The Prognostic Nutritional Index Predicts Survival and Identifies Aggressiveness of Gastric Cancer

Nutritional status has been associated with long-term outcomes in cancer patients. The prognostic nutritional index (PNI) is calculated by serum albumin concentration and absolute lymphocyte count, and it may be a surrogate biomarker for nutritional status and possibly predicts overall survival (OS) of gastric cancer. We evaluated the value of the PNI as a predictor for disease-free survival (DFS) in addition to OS in a cohort of 314 gastric cancer patients who underwent curative surgical resection. There were 77 patients in PNI-low group (PNI ≤ 47.3) and 237 patients in PNI-high group (PNI > 47.3). With a median follow-up of 36.5 mo, 5-yr DFS rates in PNI-low group and PNI-high group were 63.5% and 83.6% and 5-yr OS rates in PNI-low group and PNI-high group were 63.5% and 88.4%, respectively (DFS, P < 0.0001; OS, P < 0.0001). In the multivariate analysis, the only predictors for DFS were PNI, tumor-node-metastasis (TNM) stage, and perineural invasion, whereas the only predictors for OS were PNI, age, TNM stage, and perineural invasion. In addition, the PNI was independent of various inflammatory markers. In conclusion, the PNI is an independent prognostic factor for both DFS and OS, and provides additional prognostic information beyond pathologic parameters.     

Association of Preoperative Prognostic Nutritional Index and Postoperative Acute Kidney Injury in Patients with Colorectal Cancer Surgery

The prognostic nutritional index (PNI) has been reported to be associated with postoperative complications and prognosis in cancer surgery. However, few studies have evaluated the association between preoperative PNI and postoperative acute kidney injury (AKI) in colorectal cancer patients. This study evaluated association of preoperative PNI and postoperative AKI in patients who underwent colorectal cancer surgery. This study retrospectively analyzed 3543 patients who underwent colorectal cancer surgery between June 2008 and February 2012. The patients were classified into four groups by the quartile of PNI: Q1 (≤43.79), Q2 (43.79–47.79), Q3 (47.79–51.62), and Q4 (≥51.62). Multivariate regression analysis was performed to assess the risk factors for AKI and 1-year mortality. AKI was defined according to Kidney Disease Improving Global Outcomes classification (KDIGO) criteria. Additionally, we assessed surgical outcomes such as hospital stay, ICU admission, and postoperative complications. The incidence of postoperative AKI tended to increase in the Q1 group (13.4%, 9.2%, 9.4%, 8.8%). In the multivariate analysis, high preoperative PNI was significantly associated with low risk of postoperative AKI (adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93–0.99, p = 0.003) and low 1-year mortality (OR: 0.92, 95% CI: 0.86–0.98, p = 0.011). Male sex, body mass index, diabetes mellitus, and hypertension were risk factors for AKI. The Q1 (≤43.79) group had poor surgical outcomes, such as postoperative AKI (OR: 1.52, 95% CI: 1.18–1.95, p = 0.001), higher rates of ICU admission (OR: 3.13, 95% CI: 1.82–5.39, p < 0.001) and higher overall mortality (OR: 3.81, 95% CI: 1.86–7.79, p < 0.001). In conclusion, low preoperative PNI levels, especially in the Q1 (≤43.79), were significantly associated with postoperative AKI and surgical outcomes, such as hospital stay, postoperative ICU admission, and mortality.     

Effect of Perioperative Immuno-Enhanced Enteral Nutrition on Inflammatory Response,Nutritional Status,and Outcomes in Head and Neck Cancer Patients Undergoing Major Surgery

Administration of imunno-enhanced nutritional support may decrease postoperative morbidity, mortality, and infectious complications in cancer patients. The aim of this study was to verify that perioperative enteral diet, enriched with the nutrients arginine, ribonucleic acid (RNA), and ω-3 fatty acids improves outcomes of head and neck cancer patients undergoing major surgery. Forty patients with squamous cell carcinoma of the head and neck were studied. Group 1 received no preoperative nutritional support, whereas Group 2 received an oral formula with nutrients arginine, RNA, and ω-3 fatty acids. After surgery, Group 1 received a standard enteral formula, whereas Group 2 received an enriched enteral formula. Albumin (g/dl), prealbumin, fibrinogen, CRP, Il-6, and TNFa were measured 5 days before and 8 days after surgery. No statistically significant difference was observed for all the evaluated markers between postoperative and preoperative levels for both groups. The rate of complications was significantly reduced in the total number of patients receiving immunonutrition and in the particular subgroup of well-nourished patients receiving an immuno-enhanced diet. Perioperative enteral immuno-enhanced feeding in head and neck cancer patients undergoing major surgery may influence the postoperative outcomes by reducing the frequency rate of infections and wound complications.     

