Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support.
OBJECTIVE
This study investigated the effects of nutritional support on postoperative complications, in relation with demographic and nutritional factors, intraoperative factors, type and routes of nutritional regimens.


METHODS
A series of 1410 subjects underwent major abdominal surgery for gastrointestinal cancer and received various types of nutritional support: standard intravenous fluids (SIF; n=149), total parenteral nutrition (TPN; n=368), enteral nutrition (EN; n=393), and immune-enhancing enteral nutrition (IEEN; n=500). Postoperative complications, considered as major (if lethal or requiring re-operation, or transfer to intensive care unit), or otherwise minor, were recorded.


RESULTS
Major and minor complications occurred in 101 (7.2%) and 446 (31.6%) patients, respectively. Factors correlated with postoperative complications at multivariate analysis were pancreatic surgery, (p<0.001), advanced age (p=0.002), weight loss (p=0.019), low serum albumin (p=0.019) and nutritional support (p=0.001). Nutritional support reduced morbidity versus SIF with an increasing protective effect of TPN, EN, and IEEN. This effect remained valid regardless the severity of risk factors identified at the multivariate analysis and it was more evident by considering infectious complications only.


CONCLUSIONS
Pancreatic surgery, advanced age, weight loss and low serum albumin are independent risk factors for the onset of postoperative complications. Nutritional support, particularly IEEN, significantly reduced postoperative morbidity.
Department of Surgery, Hospital of Prato, Piazza dell'Ospedale 5, 59100 Prato, Italy. dottfb@tin.it
Federico
F
Bozzetti
Luca
L
Gianotti
Mario
M
Braga
Valerio
V
Di Carlo
Luigi
L
Mariani
D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy; D004750:Enteral Nutrition; D005260:Female; D005440:Fluid Therapy; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007107:Immune System / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy; D010289:Parenteral Nutrition, Total; D019990:Perioperative Care / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
D012709:Serum Albumin