Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2211-2220
Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2211
Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy: A single-center retrospective study
Xi-Ning Zhao, Jing Lu, Hong-Yong He, Sheng-Jin Ge
Xi-Ning Zhao, Sheng-Jin Ge, Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Jing Lu, Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Hong-Yong He, Department of General Surgery/Emergency Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Co-first authors: Xi-Ning Zhao and Jing Lu.
Co-corresponding authors: Hong-Yong He and Sheng-Jin Ge.
Author contributions: Zhao XN and Lu J collected and analyzed the data, wrote the manuscript; He HY and Ge SJ designed the study and edited the manuscript; Zhao XN and Lu J contributed equally to this work. All authors have read and approved the final manuscript. There are three main reasons for designating He HY and Ge SJ as co-corresponding authors. First, the research was a collaborative effort, and this designation accurately reflects the distribution of responsibilities and the significant time and effort each author devoted to completing the study and the resultant paper. Second, the research team comprised authors with diverse expertise and skills from different fields. The designation of co-corresponding authors best represents this diversity, promoting a comprehensive and in-depth examination of the research topic. Third, He HY and Ge SJ collaborated to design and refine the study protocol and contributed equally to reviewing and editing the manuscript. Recognizing these researchers as co-corresponding authors acknowledges and respects their equal contributions and highlights the spirit of teamwork and collaboration in this study. In summary, designating He HY and Ge SJ as co-corresponding authors accurately reflects our team's collaborative spirit, equal contributions, and diverse expertise, thereby enhancing the overall quality and reliability of the manuscript.
Supported by National Natural Science Foundation of China, No. 82373417; Natural Science Foundation of Shanghai, No. 23ZR1409900; Clinical Research Plan of SHDC, No. SHDC2020CR3048B; and Clinical Research Fund of Zhongshan Hospital, Fudan University, No. ZSLCYJ202343.
Institutional review board statement: This study was approved by the Clinical Research Ethics Committee of Zhongshan Hospital of Fudan University (B2021-392).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors claim no conflict of interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Yong He, MD, PhD, Deputy Chief Physician, Department of General Surgery/Emergency Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. he.hongyong@zs-hospital.sh.cn
Received: April 20, 2024
Revised: May 23, 2024
Accepted: June 12, 2024
Published online: July 27, 2024
Processing time: 92 Days and 16.1 Hours
Abstract
BACKGROUND

The population of elderly patients with gastric cancer is increasing, which is a major public health issue in China. Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer.

AIM

To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy.

METHODS

A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020.

RESULTS

The overall rate of malnutrition was 31.8%. The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group (P < 0.001). Nutritional characteristics in the malnourished group, including body mass index, prognostic nutritional index (PNI), albumin, prealbumin, and hemoglobin, were all significantly lower than those in the well-nourished group. The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the well-nourished group (22.1% vs 33.5%, P = 0.001). Age ≥ 70 years (HR = 1.216, 95%CI: 1.048-1.411), PNI < 44.5 (HR = 1.792, 95%CI: 1.058-3.032), operation time ≥ 160 minutes (HR = 1.431, 95%CI: 1.237-1.656), and postoperative complications grade III or higher (HR = 2.191, 95%CI: 1.604-2.991) were all recognized as independent risk factors associated with delayed discharge.

CONCLUSION

Malnutrition is relatively common in elderly patients undergoing gastrectomy. Low PNI is an independent risk factor associated with delay discharge. More strategies are needed to improve the clinical outcome of these patients.

Keywords: Gastric cancer; Preoperative nutritional status; Malnutrition; Elderly; Radical gastrectomy

Core Tip: Malnutrition is a significant risk factor for adverse clinical outcomes in elderly gastric cancer patients. In our investigation of the nutritional status and perioperative nutritional support of elderly surgical patients with gastric cancer, we discovered that the overall frequency of malnutrition was 31.8%. The incidence of postoperative complications in the malnourished group was significantly higher than that in the well-nourished group. Nutritional characteristics of patients in the malnourished group were recognized as independent risk factors associated with delayed discharge.