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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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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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Current Status of Calorie Support during the Immediate Post-Operative Period Following a Gastrectomy
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Eung Kyu Kim, Jae-Moon Bae, You Na Kim, Ji Yeong An, Min-Gew Choi, Jun Ho Lee, Tae Sung Sohn, Sung Kim
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Surg Metab Nutr 2019;10(2):66-74. Published online December 30, 2019
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DOI: https://doi.org/10.18858/smn.2019.10.2.66
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Purpose:The aim of this study was to elucidate the patterns of calorie support during the immediate postoperative period following a gastrectomy in gastric cancer patients. Materials and Methods:The clinicopathologic characteristics and nutritional parameters, including the actual infused amount of calories during the immediate postoperative period, were retrospectively collected and analyzed, This was data from a total 1,390 cases out of 1,404 patients who underwent curative gastrectomy at Samsung Medical Center, from Jan. 1 2016 through Dec. 31, 2016. Results:The actual infused amount of calories during the immediate postoperative period (the first three days following surgery) was only 41.6% of the recommended average intake of calories, which was significantly lower (759.8±139.4 kcal/day vs 1,825.7±251.6 kcal/day, respectively). The target calories supply per unit body weight was 30 kcal/kg. According to the operative method, the average infused amount of calories was lower in open gastrectomy compared to when utilizing the minimal invasive methods (laparoscopic assisted or robot assisted gastrectomy) (742.11 kcal/day:11.7 kcal/kg vs 792.95 kacl/day:12.8 kcal/kg or 791.43 kcal/day:12.8 kcal/kg, respectively). In regards to the operative type, the average infused amount of calories was higher in subtotal gastrectomy compared to that in total gastrectomy (732.1 kcal/day:12.23 kcal/kg vs 689.5 kcal/day:11.7 kcal/kg, respectively). The female group had a higher calorie supply per unit body weight compared to that of the male group (766.0 kcal/day:13.7 kcal/kg vs 758.9 kcal/day:11.3 kcal/kg, respectively). According to body mass index (BMI), the low BMI group had a lower calorie intake compared to that of the normal or high BMI group (700.2 kcal/day:15.3 kcal/kg vs 761.8 kcal/day:13.6 kcal/kg vs 766.5 kcal/day:11.1 kcal/kg, respectively). The actual infused amount of calorie significantly varied day by day in all the groups (range: 31.52 kcal/day to 1,559.31 kcal/day). Conclusion:The actual calorie intake significantly varied from day-to-day. Moreover, the intake was significantly lower than the average daily recommended amount of calories following a gastrectomy in gastric cancer patients during the immediate postoperative period.
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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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