Impact of Malnutrition After Gastrectomy for Gastric Cancer on Long-Term Survival

Keiichi Fujiya, Taiichi Kawamura, Katsuhiro Omae, Rie Makuuchi, Tomoyuki Irino, Masanori Tokunaga, Yutaka Tanizawa, Etsuro Bando, Masanori Terashima

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Preoperative malnutrition can worsen morbidity and mortality; however, the role of postgastrectomy nutritional status remains unclear. Our purpose was to clarify whether malnutrition after gastrectomy could predict long-term survival. Methods: Patients with pathological stage I, II, and III gastric cancer who underwent gastrectomy between 2002 and 2013 were included. The nutrition risk index (NRI) was evaluated before and at 1, 3, 6 and 12 months after gastrectomy. The patients were divided into normal (NRI CloseSPigtSPi 97.5) or malnutrition (NRI ≤ 97.5) groups, and we compared the correlations of clinicopathological characteristics, surgical treatment, and overall survival between the two groups. Results: Among the 760 participants, patients in the malnutrition group were significantly older and had higher incidences of comorbidity and advanced cancer than the patients in the normal group. Multivariate analysis showed that overall survival was poorer in the malnutrition group before gastrectomy [hazard ratio (HR) 1.68] and at 1 month (HR 1.77), 3 months (HR 2.18), 6 months (HR 1.81) and 12 months (HR 2.17) after gastrectomy (all p OpenSPiltSPi 0.01). Malnutrition at 1 and 3 months after gastrectomy was significantly associated with poor cause-specific survival. Total gastrectomy, preoperative malnutrition, older age, and adjuvant chemotherapy were independent risk factors of postoperative malnutrition at 12 months postgastrectomy. Conclusions: Malnutrition before gastrectomy and at 1, 3, 6 and 12 months after gastrectomy significantly and adversely affects overall survival. Nutritional interventions to lessen the impact of postoperative malnutrition offer hope for prolonged survival.

Original languageEnglish
Pages (from-to)974-983
Number of pages10
JournalAnnals of Surgical Oncology
Volume25
Issue number4
DOIs
Publication statusPublished - 2018 Apr 1
Externally publishedYes

Fingerprint

Gastrectomy
Malnutrition
Stomach Neoplasms
Survival
Nutrition Assessment
Adjuvant Chemotherapy
Nutritional Status
Comorbidity
Multivariate Analysis
Morbidity
Mortality
Incidence

Keywords

  • Albumin
  • Body weight
  • Elderly

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Fujiya, K., Kawamura, T., Omae, K., Makuuchi, R., Irino, T., Tokunaga, M., ... Terashima, M. (2018). Impact of Malnutrition After Gastrectomy for Gastric Cancer on Long-Term Survival. Annals of Surgical Oncology, 25(4), 974-983. https://doi.org/10.1245/s10434-018-6342-8

Impact of Malnutrition After Gastrectomy for Gastric Cancer on Long-Term Survival. / Fujiya, Keiichi; Kawamura, Taiichi; Omae, Katsuhiro; Makuuchi, Rie; Irino, Tomoyuki; Tokunaga, Masanori; Tanizawa, Yutaka; Bando, Etsuro; Terashima, Masanori.

In: Annals of Surgical Oncology, Vol. 25, No. 4, 01.04.2018, p. 974-983.

Research output: Contribution to journalArticle

Fujiya, K, Kawamura, T, Omae, K, Makuuchi, R, Irino, T, Tokunaga, M, Tanizawa, Y, Bando, E & Terashima, M 2018, 'Impact of Malnutrition After Gastrectomy for Gastric Cancer on Long-Term Survival', Annals of Surgical Oncology, vol. 25, no. 4, pp. 974-983. https://doi.org/10.1245/s10434-018-6342-8
Fujiya, Keiichi ; Kawamura, Taiichi ; Omae, Katsuhiro ; Makuuchi, Rie ; Irino, Tomoyuki ; Tokunaga, Masanori ; Tanizawa, Yutaka ; Bando, Etsuro ; Terashima, Masanori. / Impact of Malnutrition After Gastrectomy for Gastric Cancer on Long-Term Survival. In: Annals of Surgical Oncology. 2018 ; Vol. 25, No. 4. pp. 974-983.
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AU - Fujiya, Keiichi

