title: How do surgical stress and low perioperative serum protein and albumin impact upon short term morbidity and mortality in gastric cancer surgery?
abstract: BACKGROUND
  Patients undergoing surgery for gastric cancer may be expected to develop a certain range of postoperative complications. This retrospective cohort study determined if gauging the serum value of total proteins and albumins before and especially after surgery can predict an undesired short term outcome in patients with gastric resections for cancer, as we have not found studies debating the link between low postoperative total proteins or albumins and early postoperative morbidity.
  
  
  METHODS
  A total of 195 patients with gastric cancer who had been subjected to gastric resection (83 patients) or total gastrectomy (111 patients), were subsequently arranged into study group pairs. In each of these group pairs, one group had a complication, while another was without said complication, or total vs. subtotal gastrectomy, etc. Each of these group pairs were compared between them in order to determine if total serum proteins and/or albumins, before and/or after surgery could predict the onset of certain complications or death. In the end, we performed ROC curves to determine the predictability value of variables for certain complications.
  
  
  RESULTS
  preoperative serum albumin can predict an early onset of anastomotic leakage (p=0.02) as it can predict the occurrence of general complications (p=0.018) and surgical wound infections (p=0.029) as well as a higher risk of reoperation for the management of complications (p=0.028). Total serum protein may be tied to a higher surgical stress, like albumin, as it was significantly lower in patients undergoing total gastrectomy as compared to those subjected to subtotal gastrectomy (p=0.0001 total proteins, p=0.0001 albumins). Postoperative low total serum proteins and albumins translate in a risk of early postoperative death (p=0.031 total proteins, p=0.001 albumins).
  
  
  CONCLUSIONS
  We demonstrated the fact that total serum proteins and serum albumins, checked both before and after surgery, are of great value in helping predict a series of postoperative complications in gastric cancer surgery and that they can also be used as surgical stress markers.
authors.affiliation: Department of Surgery, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Munteanu
authors.affiliation: Department of Surgery, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
authors.forename: Doru
authors.initials: D
authors.lastname: Munteanu
authors.affiliation: Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Stefan
authors.initials: S
authors.lastname: Tigan
authors.affiliation: Department of Surgery, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Bartos
authors.affiliation: Department of Surgery, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
authors.forename: Cornel
authors.initials: C
authors.lastname: Iancu
keywords: complications; gastrectomy; gastric surgery; protein; serum albumin; stomach neoplasms