Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan.
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
World J Surg. 2022 Mar;46(3):624-630. doi: 10.1007/s00268-021-06384-x. Epub 2022 Jan 6.
Preoperative malnutrition is believed to contribute to increased postoperative complications. Preoperative serum prealbumin level was reported to be a predictor of nutritional status and postoperative complications after gastrointestinal surgery, including gastrectomy. Gastric outlet obstruction caused by gastric cancer leads to insufficient nutritional status. However, the impact of preoperative enteral nutrition using naso-jejunal feeding tubes for patients with gastric outlet obstruction is not fully understood.
From July 2010 to June 2020, 50 patients with gastric cancer-induced outlet obstruction who underwent gastrectomy following preoperative enteral nutrition via feeding tube were included. We investigated the relationship between changes in nutritional status after preoperative enteral nutrition and postoperative complications. Postoperative complications were defined as grade ≥II based on the Clavien-Dindo classification.
The median period of preoperative enteral nutrition was 10 days. The median increase rate of the serum prealbumin level was 10.5% (interquartile range, 0.63-38.2%), and patients with an increase rate ≥ 10% were defined as the elevated group. Postoperative morbidity was significantly higher in the non-elevated group (P = 0.0031). Univariate and multivariate analyses showed that an increased rate of the serum prealbumin level was an independent risk factor of postoperative complications for patients with gastric outlet obstruction caused by gastric cancer (P = 0.0025 and P = 0.009, respectively).
Preoperative enteral nutrition improved the serum prealbumin level of patients with gastric cancer-induced outlet obstruction, and an increased rate of prealbumin can be an indicator of sufficient preoperative enteral nutrition and decreased postoperative morbidity.
术前营养不良被认为会增加术后并发症。术前血清前白蛋白水平被报道可预测胃肠道手术后的营养状况和并发症，包括胃癌胃切除术。胃癌引起的胃出口梗阻导致营养状况不足。然而，术前经鼻空肠喂养管给予肠内营养对胃出口梗阻患者的影响尚不完全清楚。
从 2010 年 7 月至 2020 年 6 月，50 例胃癌引起的出口梗阻患者在术前经喂养管进行肠内营养后接受胃切除术。我们调查了术前肠内营养后营养状况变化与术后并发症的关系。术后并发症根据 Clavien-Dindo 分类定义为≥Ⅱ级。
术前肠内营养的中位时间为 10 天。血清前白蛋白水平的中位升高率为 10.5%（四分位距，0.63-38.2%），升高率≥10%的患者定义为升高组。非升高组的术后发病率明显更高（P=0.0031）。单因素和多因素分析表明，血清前白蛋白水平升高率是胃癌引起的胃出口梗阻患者术后并发症的独立危险因素（P=0.0025 和 P=0.009）。
术前肠内营养改善了胃癌引起的出口梗阻患者的血清前白蛋白水平，前白蛋白的升高率可以作为充分术前肠内营养和降低术后发病率的指标。