Effect of perioperative immuno-enhanced enteral nutrition on inflammatory response, nutritional status, and outcomes in head and neck cancer patients undergoing major surgery

Administration of immuno-enhanced nutritional support may decrease postoperative morbidity, mortality, and infectious complications in cancer patients. The aim of this study was to verify that perioperative enteral diet, enriched with the nutrients arginine, ribonucleic acid (RNA), and ω-3 fatty acids improves outcomes of head and neck cancer patients undergoing major surgery. Forty patients with squamous cell carcinoma of the head and neck were studied. Group 1 received no preoperative nutritional support, whereas Group 2 received an oral formula with nutrients arginine, RNA, and ω-3 fatty acids. After surgery, Group 1 received a standard enteral formula, whereas Group 2 received an enriched enteral formula. Albumin (g/dl), prealbumin, fibrinogen, CRP, Il-6, and TNFa were measured 5 days before and 8 days after surgery. No statistically significant difference was observed for all the evaluated markers between postoperative and preoperative levels for both groups. The rate of complications was significantly reduced in the total number of patients receiving immunonutrition and in the particular subgroup of well-nourished patients receiving an immuno-enhanced diet. Perioperative enteral immuno-enhanced feeding in head and neck cancer patients undergoing major surgery may influence the postoperative outcomes by reducing the frequency rate of infections and wound complications.     

Assessment of Body Composition as an Indicator of Early Peripheral Parenteral Nutrition Therapy in Patients Undergoing Colorectal Cancer Surgery in an Enhanced Recovery Program

Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced recovery program. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Postoperative complications and length of hospital stay (LOS) were assessed. Results: Of the 156 patients analyzed, 88 patients (56.4%) were classified as having high-risk BC according to CT measurements. PPN led to a 15.4% reduction in postoperative complications in high-risk vs. 1.7% in low-risk BC patients. In the multivariate analysis, high-risk BC was related to an OR (95% CI) of 2 (p = 0.044) of presenting complications and of 1.9 (p = 0.066) for major complications, and was associated with an increase in LOS of 3.6 days (p = 0.039). Conclusions: The measurement of patients’ BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes.     

Association Between Preoperative Nutritional Status and Postoperative Outcome in Head and Neck Cancer Patients

Head and neck cancer patients treated with surgery often experience significant postoperative morbidities. Administering preoperative nutritional intervention may improve surgical outcomes, but there is currently a paucity of data reviewing the association between preoperative nutritional status and postoperative outcome. It is therefore of importance to investigate this association among head and neck cancer patients. To assess the association between preoperative nutritional status and postoperative outcome in head and neck cancer patients treated with surgery, a retrospective study of 70 head and neck cancer patients who were surgically treated between 2013 and 2014 in a tertiary referral head and neck surgery center in Hong Kong was conducted. Clinical data regarding preoperative nutritional status and postoperative outcome were retrieved from a computer record system. Logistic and linear regressions were used to analyze the appropriate parameters. A higher preoperative albumin level was associated with lower rates of postoperative complications and better wound healing (P < 0.05). In contrast, preoperative body mass index, hemoglobin level, and absolute lymphocyte count did not demonstrate significant associations with postoperative outcome. As high albumin levels are associated with better surgical outcome in head and neck cancer patients, preoperative intervention strategies that boost albumin levels could be considered for improving surgical outcome.     

新单孔腹腔镜与传统手术治疗小儿疝临床疗效比较

目的观察新单孔法实施腹腔镜疝内环口高位结扎术与传统高位结扎手术临床对比疗效并分析总结方法。方法分析该院普外科2010年1月—2012年1月来收治确诊的小儿疝气患者152例,将两组患者随机分为两组,手术时间、术中出血量、住院时间为检测指标。对照组76例:传统高位结扎手术;治疗组76例:新单孔法实施腹腔镜疝内环口高位结扎术。将两组的临床资料进行整理分析以及探讨两组手术方式的优缺点。结果经治疗后,两组患者疝气修补手术很成功,治疗组新单孔法实施腹腔镜疝内环口高位结扎术比较对照组传统高位结扎手术术中手术时间少、手术中出血量少及住院的时间少等优点,极大程度上减少了复发率及术后的并发症,差异有统计学意义(P<0.05)。结论新单孔法实施腹腔镜疝内环口高位结扎术在小儿安全性及术后的身体恢复要有优势,值得临床上推广应用,所以要好好掌握相关技术,给患者解除痛苦。     

