Impact of nutritional risk on short-term clinical outcomes after laparoscope-assisted radical gastrectomy for gastric cancer / 中华消化外科杂志

ABSTRACT

Objective To explore the impact of nutritional risk on short-term clinical outcomes after laparoscope-assisted radical gastrectomy for gastric cancer.Methods The retrospective case-control study was conducted.The clinical data of 150 patients who underwent laparoscopic gastrectomy at the First Affiliated Hospital of Wenzhou Medical University between June 2014 and April 2016 were collected.According to nutritional risk screening 2002 (NRS 2002),42 and 108 patients were respectively divided into the nutritional risk group (NRS 2002 score ≥3) and non-nutritional risk group (NRS 2002 score ＜3).Laparoscope-assisted radical subtotal gastrectomy or total gastrectomy was performed based on tumor location.Observation indicators(1) postoperative short-term clinical outcomes:postoperative complications,duration of postoperative hospital stay,hospital expenses,unplanned readmission within 30 days after discharging.Postoperative complications meant total complications within 30 days postoperatively,grade Ⅰ-Ⅴ of Clavien-Dindo grade was complication classification.Grade Ⅱ and above of Clavien-Dindo grade were analyzed in this research.(2) Risk factors analysis affecting occurrence of postoperative complications of patients.Measurement data with normal distribution were represented as x±s and analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (Qn) and analyzed using the Mann-Whitney U test.Categorical variables were described as number and percentage and analyzed by the chisquare test.Ranked data were analyzed by the Mann-Whitney U test.Univariate analysis was done by the chi-square test.P＜0.1 of univariate analysis was used to multivariate analysis.COX regression model in multivariate analysis was built using progressive condition method.Results (1) Postoperative short-term clinical outcomes:number of patients with total complications,number of patients with severe complications,duration of postoperative hospital stay,hospital expenses and number of patients with unplanned readmission within 30 days after discharging were 9,2,11 days (9 days,16 days),57 825 yuan (51 894 yuan,66 908 yuan),2 in the nutritional risk group and 16,3,11 days (9 days,13 days),55 067 yuan (49 395 yuan,62 423 yuan),8 in the non-nutritional risk group,respectively,with no statistically significant difference between the 2 groups (X2=0.952,0.010,Z=-1.133,-1.691,X2 =0.048,P＞0.05).Results of univariate analysis showed that age was a risk factor affecting incidence of complications after laparoscope-assisted radical gastrectomy for gastric cancer (X2 =4.468,P＜ 0.05).Results of multivariate analysis showed that preoperative hypoproteinemia was an independent risk factor affecting incidence of complications after laparoscope-assisted radical gastrectomy for gastric cancer (OR =2.797,95％ confidence interval1.053-7.435,P＜0.05).Conclusion There is little poor impact of nutritional risk on short-term outcomes after laparoscope-assisted radical gastrectomy for gastric cancer,preoperative hypoproteinemia is an independent risk factor affecting occurrence of grade Ⅱ and above of postoperative complications.