Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2017; 23(27): 4978-4985
Published online Jul 21, 2017. doi: 10.3748/wjg.v23.i27.4978
Postoperative decrease of serum albumin predicts short-term complications in patients undergoing gastric cancer resection
Zhi-Jian Liu, Xiao-Long Ge, Shi-Chao Ai, Hong-Kan Wang, Feng Sun, Li Chen, Wen-Xian Guan
Zhi-Jian Liu, Shi-Chao Ai, Feng Sun, Li Chen, Wen-Xian Guan, Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Xiao-Long Ge, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
Hong-Kan Wang, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Liu ZJ and Ge XL contributed equally to this work; Ge XL, Liu ZJ and Guan WX contributed to study conception and design; Ge XL, Liu ZJ and Wang HK contributed to data acquisition; Chao AS, Sun F and Wang HK contributed to analysis and interpretation of data; Wang HK and Sun F contributed to drafting of the manuscript; Guan WX and Chen L contributed to critical revision of the manuscript.
Supported by the National Natural Science Foundation of China, No. 81372364; the State Key Program of Nanjing of China, No. ZKX14022.
Institutional review board statement: This study was approved by the Ethics Committee of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki and the guidelines of the Ethics Committee of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at guan-wx@163.com. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Wen-Xian Guan, Professor, Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing 210008, Jiangsu Province, China. guan-wx@163.com
Telephone: +86-25-68182098 Fax: +86-25-68182097
Received: February 22, 2017
Peer-review started: February 22, 2017
First decision: April 21, 2017
Revised: May 12, 2017
Accepted: June 1, 2017
Article in press: June 1, 2017
Published online: July 21, 2017
Processing time: 148 Days and 9.3 Hours
Abstract
AIM

To find an accurate and simple predictor for postoperative short-term complications after gastrectomy.

METHODS

Two hundred and twenty-three patients undergoing gastric cancer resection between October 1, 2015 and September 30, 2016 were enrolled in this study. Univariate and multivariate analyses were used to identify risk factors for complications after gastrectomy. The cutoff values and diagnostic accuracy were examined by receiver operating characteristic curves.

RESULTS

Sixty-two (27.8%) patients had short-term complications after gastric cancer resection. The postoperative decrease in serum albumin (∆ALB) was an independent risk factor for complications (OR = 17.957, 95%CI: 6.073-53.095, P < 0.001). The cutoff value was 14.0% and the area under the curve was higher than that of C-reactive protein on postoperative day 3 (area under the curve: 0.806 vs 0.709). Patients with ∆ALB ≥ 14.0% were more likely to have short-term complications after gastrectomy (46.7% vs 5.0%, P < 0.001), prolonged hospital stay (17.2 ± 10.8 d vs 14.1 ± 4.2 d, P = 0.007) and higher comprehensive complication index (P < 0.001) than those with ∆ALB < 14.0%.

CONCLUSION

Postoperative ∆ALB with a cutoff of 14.0% can be used to recognize patients who have high risk of short-term complications following gastric cancer resection.

Keywords: Gastric cancer; Postoperative complications; Gastrectomy; Serum albumin; Predictor

Core tip: In this work, we investigated whether postoperative decrease of serum albumin can predict short-term complications following gastric cancer resection. Results indicate that the decrease of serum albumin could be more accurate than postoperative C-reactive protein in predicting complications after gastrectomy. Surgeons are warned of potential postoperative complications in patients whose serum albumin levels reduce by more than 14.0%. This is the first evaluation of the relationship between decrease in albumin and postoperative complications in gastric cancer resection.