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Clinical Implications of the Cut-off Value of the Preoperative Prognostic Nutritional Index in Patients with Early Stage Gastric Cancer
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Ji Hye Jung, Ji Yeong An, You Na Kim, Min Gew Choi, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim
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Surg Metab Nutr 2019;10(2):59-65. Published online December 30, 2019
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DOI: https://doi.org/10.18858/smn.2019.10.2.59
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 Abstract
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Purpose:The perioperative nutritional status is a potential prognostic factor in gastric cancer patients. This study assessed the optimal cut-off value of the prognostic nutritional index (PNI) for predicting the survival of patients with early stage gastric cancer and evaluated its power for predicting the survival after gastric cancer surgery. Materials and Methods:This study reviewed the data of 8,014 patients with stage T1N0~1M0 and T2~3N0M0 gastric cancer who underwent a curative gastrectomy without adjuvant chemotherapy between January 2006 and December 2015. The log-rank test on SAS was conducted to determine the preoperative PNI cut-off value that indicated the most significant difference in survival, and the clinical features and oncological outcomes were analyzed according to the cut-off value of the preoperative PNI. Results:The preoperative PNI cut-off value that indicated the most significant difference in survival was 43.7. Using this cut-off value, patients were classified into high PNI and low PNI groups. The five-year overall survival rate was 96.9% and 81.5% for the high and low PNI group, respectively (P<0.001). Considering each stage (Ia, Ib, and IIa), the overall survival rates were significantly higher for the high PNI group than the low PNI group. Multivariable analysis revealed the cut-off value of the preoperative PNI to be among the independent risk factors for survival. Conclusions:The cut-off value of the preoperative PNI that could be used to determine the significant differences in the survival of patients with early stage gastric cancer was identified and proven to have a significant impact on predicting survival.
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Intestinal Rehabilitation after Extensive Bowel Resection in Post-Gastrectomy Patients
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Seung Rim Han, Sanghoon Lee, Chae-Youn Oh, Hyun-Jung Kim, Hyo Jung Park, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Jeong-Meen Seo
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Surg Metab Nutr 2015;6(2):33-37. Published online December 30, 2015
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DOI: https://doi.org/10.18858/smn.2015.6.2.33
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Purpose:Surgical complications requiring massive bowel resection after gastrectomy are rare. However, when such an event occurs the patient may develop short bowel syndrome and intestinal failure. We report our experience of intestinal rehabilitation in four post-gastrectomy patients. Materials and Methods:From January 2011 to June 2014, four cases of short bowel syndrome were identified in post-gastrectomy patients. All patients were managed by a multidisciplinary team specialized in the care of intestinal failure patients. Patients’ medical records were reviewed retrospectively. Results:The original diagnosis was early gastric cancer in all patients. One patient had synchronous esophageal cancer. Patients required extensive bowel resection due to bowel strangulation from internal herniation (3 cases), superior mesenteric artery torsion (1 case). Remnant small bowel length ranged from 10 cm to 80 cm and partial resection of the colon was performed in three cases. One patient received serial transverse enteroplasty (STEP) and one patient is receiving continuous enteral feeding via surgical gastrostomy. There were no cases of intestinal failure-associated liver disease. Two patients are receiving home parenteral nutrition in varying degrees. Two patients have been weaned off parenteral nutrition. Conclusion:Four post-gastrectomy patients with short bowel syndrome were managed. Despite application of various medical and surgical measures, weaning off parenteral nutrition was difficult in these patients.
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