Improvement of nutritional measures during preoperative parenteral nutrition in patients selected by the prognostic nutritional index: a randomized controlled trial

Patients undergoing major gastrointestinal surgery who had a prognostic nutritional index (PNI) score of greater than 30% were randomized to receive a preoperative course of 10 days of intravenous nutrition or to undergo surgery at the next convenient operation list. Two groups of 17 patients were well matched for age, sex, and nutritional status. Although they underwent diverse operations, the extent of these was similar: 12 +/- 3 days of parenteral nutrition resulted in weight gain, 3.2 +/- 2.3 kg p less than 0.01; increased triceps skinfold, 0.6 +/- 1.2 mm p less than 0.05; improved immunological state, p less than 0.02; and improved PNI, 5.5 +/- 10.1% p less than 0.05. The changes in serum albumin and transferrin were not significant. There were only three major complications with one death in the treatment group but this was not significantly different from the control group which had six major complications and three deaths. This study suggests that patients with demonstrable nutritional depletion who require major gastrointestinal surgery will benefit from a preoperative course of parenteral nutrition, but to conclusively prove this a large and probably multicentre study will be required.     

The Prognostic Significance of the Geriatric Nutritional Risk Index in Patients with Esophageal Squamous Cell Carcinoma

The aim of this study was to investigate the impact of the geriatric nutritional risk index (GNRI) on the long-term outcomes in 137 esophageal squamous cell carcinoma (ESCC) patients who underwent curative esophagectomy. The GNRI was calculated from the serum albumin value and the body weight. The cutoff value of the GNRI was set at 98. A multivariate analysis was performed to identify prognostic factors for the overall survival (OS). The mean preoperative GNRI was 99.9?±?7.8. Forty-five (32.8%) patients had a GNRI of <98. The GNRI was significantly associated with the tumor depth (p?=?0.001), level of carcinoembryonic antigen (CEA; p?=?0.009) and level of C-reactive protein (CRP; p?=?0.028). The GRNI was significantly associated with the OS (p?<?0.001). The multivariate analysis identified the GNRI as an independent predictor for the OS. Death due to EC was more frequent in the patients with a low GNRI than in the patients with a high GNRI (p?=?0.004). Our results suggest that the GRNI is a simple and reliable predictor of the postoperative survival in ESCC patients. A low preoperative GNRI may indicate a higher risk of EC death.     

Nutritional,immunological and antioxidant defense status of outpatients diagnosed with colorectal cancer – a case–control study of the little-studied population

Abstract

This cross-sectional study was conducted to investigate nutritional and immunological status of colorectal cancer (CRC) patients in a little-studied population from developing country, Pakistan. Data on 81 CRC patients and 37 healthy controls (HCs) were collected on nutritional status, nutrient intake, percent body fat (%BF), selected immunological parameters, phytochemical index (PI), healthy eating index (HEI), and prognostic nutrition index (PNI). Blood samples were used for immunological and antiradical defense potential (expressed as 50% hemolysis time; HT₅₀). Results show 40/81 (49.4%) patients reported weight loss in past 3–6?mo, Significant differences were found in HEI values between patients vs. HCs, and between patients in low vs. high PNI groups (P, for all trends <0.05). Patients in the higher PNI group were heavier, had higher % BF, higher energy intake, and higher PI score as compared to patients in the low PNI group (P?<?0.05). Low PNI was positively associated with non-significantly lower CD4:CD8 ratios, higher B-cells and NK cells (P, for all trends >0.05), but with significantly higher hs-CRP levels, and lower HT₅₀ values (P, for all trends <0.001). In conclusion, CRC patients in a little-studied population have compromised nutritional and immunological health with lower HEI and PNI scores.     

