Mide Kanserli Hastalarda Preoperatif Nütrisyonel Desteğin Postoperatif Morbidite ve Mortalite Üzerine Etkisi: Tek Merkezli Retrospektif Veri Analizi

Öz

Amaç: Mide kanserli hastalarda kilo kaybı ve malnütrisyon sıklıkla görülmektedir. Bu nedenle özellikle mide kanserli hastalarda beslenme önemlidir. Bu çalışmada mide kanserli hastalarda ameliyat öncesi beslenme desteğinin ameliyat sonrası morbidite ve mortalite üzerine etkisini belirlemeyi amaçladık.
Materyal ve Metot: Aralık 2015 ile Aralık 2019 tarihleri arasında mide kanseri nedeniyle gastrektomi yapılan toplam 110 hasta retrospektif olarak incelendi. Hastalara ameliyat öncesi ve sonrası beslenme desteği verilip verilmediği belirlendi. Klinikopatolojik özellikler ve kısa dönem sonuçları karşılaştırıldı.
Bulgular: Gastrektomi yapılan hastalarda genel morbidite %29.1 (n=32) idi. Yaş arttıkça majör komplikasyon oranının istatistiksel olarak arttığı görüldü (p<0.001). Komorbidite de majör komplikasyonlar için bir risk faktörü olarak bulundu (OR 3.917, %95 CI 1.423-10.781; p=0.006). Özellikle diyabet tanısı olan hastalarda komplikasyon insidansı artmaktadır (OR 3.743, %95 CI 1.201-11.666; p=0.040). Preoperatif beslenme alan hastaların %6.7’sinde (n=2) anastomoz kaçağı gelişirken, beslenme desteği almayan hastaların %10’unda (n=8) anastomoz kaçağı gelişti (p=0.588). Aynı şekilde preoperatif nütrisyon desteği alan hastaların postoperatif yatış süresi, postoperatif komplikasyonlar ve mortalitesi arasındaki ilişki kanıtlanamamıştır.
Sonuç: Bu çalışma, mide kanserli hastalarda ameliyat öncesi beslenmenin morbidite ve mortalite oranlarında iyileşme ile ilişkili olmadığını ortaya koymaktadır. Mide kanserli hastalarda ameliyat öncesi beslenme ile morbidite-mortalite oranları arasındaki kesin ilişkiyi ortaya çıkarmak için ameliyat öncesi beslenme desteğine odaklanan geniş, çok merkezli ileriye dönük çalışmalara ihtiyaç vardır.

The Effect of Preoperative Nutritional Support on Postoperative Morbidity and Mortality in Patients With Gastric Cancer: A Single Center Retrospective Study

Öz

Aim: Weight loss and malnutrition are frequently observed in patients with gastric cancer. Therefore, nutrition is important, especially in patients with gastric cancer. In this study, we aimed to identify the effect of preoperative nutritional support on postoperative morbidity and mortality in patients with gastric cancer.
Material and Method: A total of 110 patients underwent gastrectomy due to gastric cancer between December 2015 and December 2019 were retrospectively analyzed. It was determined whether the patients were given preoperative and postoperative nutritional support. Clinicopathological features and short-term results were compared.
Results: Overall morbidity was 29.1% (n=32) in patients who underwent gastrectomy. It was observed that the rate of major complications increased statistically with increasing age (p<0.001). Comorbidity was also found to be a risk factor for major complications (OR 3.917, 95% CI 1.423-10.781; p=0.006). The incidence of complications increases especially in patients with a diagnosis of diabetes (OR 3.743, 95% CI 1.201-11.666; p=0.040). While anastomotic leak developed in 6.7% (n=2) of the patients who were taken preoperative nutrition, anastomotic leak developed in 10% (n=8) of the patients who were not taken nutritional support (p=0.588). Likewise, the relationship between the postoperative length of stay, postoperative complications and mortality of patients receiving preoperative nutritional support could not been proven.
Conclusion: The present study reveals that preoperative nutrition in patients with gastric cancer was not associated with improved morbidity and mortality rates. Large, multicenter prospective studies focusing on preoperative nutritional support are needed to uncover the exact relation of preoperative nutrition and morbidity-mortality rates in patients with gastric cancer.

