Conséquences nutritionnelles de la chirurgie en oncogériatrie. Étude descriptive et prospective

Abstract

Objective To analyse the evolution of nutritional parameters after cancer surgery in the elderly, to review patient management practices and evaluate risk factors of postoperative complications. Methods Prospective and descriptive study of a monocentric cohort of patients aged 70 years or more. Nutritional status was evaluated before surgery (D–1). Nutritional parameters were noted at D5, D10, at hospital discharge (HD) and one month later (HD1m). Results Seventy-one patients (aged 75 ± 4.7 years) were included. At preoperative assessment, 22 patients (31%) were found malnourished; three of these were severely malnourished but did not receive preoperative artificial nutritional support. Thirteen patients had oral immunonutrition (13 of 29 indications) and two had nutritional support. The surgery was major in 52 cases. Postoperative nutritional support was given to 16 patients. Eleven patients had major infectious complications and 13 had major non-infectious complications. At HD, 42 patients (60.0%) were found malnourished (nine had severe malnutrition); at HD1m, 42 patients were malnourished (five had severe malnutrition). Survival rates were 94.4% at one month and 83.1% at one year. In this limited cohort of patients, no risk factor of postoperative complications could be identified. Conclusions Cancer surgery, even when major, is feasible in the elderly, but clinical management practices, particularly perioperative nutritional support, need to be improved. Earlier nutritional and geriatric evaluation would be needed in order to provide appropriate management.