腹腔镜疝修补与开放式手术治疗老年腹股沟疝的疗效对比

目的对比腹腔镜疝修补与开放式手术治疗老年腹股沟疝的临床疗效。方法回顾性分析2014年1月至2019年1月我院收治的60例老年腹股沟疝患者的临床资料,根据治疗方法不同分为开放组(开放式手术)与腹腔镜组(腹腔镜疝修补)各30例。比较两组患者的围手术期相关指标、手术前后的VAS评分以及并发症发生情况。结果腹腔镜组的术中出血量明显少于开放组,手术时间、首次排便时间、术后卧床时间均明显短于开放组(P均<0.05)。两组术前VAS评分比较无统计学差异(P>0.05);腔镜组术后3 d的VAS评分明显低于开放组(P<0.05)。腹腔镜组并发症发生率为6.67%,明显低于开放组的26.67%(P<0.05)。结论腹腔镜疝修补术治疗老年腹股沟疝安全有效,可明显减轻患者术后疼痛感,促进康复进程,值得临床推广应用。     

Prognostic Significance of the Prognostic Nutritional Index in Patients with Recurrent Esophageal Squamous Cell Carcinoma

The aim of this study was to evaluate the prognostic impact of the prognostic nutritional index (PNI) in patients with recurrent esophageal squamous cell carcinoma (ESCC). We retrospectively reviewed 76 ESCC patients who developed recurrence after curative subtotal esophagectomy at Nara Medical University Hospital between January 2001 and October 2016. The PNI at ESCC recurrence was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (/mm³). The cutoff value of the PNI was set at 45. Multivariate analysis was performed to identify the prognostic factors. The mean PNI was 44.0 ± 5.8, and 42 (55.3%) patients had a PNI <45 at recurrence. The multivariate analysis identified a low PNI (P = 0.047), multiple recurrence sites (P = 0.002), and no treatment for recurrence (P = 0.034) as independent factors for a short survival time after recurrence. A low PNI was significantly associated with a high performance status score, high C-reactive protein level, and short duration of treatment for recurrence. In conclusion, the PNI at recurrence can predict the survival time in patients with recurrent ESCC.     

术前呼吸功能训练对开胸手术患者术后呼吸功能恢复的效果观察

目的：探讨术前呼吸功能训练对开胸手术患者术后呼吸功能恢复的应用效果,为临床推广做出指导。方法：选取本院2010年1月-2013年1月收治的86例需行开胸手术的患者作为研究对象,按照随机数字表法将其分为对照组和观察组各43例,对照组给予常规护理,观察组在对照组的基础上进行术前呼吸功能训练,观察比较两组患者术后呼吸功能的恢复情况。结果：观察组的术后氧分压（PO2）以及二氧化碳分压（PCO2）均明显优于对照组,差异均有统计学意义（P＜0.05）;观察组的术后抗生素使用时间、吸氧时间和住院时间均明显短于对照组,且呼吸系统并发症发生率明显低于对照组,差异均有统计学意义（P＜0.05）。结论：术前呼吸功能训练对开胸手术患者术后呼吸功能恢复的应用效果显著,能大大减少患者的术后并发症,利于患者术后呼吸功能的恢复,值得临床推广应用。     

三种子宫肌瘤剔除术的效果与安全性的分析

目的:探讨3种子宫肌瘤剔除术的疗效与安全性。方法:将60例子宫肌瘤患者随机分为三组各20例,其中治疗组行阴道式手术治疗,对照组行腹腔镜术治疗,观察组行传统开腹术治疗。观察对比三组的手术时间、肠功能恢复时间、住院时间及术后并发症发生情况。结果:治疗组与对照组比较差异有显著性(χ2=3.89,P<0.05);治疗组与观察组比较差异有显著性(χ2=5.13,P<0.05);对照组与观察组比较差异有显著性(χ2=4.26,P<0.05)。结论:采用阴道式手术的手术时间、术中出血量、术后胃肠功能恢复时间及住院时间均优于其他两组,且具有微创、安全性高、并发症少、不影响美观、恢复快等优势,适合在基层医院推广应用。     

腹腔镜与开腹直肠癌根治术临床对比研究

目的 探讨应用腹腔镜技术行直肠癌根治术的可行性及临床疗效.方法 对2004年1月至2007年12月行腹腔镜直肠癌根治术28例患者(腹腔镜组)及同期行开腹直肠癌根治术26例患者(开腹组)在手术相关指标、术后恢复指标、根治性指标、住院时间、术后并发症等方面进行比较.结果 腹腔镜组术中出血量明显少于开腹组[(148.0±26.5)ml比(396.0±79.6)ml,P<0.01];术后进食时间和留置导尿管时间明显早于开腹组[(2.8±0.1)d比(3.9±0.3)d,(4.2±0.2)d比(6.0±0.8)d,P<0.05];住院时间明显短于开腹组[(9.8±1.1)d比(13.2±2.8)d,P<0.01].腹腔镜组与开腹组的手术时间、清除淋巴结数量、术后并发症、局部复发、远处转移方面差异均无统计学意义(P>0.05).结论应用腹腔镜技术行直肠癌根治术安全可行,能达到与开腹手术相同的效果,并且具有创伤小、失血量少、恢复快等优点.     

