Georges Pompidou European Hospital, Rene Descartes University, Paris, France.
Ann Thorac Surg. 2013 Feb;95(2):392-6. doi: 10.1016/j.athoracsur.2012.06.023. Epub 2012 Jul 26.
The influence of nutritional status on outcome after major lung resection remains controversial. Nutritional assessment is not included as a major recommendation in lung cancer guidelines. The purpose of this study was to assess the nutritional status of patients referred for pneumonectomy and to assess the predictive value of malnutrition in determining the surgical outcome.
This study was a multicenter observational trial. The eligibility criterion for participants was pneumonectomy for lung cancer. Criteria for group classification according to nutritional status were albumin and transthyretin levels. Predicted outcomes were major infectious and noninfectious complications and 90-day mortality. Univariate analysis identified independent variables for the predictive model of age, sex, induction chemotherapy, extended resections, treatment side, smoking, and malnutrition. Predictive variables were then included in a logistic regression model.
Between January 2010 and December 2011, 86 (mean age, 61.5 years) consecutive patients referred for pneumonectomy (left side, n = 58; right side, n = 28) at 4 thoracic surgery centers were included. The malnutrition group included 33 patients (39%) and the normal nutritional status group included 53 patients. Univariate analysis elected malnutrition, recent active smoking, and extended resection to be included in a multivariate analysis. Multivariate analysis identified malnutrition, recent smoking, and extended resection as predictive variables for major complications and mortality.
The frequency of malnutrition detected by biological markers was dramatically high. Malnutrition, as well as recent active smoking and extended resection, is a predictive factor for infectious complications and mortality after pneumonectomy. Nutritional assessment with appropriate markers should be considered before pneumonectomy.
营养状况对大肺切除术后结果的影响仍存在争议。营养评估并未被纳入肺癌指南的主要推荐中。本研究旨在评估接受肺切除术患者的营养状况，并评估营养不良对确定手术结果的预测价值。
这是一项多中心观察性试验。参与者的入选标准为肺癌行肺切除术。根据营养状况进行分组的标准是白蛋白和转甲状腺素水平。预测结果为主要感染性和非感染性并发症以及 90 天死亡率。单因素分析确定了年龄、性别、诱导化疗、扩大切除术、治疗侧、吸烟和营养不良等预测模型的独立变量。然后将预测变量纳入逻辑回归模型。
2010 年 1 月至 2011 年 12 月，在 4 个胸外科中心连续纳入 86 例接受肺切除术（左侧 58 例，右侧 28 例）的患者。营养不良组包括 33 例（39%），营养正常组包括 53 例。单因素分析选择营养不良、近期主动吸烟和扩大切除术纳入多因素分析。多因素分析确定营养不良、近期吸烟和扩大切除术是主要并发症和死亡率的预测因素。
通过生物标志物检测到的营养不良发生率非常高。营养不良以及近期主动吸烟和扩大切除术是肺切除术后感染并发症和死亡率的预测因素。在进行肺切除术之前，应考虑使用适当的标志物进行营养评估。
