Annals of Clinical Nutrition and Metabolism

Nutritional Support for Cancer Patients: Yoontaek Lee; Surg Metab Nutr 2019;10(2):27-31. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.27

Abstract PDF: Cancers are the leading cause of death worldwide, and various modalities of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies, have been applied. Malnutrition and a loss of muscle mass are encountered frequently in cancer patients and adversely affect the clinical outcomes. Therefore, screening for, monitoring, and treating malnutrition are important procedures in treating cancer patients. This paper reviews the guidelines as well as comparative studies describing the nutritional support provided to cancer patients and describes the evidence-based guidelines and recommendation for each topic.

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Survey and Analysis of the Application and Implementations of Enhanced Recovery after Surgery (ERAS) Program for Surgical Patients in the Major Hospitals in Korea: Eun Young Kim, In Kyu Lee; Surg Metab Nutr 2019;10(2):32-45. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.32

Abstract PDF: Purpose:

A questionnaire survey was conducted using e-mail to investigate the application status of ERAS in Korea and its implementation by their institution. The perceptions of ERAS by medical staff and the factors that interfered with the application of ERAS were investigated.

Materials and Methods:

From July 2017 to March 2019, a questionnaire was sent by e-mail to members of the KSSMN. This consisted of 41 questions divided into three parts to investigate 1) respondents’ prior knowledge and understanding of ERAS, 2) actual components of ERAS and its clinical application, and 3) performance and preference of the respondents to ERAS. The items were categorized into “high acceptance” when more than 75% of respondents answered “yes”, or the items into “low acceptance” when less than 25% answered “no”.

Results:

Overall, 86 participants completed the survey. Of these, 59(68.6%) had prior knowledge of ERAS and 29 (33.7%) applied ERAS clinically. Seventy (81.4%) and 40 (46.5%) answered that ERAS would have a positive effect on shortening the hospital stay and reducing the number of complications. Seventy four (86%) indicated that they would implement ERAS in the future. The factors impeding the implementation of ERAS were a lack of understanding of physicians and a shortage of manpower and resources for ERAS.

Conclusion:

The ERAS implementation rate and awareness level of surgeons were low, but the positive expectations of the clinical efficacy of ERAS and the wiliness to accept were high. Overall, it would be necessary to cooperate with institutions to improve the manpower and resources, and supplement the education to overcome the lack of awareness, which has been pointed out as an obstacle to the implementation of ERAS.

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Postoperative Weight Changes, Nutritional Status and Clinical Significance of Colorectal Cancer Patients: Sun Young Kim, Ji Sun Kim, Eon Chul Han; Surg Metab Nutr 2019;10(2):46-53. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.46

Abstract PDF: Purpose:
Although weight loss is an important factor for assessing the nutritional status, patient counselling or management is limited due to fewer studies on weight loss after colorectal cancer surgery.
Materials and Methods:
Totally, 374 patients were included in the analysis (between August 2010 to December 2016). Patients’ weight was determined before surgery, and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Change in weight was reviewed based on the gender and administration of chemotherapy. Severe weight loss is defined as greater than 5% weight loss after surgery.
Results:
The weight changes post-surgery at 1 week (−2.56±2.62 vs. −3.36±2.68, P<0.005), 6 weeks (−3.23±3.82 vs. −4.57±3.96, P=0.001), and 3 months (−0.93±5.01 vs. −2.79±4.86, P<0.001) were significantly greater in male subjects, as compared to female patients. However, at 6 months post-surgery, most patients showed weight gain with no statistical significance between the genders (1.11±4.64 vs. 1.94±6.26, P=0.143). Weight change based on treatment (with or without chemotherapy) reveal significant differences between the genders at 3 months post-surgery only (−1.33±4.65 vs. −2.52 ±5.15, P=0.027). Multivariate analysis for factors of severe weight loss show that the male gender [adjusted odds ratio (OR): 1.83, P=0.027)], adjuvant chemotherapy (adjusted OR 2.11, P=0.008), and presence of post-operative complications (adjusted OR 2.12, P=0.029) were significant factors.
Conclusion:
In postoperative colorectal cancer patients, the weight and nutritional status require careful monitoring for at least 2 months after surgery, in order to prevent hindrance to chemotherapy. (Surg Metab Nutr 2019;10:-53)

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Relationship of Sarcopenia with the Outcomes of Patients who Underwent Surgery for Bile Duct Cancer: Hye Jin Kim, Min-Su Park, Bum-Soo Kim, Sang-Mok Lee; Surg Metab Nutr 2019;10(2):54-58. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.54

Abstract PDF: Purpose:
This study investigated the impact of Sarcopenia by examining the psoas muscle on the outcomes after bile duct resection for bile duct cancer.
Materials and Methods:
This study retrospectively analyzed 101 patients who underwent surgery for bile duct cancer between January 2006 and December 2015 at Kyung-Hee University Hospital. Skeletal muscle mass was evaluated by performing preoperative computed tomography to define Sarcopenia. Patients were classified into two groups by the median value of the psoas muscle index (PMI).
Results:
The median value of the psoas muscle index in female patients was 463.9 mm²/m², and the median value of the psoas muscle index in males was 688.7 mm²/m². In the sarcopenia group, the 1, 3, and 5-year recurrence free survival rates were 74.5%, 52.9%, and 27.5%, respectively. On the other hand, in the non-sarcopenia group the 1, 3, and 5-year recurrence free survival rates were 50%, 34%, and 28%, respectively. In the sarcopenia group, the 1, 3, and 5-year overall survival rates were 84.3%, 54.9%, and 31.4%, respectively. In the non-sarcopenia group, 1, 3, and 5-year overall survival rates were 58%, 40%, and 32%, respectively. However, recurrence-free survival and overall survival were not correlated with sarcopenia (P=0.131, P=0.163).
Conclusion:
Sarcopenia using the psoas muscle index (PMI) has no impact on outcomes of bile duct cancer patients who underwent surgery. (Surg Metab Nutr 2019;10:-58)

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Clinical Implications of the Cut-off Value of the Preoperative Prognostic Nutritional Index in Patients with Early Stage Gastric Cancer: Ji Hye Jung, Ji Yeong An, You Na Kim, Min Gew Choi, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim; Surg Metab Nutr 2019;10(2):59-65. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.59

Abstract PDF: 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: Eung Kyu Kim, Jae-Moon Bae, You Na Kim, Ji Yeong An, Min-Gew Choi, Jun Ho Lee, Tae Sung Sohn, Sung Kim; Surg Metab Nutr 2019;10(2):66-74. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.66

Abstract PDF: 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.