腹腔镜下大子宫全切除84例临床体会

目的：探讨腹腔镜下大子宫切除的临床可行性及手术技巧。方法：回顾分析腹腔镜下大子宫全切84例临床资料，包括术前评估、手术情况、术后随诊。结果：84例均在腹腔镜下顺利成，无1例中转开腹，无严重并发症。结论：有经验的腔镜医师，合理选择使用腹腔镜手术器械，腹腔镜下大子宫切除是安全可行的。     

两种广泛性子宫切除术治疗早期子宫颈癌的疗效比较

目的:比较腹腔镜与开腹广泛性子宫切除术治疗早期子宫颈癌的疗效。方法:选择2005年7月～2008年12月期间在六盘水市妇女儿童医院行广泛性子宫切除术的早期子宫颈癌患者137例,按手术方式分为两组,观察组85例接受腹腔镜广泛性子宫切除术治疗;对照组52例接受开腹广泛性子宫切除术治疗。术后对患者进行长达3年的随访,记录患者的生存情况。结果:①观察组手术时间显著长于对照组(P<0.05),术中出血量显著少于对照组(P<0.05);两组患者盆腔淋巴结清除数目、阴道切除长度、宫旁组织切除长度相比差异无统计学意义(P>0.05)。②观察组术后肛门排气时间、术后排尿功能恢复时间显著短于对照组,术后并发症发生率显著低于对照组(P<0.05)。③两组患者的复发率、1年生存率、3年生存率、术后生活质量评分相比差异无统计学意义(P>0.05)。结论:腹腔镜与开腹广泛性子宫切除术治疗早期子宫颈癌的远期疗效相近,但是腹腔镜广泛性子宫切除术具有术中出血量少、术后恢复快、并发症发生率低等优点,因此该术式是治疗早期宫颈癌的一种理想术式。     

妇科腹腔镜术后并发症护理干预的效果评价

目的探讨护理干预在妇科腹腔镜术后并发症护理中的临床效果。方法将2013年2月—2014年1月在我院住院接受腹腔镜手术的患者63例,按入院时间分为对照组（31例）和实验组（32例）,对照组术后采用常规护理方法,实验组术后采用常规护理＋干预护理方法,对两组患者术后出现并发症的情况进行统计分析。结果实验组与对照组相比,术后出现并发症的患者例数显著少于对照组,差异具有统计学意义,P〈0.05;患者开始排气和排便的时间实验组也要明显优于对照组（P〈0.05）。结论对接受了妇科腹腔镜手术的患者实施护理干预,能够显著降低患者术后出现并发症的风险,有助于患者恢复和取得好的护理效果。     

Preoperative nutritional status and prognostic nutritional index in patients with benign disease undergoing abdominal operations–Part I.

The aim of the first part of this study was to detect the incidence of preoperative malnutrition of clinical importance in patients with benign disease.

The preoperative nutritional status of 52 consecutive adult patients undergoing abdominal operations for benign conditions was studied prospectively by objective and subjective nutritional criteria. The postoperative outcome was monitored until discharge or death. The preoperative nutritional status was correlated with the postoperative outcome.

Protein energy malnutrition was identified in 20 (38%) of the 52 patients. Of these 20 malnourished patients, 15 (75%) developed complications after surgery, compared with 7 (22%) of the 32 well-nourished patients (p < 0.01). The most common abnormal values were serum transferrin concentration (n = 8), subscapula skinfold (n = 11), serum urea:serum creatinine ratio (n = 17), loss of appetite for more than 5 days (n = 24), and preoperative stay in hospital of longer than 5 days (n = 19).

These results indicate that a combination of objective and subjective criteria may be important in the identification of clinical malnutrition.     

泌尿外科后腹腔镜手术的配合及护理

目的：总结泌尿外科后腹腔镜手术的护理配合经验,提高手术配合质量。方法：对30例泌尿外科后腹腔镜手术的护理配合过程进行总结分析,根据手术要求,做好术前访视;手术进程中要求护士技术操作熟练,与医师配合良好;重视术后护理。结果：30例手术均顺利完成,术后未出现相关并发症,术后7～14d出院。结论：做好术前访视,术中护士技术操作熟练,与医师配合良好,重视术后护理等是后腹腔镜手术取得成功的重要因素之一。