify the predictive and prognostic significance of PNI in elderly patients who underwent gastrectomy for gastric cancer.

Methods

Two hundred ninety-five patients, including 196 nonelderly patients under 75 years old (group NE) and 99 elderly patients (group E), were eligible. We collected the data on nutritional status and the outcome of gastrectomy, including morbidity, mortality, and survival of these patients. A Cox proportional hazards model was used to evaluate the prognostic significance.

Results

The PNI was significantly lower in group E than in group NE. Both morbidity and mortality rates after gastrectomy were similar between the groups. Although PNI could not predict the postoperative events in group NE, low PNI might be a risk of mortality and morbidity in the elderly. Although survival after gastrectomy was similar among groups divided by the median PNI value (49.2) in group NE, the prognosis of PNI-L (<44.7) was significantly poorer than PNI-H (PNI ≧ 44.7) in group E. Multivariate analysis demonstrated that PNI-L was an independent prognostic factor in the elderly.

Conclusions

The PNI predicts both short-term and long-term outcomes after gastrectomy in the elderly.

Keywords

Gastric Cancer Prognostic Nutritional Index Total Lymphocyte Count Subjective Global Assessment Preoperative Weight Loss 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

The authors declare that no financial or conflict of interest exists in the content of the article.

References

  1. 1.
    Roder DM (2002) The epidemiology of gastric cancer. Gastric Cancer 5:5–11PubMedCrossRefGoogle Scholar
  2. 2.
    Saito H, Osaki T, Murakami D et al (2006) Effect of age on prognosis in patients with gastric cancer. Aust N Z J Surg 76:458–461CrossRefGoogle Scholar
  3. 3.
    Saif MW, Makrilia N, Zalonis A et al (2010) Gastric cancer in the elderly: an overview. Eur J Surg Oncol 36:709–717PubMedCrossRefGoogle Scholar
  4. 4.
    Benhamiche AM, Faivre J, Tazi AM et al (1997) Time trends in diagnostic strategy, treatment, and prognosis of gastric cancer in the elderly: a population based study. Eur J Cancer Prev 6:71–77PubMedCrossRefGoogle Scholar
  5. 5.
    Katai H, Sasako M, Sano M et al (1998) The outcome of surgical treatment for gastric carcinoma in the elderly. Jpn J Clin Oncol 28:112–115PubMedCrossRefGoogle Scholar
  6. 6.
    Kubota H, Katoh T, Dahr DK et al (2000) Gastric resection in the aged (> or =80 years) with gastric carcinoma: a multivariate analysis of prognostic factors. Aust N Z J Surg 70:254–257PubMedCrossRefGoogle Scholar
  7. 7.
    Kunisaki C, Akiyama H, Nomura M et al (2006) Comparison of surgical outcomes of gastric cancer in the elderly and middle-aged patients. Am J Surg 191:216–224PubMedCrossRefGoogle Scholar
  8. 8.
    Orsenigo E, Tomajer V, Palo SD et al (2007) Impact of age on postoperative outcomes in 1,118 gastric cancer patients undergoing surgical treatment. Gastric Cancer 10:39–44PubMedCrossRefGoogle Scholar
  9. 9.
    Coniglio A, Tiberio GA, Busti M et al (2004) Surgical treatment for gastric carcinoma in the elderly. J Surg Oncol 88:201–205PubMedCrossRefGoogle Scholar
  10. 10.
    Wu CW, Lo SS, Shen KH et al (2000) Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg 24:465–472. doi: 10.1007/s002689910074 PubMedCrossRefGoogle Scholar
  11. 11.
    Gretschel S, Esteves-Schwarz L, Hünerbein M et al (2006) Gastric cancer surgery in elderly patients. World J Surg 30:1468–1474. doi: 10.1007/s00268-005-0633-5 PubMedCrossRefGoogle Scholar
  12. 12.
    Nitenberg G, Raynard B (2000) Nutritional support of the cancer patients: issues and dilemmas. Crit Rev Oncol Hematol 34:137–168PubMedCrossRefGoogle Scholar
  13. 13.
    Ferreras N, Artigas V, Cardona D et al (2005) Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer. Clin Nutr 24:55–65CrossRefGoogle Scholar
  14. 14.
    Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nippon Geka Gakkai Zasshi 85:1001–1005 (in Japanese; English abstract)Google Scholar
  15. 15.
    Nozoe T, Ninomiya M, Maeda T et al (2010) Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric cancer. Surg Today 40:440–443PubMedCrossRefGoogle Scholar
  16. 16.
    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112CrossRefGoogle Scholar
  17. 17.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer 14:113–123CrossRefGoogle Scholar
  18. 18.
    Polanczyk CA, Marcantonio E, Goldman L et al (2001) Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 134:637–643PubMedGoogle Scholar
  19. 19.
    Leung JM, Dzankic S (2001) Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc 49:1080–1085PubMedCrossRefGoogle Scholar
  20. 20.
    Giner M, Laviano A, Meguid MM et al (1996) In 1995 a correlation between malnutrition and poor outcome critically ill patients still exists. Nutrition 12:23–29PubMedCrossRefGoogle Scholar
  21. 21.
    Arnaud-Battandier F, Malvy D, Jeandel C et al (2004) Use of oral supplements in malnourished elderly patients living in the community: a pharmaco-economic study. Clin Nutr 23:1096–1103PubMedCrossRefGoogle Scholar
  22. 22.
    Ahmed T, Haboubi N (2010) Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging 5:207–216PubMedGoogle Scholar
  23. 23.
    Detsky AS, McLaughlin JR, Baker JP et al (1987) What is subjective global assessment of nutritional status? J Parenteral Enteral Nutr 11:8–13CrossRefGoogle Scholar
  24. 24.
    Vellas B, Villars H, Abellan G et al (2006) Overview of the MNA—its history and challenges. J Nutr Health Aging 10:456–463PubMedGoogle Scholar
  25. 25.
    Kondrup J, Rasmussen HH, Hamberg O et al (2003) Nutritional risk screening NRS 2002: a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336PubMedCrossRefGoogle Scholar
  26. 26.
    Garth AK, Newsome CM, Simmance N et al (2010) Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet 23:393–401PubMedCrossRefGoogle Scholar
  27. 27.
    Izaks GJ, Remarque EJ, Becker SV et al (2003) Lymphocyte count and mortality risk in older persons. The Leiden 85-plus study. J Am Geriatr Soc 51:1461–1465PubMedCrossRefGoogle Scholar
  28. 28.
    Lesourd B (1995) Protein undernutrition as the major cause of decreased immune functions in the elderly: clinical and functional implications. Nutr Rev 53:S86–S94PubMedCrossRefGoogle Scholar
  29. 29.
    Omran ML, Morley JE, Goy R (2000) Assessment of protein energy malnutrition in older persons, part II: laboratory evaluation. Nutrition 16:131–140PubMedCrossRefGoogle Scholar
  30. 30.
    Seiler WO (2001) Clinical pictures of malnutrition in ill elderly subjects. Nutrition 17:496–498PubMedCrossRefGoogle Scholar
  31. 31.
    Braga M, Gianotti L, Vignali A et al (1998) Immunonutrition in gastric cancer surgical patients. Nutrition 14:831–835PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Masayuki Watanabe
    • 1
  • Masaaki Iwatsuki
    • 1
  • Shiro Iwagami
    • 1
  • Takatsugu Ishimoto
    • 1
  • Yoshifumi Baba
    • 1
  • Hideo Baba
    • 1
  1. 1.Department of Gatsroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan

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