ABSTRACT
OBJECTIVES: This study aimed to evaluate the effect of preoperative immunonutrition on the rate of postoperative complication and survival of patients with gastric cancer. METHODS: A retrospective cohort was formed after data collection of patients hospitalized with gastric cancer. Postoperative complications classified according to the Clavien-Dindo classification system, length of hospital stay, readmissions, and rates of survival at 6 mo, 1 y, and 5 y were analyzed. A χ2 or Fisher's exact test, Student or Mann-Whitney t test, and Kaplan-Meier and Cox regressions were used in the statistical analysis. RESULTS: A total of 164 patients were included in the study, with 56 patients assigned to the immunonutrition group and 108 to the conventional group. There were no significant differences in postoperative complications between the immunonutrition and conventional groups (51.8% versus 58.3%; Pâ¯=â¯0.423). The most frequent complications were fistula and surgical wound infection. Length of hospital stay did not differ between the groups (median of 7.0 d: Pâ¯=â¯0.615) and the presence of readmissions did not differ either (12.5% versus 15.7%; Pâ¯=â¯0.648). In the multivariate Cox regression, in a pooled model for group, age, sex, body mass index, Charlson comorbidity index, staging, neoadjuvant chemotherapy, and type of surgery, there was a significant difference in survival rates at 6 mo (Pâ¯=â¯0.011), 1 y (Pâ¯=â¯0.006), and 5 y (P < 0.001). CONCLUSIONS: Preoperative immunonutrition in patients with gastric cancer did not reduce postoperative complications or length of hospital stay. More studies are needed to confirm the benefit of immunonutriton supplementation for overall survival when associated with other protective factors.
Subject(s)
Nutrition Therapy/mortality , Postoperative Complications/mortality , Preoperative Care/mortality , Stomach Neoplasms/therapy , Aged , Female , Humans , Length of Stay , Male , Middle Aged , Nutrition Therapy/methods , Postoperative Complications/etiology , Preoperative Care/methods , Retrospective Studies , Stomach Neoplasms/mortality , Survival Rate , Treatment OutcomeABSTRACT
Objetivo: Avaliar o efeito da terapia nutricional imunomoduladora pré-operatória na taxa de complicação pós-operatória e sobrevida de pacientes com câncer gástrico. Métodos: Uma coorte retrospectiva foi formada após coleta de dados dos pacientes internados com câncer gástrico. Complicações pós-operatórias classificadas de acordo com ClavienDindo, tempo de internação hospitalar, reinternações e sobrevida de 6 meses, 1 ano e 5 anos foram analisados. Teste qui-quadrado ou exato de Fischer, teste t de Studant ou Mann Wthitney, Kaplan-Meier e Regressão de Cox foram utilizados na análise estatística. Resultados: Foram incluídos 164 pacientes, 56 no grupo imunonutrição e 108 no grupo convencional. Não houve diferenças significativas nas complicações pós-operatórias entre o grupo imunonutrição e o convencional (51,8% vs. 58,3%, p = 0,423). As complicações mais frequentes foram fístula e infecção de ferida operatória. O tempo de internação hospitalar não diferiu entre os grupos (mediana de 7,0 dias em ambos, p = 0,615) assim como a presença de reinternações (12,5% vs. 15,7%, p = 0,648). Na regressão multivariada de Cox, em modelo ajustado para grupo, idade, sexo, índice de massa corporal, índice de comorbidade de Charlson, estadiamento, quimioterapia neoadjuvante e tipo de cirurgia, houve diferença significativa na sobrevida em 6 meses (p = 0,011), 1 ano (p = 0,006) e 5 anos (p < 0,001). Conclusões: Terapia nutricional imunomoduladora no pré-operatório de pacientes com câncer gástrico não reduziu as complicações pós-operatórias ou o tempo de internação hospitalar. Apesar disso, essa suplementação pode melhorar a sobrevida de até 5 anos, quando associada a outros fatores de proteção.
Objective: To evaluate the effect of preoperative immunonutrition on the rate of postoperative complication and survival of patients with gastric cancer. Methods: A retrospective cohort was formed after data collection of patients hospitalized with gastric cancer. Postoperative complications classified according to Clavien-Dindo, length of hospital stay, readmissions and survival of 6 months, 1 year and 5 years were analyzed. Chisquare test or Fisher's exact test, test-t of Student or Mann Whitney, Kaplan-Meier and Cox regression were used in the statistical analysis. Results: Were included 164 patients, 56 in the immunonutrition group and 108 in the conventional group. There were no significant differences in the postoperative complications between the immunonutrition and the conventional group (51.8% vs. 58.3%, p = 0.423). The most frequent complications were fistula and surgical wound infection. Length of hospital stay did not differ between groups (median of 7.0 days in both, p = 0.615) and the presence of readmissions did not differ either (12.5% vs. 15.7%, p = 0.648). In the multivariate Cox regression, in a pooled model for group, age, sex, body mass index, Charlson comorbidity index, staging, neoadjuvant chemotherapy and type of surgery, there was a significant difference in survival at 6 months (p = 0.011), 1 year (p = 0.006) and 5 years (p < 0.001). Conclusions: Preoperative immunonutrition in patients with gastric cancer did not reduce postoperative complications or length of hospital stay. Despite this, this supplementation can improve the survival of up to five years, when associated with other protective factors.
