Park Hyeong Min, Kang Young Hwa, Lee Dong Eun, Kang Mee Joo, Han Sung-Sik, Park Sang-Jae
Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea.
Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea.
BMC Nutr. 2022 Jul 11;8(1):61. doi: 10.1186/s40795-022-00555-2.
In malnourished patients, postoperative morbidity, hospitalization period, and medical expenses are reportedly to be high. We evaluated the clinical impact of a preoperative nutritional support program (PNSP) among malnourished cancer patients.
For this quasi-experimental study, we enrolled 90 patients who underwent major pancreatobiliary cancer surgery. Malnutrition was defined as at least one of the following: (1) Patient-Generated Subjective Global Assessment (PG-SGA) grade B or C; (2) > 10% weight loss within 6 months; (3) body mass index <18.5 kg/m; and (4) serum albumin level < 3.0 g/dL. Forty-five malnourished patients allocated to the PNSP group received in-hospital PNSP for a median of 6 (4-35) days. In the PNSP group, the nutrition support team calculated the patients' daily nutritional requirements based on their nutritional status and previous day's intake. The supplementation targets were as follows: total calorie intake, 30-35 kcal/kg/day; protein intake, 1.2-1.5 g/kg/day; and lipid intake, 1-1.5 g/kg/day. Patients who did not meet the diagnostic criteria for malnutrition were allocated to the well-nourished group and underwent surgery without receiving the PNSP (n = 45). We compared the perioperative nutritional indices (as measured using PG-SGA), postoperative outcome, and quality of life (QOL) according to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0.
In the PNSP group, the proportion of patients with serum prealbumin <16 mg/dL decreased significantly after PNSP (29.5% vs. 8.9%, p = 0.013). Moreover, patients with PG-SGA grade A had a statistically significant increase (2.2% vs. 50%, p < 0.001). The overall and major complication rates were higher in the PNSP group than in the well-nourished group without significance (51.1%, 33.3%; 42.2%, 26.7%, respectively). However, the overall and major complication rates were similar between the subgroup with PG-SGA improvement after PNSP and the well-nourished group (40.9% vs. 42.2%, p = 0.958; 27.3% vs. 26.7%, p = 0.525, respectively). QOL indicators in the PNSP group were comparable with those in the well-nourished group after PNSP.
PNSP may improve perioperative nutritional status and clinical outcomes among malnourished patients with pancreatobiliary cancer.
据报道，营养不良患者术后发病率、住院时间和医疗费用较高。我们评估了术前营养支持计划（PNSP）对营养不良癌症患者的临床影响。
在这项准实验研究中，我们纳入了90例行主要胰胆管癌手术的患者。营养不良定义为以下至少一项：（1）患者主观全面评定法（PG-SGA）B级或C级；（2）6个月内体重减轻>10%；（3）体重指数<18.5kg/m²；（4）血清白蛋白水平<3.0g/dL。分配到PNSP组的45例营养不良患者在住院期间接受了中位数为6（4-35）天的PNSP。在PNSP组中，营养支持团队根据患者的营养状况和前一天的摄入量计算其每日营养需求。补充目标如下：总热量摄入，30-35kcal/kg/天；蛋白质摄入,1.2-1.5g/kg/天；脂肪摄入，1-1.5g/kg/天。不符合营养不良诊断标准的患者被分配到营养良好组，未接受PNSP即接受手术（n=45）。我们根据欧洲癌症研究与治疗组织生活质量问卷第3.0版比较了围手术期营养指标（使用PG-SGA测量）、术后结果和生活质量（QOL）。
在PNSP组中，血清前白蛋白<16mg/dL的患者比例在PNSP后显著下降（29.5%对8.9%，p=0.013）。此外，PG-SGA A级患者有统计学意义的增加（2.2%对50%，p<0.001）。PNSP组的总体和主要并发症发生率高于营养良好组，但无统计学意义（分别为51.1%、33.3%；42.2%、26.7%）。然而，PNSP后PG-SGA改善的亚组与营养良好组之间的总体和主要并发症发生率相似（分别为40.9%对42.2%，p=0.958；27.3%对26.7%，p=0.525）。PNSP组的QOL指标与PNSP后营养良好组的指标相当。
PNSP可能改善营养不良的胰胆管癌患者的围手术期营养状况和临床结局。
