Effects Of Preoperative Malnutrition On Short-and Long-term Outcomes Of Patients With Gastrectomy:Can We Do Better?

Objective This study aimed to examine the effect of preoperative nutritional status on short-and long-term outcomes in patients who underwent radical gastrectomy.It also explored the role of preoperative correction of hypoalbuminemia(PCH)in malnourished patients with gastric cancer.Background The effects of preoperative malnutrition and PCH on the short-and long-term outcomes in patients with gastric cancer are unclear.Methods We prospectively reviewed data from patients with gastric cancer who were treated in our department between January 2009 and December 2014.According to whether satisfy at least one of the following four criteria: weight loss >10% within 6 months;body mass index(BMI)<18.5 kg/m2;Subjective Global Assessment Grade C;and serum albumin <3.0 g/dl.Patients were divided into malnourished group and well-nourished group.The clinical pathological information of two groups were compared to investigate the effect of preoperative nutritional status on short-and long-term outcomes in patients who underwent radical gastrectomy.Results A total of 1,976 patients were analyzed,including 412 in the malnourished group and 1,564 in the well-nourished group.The overall incidence of complications(21.4% vs 15.5%,p=0.005)and infectious complications(16.7% vs 12.7%,P=0.034)in the malnourished group was significantly higher than that of the well-nourished group.Except for incision infection(3.2% vs 1.6%,p=0.041),there were no significant differences for other complications.In the malnourished group,98 cases of preoperative hypoproteinemia were corrected(PCH group),whereas 314 cases were not(NPCH group).The incidence of incision infection in the PCH group was significantly lower than that in the NPCH group(0% vs 4.1%,p=0.041).The median follow-up time was 39 months(1.0–88.0 months).The 3-year overall survival(OS;59.1% vs 75%,p<0.001)and disease free survival(DFS;54.8% vs 72.5%,p<0.001)were significantly lower in the malnourished group than in the well-nourished group.A multivariate Cox regression analysis showed that malnutrition was an independent prognostic factor for 3-year OS(HR=1.255(1.008-1.490),p=0.041)and DFS(HR=1.179(1.012-1.411),p=0.046).For the malnourished group with stage I gastric cancer,the PCH group and the NPCH group showed no significant differences in 3-year OS(90.0% vs 89.0%,p=0.227)or DFS(90.0% vs 87.3%,p=0.363).However,for the malnourished group with stage II/III gastric cancer,the 3-year OS(69.9% vs 47.6%,p=0.013)and DFS(55.4% vs 43.6%,p=0.046)were significantly higher in the PCH group than in the NPCH group.Conclusion The incidence of incision infection was significantly higher in patients with malnutrition than in well-nourished patients.The 3-year OS and DFS were significantly lower in malnourished patients than in well-nourished patients.PCH can both reduce the incidence of incisional infection in patients with malnutrition and significantly improve the 3-year OS and DFS for malnourished patients with stage II/III gastric cancer.