Allaire Janie, Léger Caroline, Ben-Zvi Tal, Nguilé-Makao Molière, Fradet Yves, Lacombe Louis, Fradet Vincent
a Department of Surgery , CHU de Québec-Université Laval, L'Hôtel-Dieu de Québec , Québec , Canada.
b CHU de Québec Research Center, Université Laval , Québec , Canada.
Nutr Cancer. 2017 Nov-Dec;69(8):1196-1204. doi: 10.1080/01635581.2017.1367941. Epub 2017 Oct 30.
The objective of this study was to identify nutritional preoperative factors associated with complications after radical cystectomy (RC). We prospectively evaluated the Mini-Nutritional Assessment Score, body mass index (BMI), appetite, stool frequency, hydration, food intake, weight loss, albuminemia, and prealbuminemia of 144 patients who underwent RC between January 2011 and April 2014. Postoperative complications were defined as any adverse event reported in the patient's file up to 90 days after surgery. Each complication was classified according to the Clavien-Dindo and Memorial Sloan-Kettering Cancer Center systems. The adjusted relative risk (RR) computed through a Poisson regression model was used to identify nutritional risk factors associated with post-RC complications. A high BMI >27 kg/m was associated with higher risk of low-grade complications (RR:1.47 [95% CI,1.09-2.00]) at 7 days and a four-fold increased risk of cardiac complications at 7 and 90 days (RR:3.77 [1.15-12.32] and RR:3.28 [1.35-7.98]). Decreased appetite was associated with low-grade (RR:1.43 [1.03-1.99] complications within 90 days. Preoperative weight loss >3 kg was associated with high-grade (RR:2.49 [1.23-5.05]) and wound (RR:2.51 [1.23-5.10]) complications within 90 days. This study showed that preoperative nutritional status of patients may predict the occurrence of complications up to 90 days post-RC. Development of preoperative nutritional interventions may reduce the deleterious impact of RC on patients' health.
本研究的目的是确定根治性膀胱切除术（RC）后与并发症相关的术前营养因素。我们前瞻性地评估了2011年1月至2014年4月期间接受RC手术的144例患者的微型营养评定量表评分、体重指数（BMI）、食欲、大便频率、水合作用、食物摄入量、体重减轻、白蛋白血症和前白蛋白血症。术后并发症定义为患者病历中记录的术后90天内出现的任何不良事件。每种并发症均根据Clavien-Dindo和纪念斯隆-凯特琳癌症中心系统进行分类。通过泊松回归模型计算的调整相对风险（RR）用于确定与RC术后并发症相关的营养风险因素。高BMI>27 kg/m与术后7天发生低级别并发症的风险较高相关（RR：1.47 [95%CI，1.09 - 2.00]），与术后7天和90天发生心脏并发症的风险增加四倍相关（RR：3.77 [1.15 - 12.32]和RR：3.28 [1.35 - 7.98]）。食欲下降与90天内发生低级别并发症相关（RR：1.43 [1.03 - 1.99]）。术前体重减轻>3 kg与90天内发生高级别并发症（RR：2.49 [1.23 - 5.05]）和伤口并发症（RR：2.51 [1.23 - 5.10]）相关。本研究表明，患者的术前营养状况可能预测RC术后90天内并发症的发生。开展术前营养干预可能会降低RC对患者健康的有害影响。