AU - Kawamura, Taiichi

AU - Omae, Katsuhiro

AU - Makuuchi, Rie

AU - Irino, Tomoyuki

AU - Tokunaga, Masanori

AU - Tanizawa, Yutaka

AU - Bando, Etsuro

AU - Terashima, Masanori

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N2 - Background: Preoperative malnutrition can worsen morbidity and mortality; however, the role of postgastrectomy nutritional status remains unclear. Our purpose was to clarify whether malnutrition after gastrectomy could predict long-term survival. Methods: Patients with pathological stage I, II, and III gastric cancer who underwent gastrectomy between 2002 and 2013 were included. The nutrition risk index (NRI) was evaluated before and at 1, 3, 6 and 12 months after gastrectomy. The patients were divided into normal (NRI CloseSPigtSPi 97.5) or malnutrition (NRI ≤ 97.5) groups, and we compared the correlations of clinicopathological characteristics, surgical treatment, and overall survival between the two groups. Results: Among the 760 participants, patients in the malnutrition group were significantly older and had higher incidences of comorbidity and advanced cancer than the patients in the normal group. Multivariate analysis showed that overall survival was poorer in the malnutrition group before gastrectomy [hazard ratio (HR) 1.68] and at 1 month (HR 1.77), 3 months (HR 2.18), 6 months (HR 1.81) and 12 months (HR 2.17) after gastrectomy (all p OpenSPiltSPi 0.01). Malnutrition at 1 and 3 months after gastrectomy was significantly associated with poor cause-specific survival. Total gastrectomy, preoperative malnutrition, older age, and adjuvant chemotherapy were independent risk factors of postoperative malnutrition at 12 months postgastrectomy. Conclusions: Malnutrition before gastrectomy and at 1, 3, 6 and 12 months after gastrectomy significantly and adversely affects overall survival. Nutritional interventions to lessen the impact of postoperative malnutrition offer hope for prolonged survival.

AB - Background: Preoperative malnutrition can worsen morbidity and mortality; however, the role of postgastrectomy nutritional status remains unclear. Our purpose was to clarify whether malnutrition after gastrectomy could predict long-term survival. Methods: Patients with pathological stage I, II, and III gastric cancer who underwent gastrectomy between 2002 and 2013 were included. The nutrition risk index (NRI) was evaluated before and at 1, 3, 6 and 12 months after gastrectomy. The patients were divided into normal (NRI CloseSPigtSPi 97.5) or malnutrition (NRI ≤ 97.5) groups, and we compared the correlations of clinicopathological characteristics, surgical treatment, and overall survival between the two groups. Results: Among the 760 participants, patients in the malnutrition group were significantly older and had higher incidences of comorbidity and advanced cancer than the patients in the normal group. Multivariate analysis showed that overall survival was poorer in the malnutrition group before gastrectomy [hazard ratio (HR) 1.68] and at 1 month (HR 1.77), 3 months (HR 2.18), 6 months (HR 1.81) and 12 months (HR 2.17) after gastrectomy (all p OpenSPiltSPi 0.01). Malnutrition at 1 and 3 months after gastrectomy was significantly associated with poor cause-specific survival. Total gastrectomy, preoperative malnutrition, older age, and adjuvant chemotherapy were independent risk factors of postoperative malnutrition at 12 months postgastrectomy. Conclusions: Malnutrition before gastrectomy and at 1, 3, 6 and 12 months after gastrectomy significantly and adversely affects overall survival. Nutritional interventions to lessen the impact of postoperative malnutrition offer hope for prolonged survival.

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