Anahtar Kelimeler

• gastrectomy
• nutritional support
• gastric cancer

Kaynakça

1. 1 - Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394e424
2. 2 - Liedman B, Svedlund J, Sullivan M, et al. Symptom control may improve food intake, body composition, and aspects of quality of life after gastrectomy in cancer patients. Dig Dis Sci 2001; 46(12): 2673–80.
3. 3 - Hirao M, Takiguchi S, Imamura H, et al. Comparison of Billroth I and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol. 2013;20(5):1591–7.
4. 4 - Masuzawa T, Takiguchi S, Hirao M, et al. Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study. World J Surg. 2014;38(5):1100–6.
5. 5 - Kanda M, Mizuno A, Tanaka C, et al. Nutritional predictors for postoperative shortterm and long-term outcomes of patients with gastric cancer. Medicine 2016;95:e3781.
6. 6 - Sungurtekin H, Sungurtekin U, Balci C, et al. The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr. 2004;23:227–232.
7. 7 - Kuzu MA, Terzioğlu H, Genç V, et al. Preoperative nutritional risk assessment in predicting postoperative outcome in patients undergoing major surgery. World J Surg. 2006;30:378–390.
8. 8 - Arends J, Bertz H, Bischoff SC, et al. DGEM Steering Committee S3-Guideline of the German Society for Nutritional Medicine (DGEM) Aktuelle Ernahrungsmed. 2015;40:1–74.

9. 9 - McClave SA, Kozar R, Martindale RG, et al. Summary points and consensus recommendations from the North American Surgical Nutrition Summit. JPEN J Parenter Enteral Nutr. 2013;37(suppl):99S–105S.
10. 10 - Ding D, Feng Y, Song B, et al. Effects of preoperative and postoperative enteral nutrition on postoperative nutritional status and immune function of gastric cancer patients. Turk J Gastroenterol. 2015;26:181–185.
11. 11 - Jiang XH, Li N, Li JS. Intestinal permeability in patients after surgical trauma and effect of enteral nutrition versus parenteral nutrition. World J Gastroenterol. 2003;9(8):1878–80.
12. 12 - Seres DS, Valcarcel M, Guillaume A. Advantages of enteral nutrition over parenteral nutrition. Therap Adv Gastroenterol. 2013;6(2):157–67.
13. 13 - Braunschweig CL, Levy P, Sheean PM, et al. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr. 2001;74:534–542.
14. 14 - Gianotti L, Braga M, Nespoli L, et al. A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. Gastroenterology. 2002;122:1763–1770.
15. 15 - Song GM, Tian X, Liang H, et al. Role of Enteral immunonutrition in patients undergoing surgery for gastric cancer: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2015;94(31):e1311.
16. 16 - Kim HU, Chung JB, Kim CB. The comparison between early enteral nutrition and total parenteral nutrition after total gastrectomy in patients with gastric cancer: the randomized prospective study. Korean J Gastroenterol. 2012;59:407-413.
17. 17 - Jin Y, Yong C, Ren K, et al. Effects of post-surgical parenteral nutrition on patients with gastric cancer. Cell Physiol Biochem . 2018;49(4):1320-1328.
18. 18 - Huang D, Sun Z, Huang J, et al. Early enteral nutrition in combination with parenteral nutrition in elderly patients after surgery due to gastrointestinal cancer. Int J Clin Exp Med. 2015; 8(8): 13937–13945.
19. 19 - Fujiwara Y, Fukuda S, Tsujie M, et al. Effects of age on survival and morbidity in gastric cancer patients undergoing gastrectomy. World J Gastrointest Oncol 2017;9:257-62.
20. 20 - Hsu JT, Liu MS, Wang F, et al. Standard radical gastrectomy in octogenarians and nonagenarians with gastric cancer: are short-term surgical results and long-term survival substantial? J Gastrointest Surg 2012;16:728-37.
21. 21 - Lin CS, Chang CC, Lee YW, et al. Adverse outcomes after major surgeries in patients with diabetes: a multicenter matched study. J Clin Med. 2019 Jan; 8(1): 100.
22. 22 - Nikniaz Z, Somi MH, Nagashi S, et al. Impact of early enteral nutrition on nutritional and immunological outcomes of gastric cancer patients undergoing gastrostomy: a systematic review and meta-analysis. Nutr Cancer. 2017 Jul;69(5):693-701.