Postoperative complications in gastrointestinal cancer patients: The joint role of the nutritional status and the nutritional support

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 26; no. 6; pp. 698 - 709
• Main Authors: Bozzetti, Federico, Gianotti, Luca, Braga, Mario, Di Carlo, Valerio, Mariani, Luigi
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.12.2007; Elsevier
• Subjects: Age Factors; Aged; Biological and medical sciences; Colorectal Neoplasms - mortality; Colorectal Neoplasms - surgery; Colorectal Neoplasms - therapy; Enteral Nutrition; Female; Fluid Therapy; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal cancer; Gastrointestinal Neoplasms - mortality; Gastrointestinal Neoplasms - surgery; Gastrointestinal Neoplasms - therapy; Humans; Immune System - physiology; Male; Medical sciences; Metabolic diseases; Middle Aged; Morbidity; Multivariate Analysis; Nutritional Status; Nutritional support; Nutritional Support - methods; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - surgery; Pancreatic Neoplasms - therapy; Parenteral Nutrition, Total; Perioperative Care - methods; Postoperative Care - methods; Postoperative complications; Postoperative Complications - epidemiology; Risk Factors; Serum Albumin - analysis; Stomach Neoplasms - mortality; Stomach Neoplasms - surgery; Stomach Neoplasms - therapy; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Analysis; Time Factors; Treatment Outcome; Tumors; Weight Loss; EN=enteral nutrition; TPN=total parenteral nutrition; Gastrointestinal cancer; SIF=standard intravenous fluids; Nutritional support; IEEN=immune-enhancing enteral nutrition; Postoperative complications; Nutritional status; BW=body weight; WL=weight loss; Human; Postoperative; Nutrition; Patient; Malignant tumor; Joint; Osteoarticular system; Digestive diseases; Intestinal disease; Complication; Cancer; Gastric disease; Food supplement
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2007.06.009

Summary Background & aims This study investigated the effects of nutritional support on postoperative complications, in relation with demographic and nutritional factors, intraoperative factors, type and routes of nutritional regimens. Methods A series of 1410 subjects underwent major abdominal surgery for gastrointestinal cancer and received various types of nutritional support: standard intravenous fluids (SIF; n =149), total parenteral nutrition (TPN; n =368), enteral nutrition (EN; n =393), and immune-enhancing enteral nutrition (IEEN; n =500). Postoperative complications, considered as major (if lethal or requiring re-operation, or transfer to intensive care unit), or otherwise minor, were recorded. Results Major and minor complications occurred in 101 (7.2%) and 446 (31.6%) patients, respectively. Factors correlated with postoperative complications at multivariate analysis were pancreatic surgery, ( p <0.001), advanced age ( p =0.002), weight loss ( p =0.019), low serum albumin ( p =0.019) and nutritional support ( p =0.001). Nutritional support reduced morbidity versus SIF with an increasing protective effect of TPN, EN, and IEEN. This effect remained valid regardless the severity of risk factors identified at the multivariate analysis and it was more evident by considering infectious complications only. Conclusions Pancreatic surgery, advanced age, weight loss and low serum albumin are independent risk factors for the onset of postoperative complications. Nutritional support, particularly IEEN, significantly reduced postoperative morbidity.