Lidoriki Irene, Schizas Dimitrios, Mylonas Konstantinos S, Vergadis Chrysovalantis, Karydakis Lysandros, Alexandrou Andreas, Karavokyros Ioannis, Liakakos Theodoros
First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
Department of Radiology, Laikon General Hospital, Athens, Greece.
J Am Nutr Assoc. 2022 Mar-Apr;41(3):301-309. doi: 10.1080/07315724.2021.1880986. Epub 2021 Mar 11.
Disease-related malnutrition is a debilitating condition frequently observed in patients with cancer. The aim of the current study was to prospectively examine postoperative changes in nutritional and functional status of patients undergoing surgery for gastric, esophageal, and gastroesophageal junction cancer.
Participants were prospectively recruited from September 2015 to September 2019. The assessment of malnutrition was based on the Patient-Generated Subjective Global Assessment tool. The functional assessment included the evaluation of muscle strength and physical performance, while muscle mass assessment was based on Skeletal Muscle Mass Index (SMI) derived from the analysis of computed tomography scans. The follow up of patients was scheduled at six months postoperatively.
A total of 98 patients were analyzed. Mean patient age was 60.79 ± 10.19 years and 80.6% were males. The mean unintentional weight loss at 6 months was 11.7 ± 8.0%. Patients who underwent McKeown esophagectomy reported the greatest weight loss postoperatively (16.2 ± 9.6%), whereas the lowest rate of weight loss was observed in patients who underwent partial gastrectomy (5.6 ± 6.7%). The rate of severe malnutrition declined at six months postoperatively (39.7% vs 27%). Muscle strength and physical performance were significantly deteriorated at 6 months postoperatively, except for the group of partial gastrectomy, while SMI significantly decreased in all groups of patients except for McKewon esophagectomy group. Finally, the prevalence of low muscle mass increased significantly from 43.5% in the preoperative period to 66.7% at the follow-up.
Our study revealed a significant deterioration in gastroesophageal cancer patient nutritional and functional status at six months postoperatively. The high prevalence of malnutrition and low muscle mass requires systematic follow-up and multidirectional monitoring in order to ensure the successful rehabilitation of these patients.
疾病相关营养不良是癌症患者中经常观察到的一种使人衰弱的状况。本研究的目的是前瞻性地检查接受胃、食管和胃食管交界癌手术患者术后营养和功能状态的变化。
2015年9月至2019年9月前瞻性招募参与者。营养不良的评估基于患者主观整体评估工具。功能评估包括肌肉力量和身体表现的评估，而肌肉质量评估基于通过计算机断层扫描分析得出的骨骼肌质量指数（SMI）。患者随访安排在术后6个月。
共分析了98例患者。患者平均年龄为60.79±10.19岁，80.6%为男性。6个月时平均非故意体重减轻为11.7±8.0%。接受麦克尤恩食管切除术的患者术后体重减轻最多（16.2±9.6%），而接受部分胃切除术的患者体重减轻率最低（5.6±6.7%）。术后6个月严重营养不良率下降（39.7%对27%）。除部分胃切除术组外，术后6个月肌肉力量和身体表现显著恶化，而除麦克尤恩食管切除术组外，所有患者组的SMI均显著下降。最后，低肌肉质量的患病率从术前的43.5%显著增加到随访时的66.7%。
我们的研究显示，胃食管癌患者术后6个月营养和功能状态显著恶化。营养不良和低肌肉质量的高患病率需要系统的随访和多方向监测，以确保这些患者的成功康复。
