Abstract
to determine the nutritional evaluation method that best predicts mortality in 90 days of patients submitted to gastrectomy for gastric cancer. we conducted a prospective study with 44 patients with gastric cancer, stages II to IIIa, of whom nine were submitted to partial gastrectomy, 34 to total gastrectomy, and one to esophago-gastrectomy. All patients were nutritionally evaluated through the same protocol, up to 72h after hospital admission. The parameters used were Patient-Generated Subjective Global Assessment (PGSGA), classical anthropometry, current weight and height, percentage of weight loss (%WL) and body mass index (BMI). We also measured the thickness of the thumb adductor muscle (TAM) in both hands, dominant hand (TAMD) and non-dominant hand (TAMND), as well as the calculated the prognostic nutritional index (PNI). The laboratory profile included serum levels of albumin, erythrocytes, hemoglobin, hematocrit, leukocytes, and total lymphocytes count (TLC). of the 44 patients studied, 29 (66%) were malnourished by the subjective method, 15 being grade A, 18 grade B and 11 grade C. Cases with PGSGA grade B and TAMD 10.2±2.9 mm were significantly associated with higher mortality. The ROC curves (95% confidence interval) of both PGSGA and TAMD thickness reliably predicted mortality at 30 and 90 days. No laboratory method allowed predicting mortality at 90 days. PGSGA and the TAMD thickness can be used as preoperative parameters for risk of death in patients undergoing gastrectomy for gastric cancer.
Highlights
With decreasing incidence and mortality in many countries in the last decades, gastric cancer is still common worldwide and its prognosis is poor[1,2,3,4]
We calculated the prognostic nutritional index (PNI) using the following formula: 10x serum albumin value (g/dl) + 0.005 x total lymphocytes count in the peripheral blood[6]
The consumptive process occurs according to a cascade of events and is independent of the size of the surgical procedure, which explains the most expressive and evidenced mortality in the most malnourished patients[10]
Summary
With decreasing incidence and mortality in many countries in the last decades, gastric cancer is still common worldwide and its prognosis is poor[1,2,3,4]. Patients with gastric cancer have a high risk of malnutrition, with a weight loss greater than 10% in the last six months reported in 30% to 38% of cases[5]. Malnutrition, defined as a state of deficiency of energy, protein and other specific nutrients, has a negative impact on clinical outcome, with a longer hospital stay and increased mortality[7]. Nutritional assessment is known to be difficult, since none of the currently used methods or instruments alone or in combination have proven to be adequate to increase its sensitivity and specificity[11,12,13]
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