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02.01.2024 | Review

Effect of Preoperative Malnutrition Based on Albumin and BMI on Hepatocellular Carcinoma Surgery and Prediction of Risk Factors of Complications

verfasst von: Weiqiang Jin, Shiming Jiang, Anke Chen, Yong Chen

Erschienen in: Journal of Gastrointestinal Cancer | Ausgabe 2/2024

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Abstract

Background

To investigate the correlation between preoperative malnutrition and perioperative variables in patients with hepatocellular carcinoma (HCC) and to analyze the risk factors of complications after HCC resection.

Methods

All patients who underwent hepatectomy because of HCC in the First Affiliated Hospital of Chongqing Medical University from June 1, 2018, to December 1, 2021, were analyzed retrospectively. Preoperative malnutrition was defined as body mass index (BMI) < 18.5 kg/m2 or serum albumin level < 3.5 g/dL within 30 days before operation.

Results

A total of 415 patients with HCC hepatectomy were included, and 75 (18.1%) were classified as malnutrition group. In the malnutrition group, blood loss (662.1 ± 748.1 VS 404.6 ± 681.9, P = 0.002), transfusion rate (36.0% VS 13.5%, P < 0.001), postoperative hospital stays (13.3 ± 9.6 VS 10.1 ± 4.2, P < 0.001), 30-day postoperative mortality (4.0 VS 0.6%, P = 0.043), complications rate (68% VS 34.8%, P < 0.001), and severe complication rate (17.3% VS 2.4%, P < 0.001) were significantly higher than those in the well-nourished group. Multivariate analysis showed that age (HR 1.037, 95% CI 1.015–1.059, P = 0.001), preoperative malnutrition (HR 2.933, 95% CI 1.515–5.679, P = 0.001), simultaneous cholecystectomy (HR 2.004, 95% CI 1.168–3.440, P = 0.012), cirrhosis (HR 4.997, 95% CI 2.864–8.718, P < 0.001), and transfusion (HR 5.166, 95% CI 2.272–11.748, P < 0.001) were independent risk factors for postoperative complications. In addition, preoperative malnutrition (HR 8.209, 95% CI 2.711–24.864, P < 0.001) and operation time (HR 1.088, 95% CI 1.003–1.103, P = 0.004) were independent risk factors for severe complications.

Conclusion

Preoperative malnutrition can adversely affect the outcome of HCC resection. For patients with advanced age, cirrhosis, and malnutrition, preoperative planning is very important, and we should be more careful during the operation to avoid transfusion caused by bleeding and not to carry out preventive cholecystectomy, which are helpful to reduce the occurrence of postoperative complications.
Literatur
1.
Zurück zum Zitat Allard JP, Keller H, Jeejeebhoy KN, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: a prospective cohort study. Clin Nutr. 2016;35:144–52.CrossRefPubMed Allard JP, Keller H, Jeejeebhoy KN, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: a prospective cohort study. Clin Nutr. 2016;35:144–52.CrossRefPubMed
2.
Zurück zum Zitat Norman K, Pichard C, Lochs H, et al. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5–15.CrossRefPubMed Norman K, Pichard C, Lochs H, et al. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5–15.CrossRefPubMed
3.
Zurück zum Zitat Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8:514–27.CrossRefPubMedPubMedCentral Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8:514–27.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Huang TH, Hsieh CC, Kuo LM, et al. Malnutrition associated with an increased risk of postoperative complications following hepatectomy in patients with hepatocellular carcinoma. HPB (Oxford). 2019;21:1150–5.CrossRefPubMed Huang TH, Hsieh CC, Kuo LM, et al. Malnutrition associated with an increased risk of postoperative complications following hepatectomy in patients with hepatocellular carcinoma. HPB (Oxford). 2019;21:1150–5.CrossRefPubMed
5.
Zurück zum Zitat Shaw C, Fleuret C, Pickard JM, et al. Comparison of a novel, simple nutrition screening tool for adult oncology inpatients and the malnutrition screening tool (mst) against the patient-generated subjective global assessment (pg-sga). Support Care Cancer. 2015;23:47–54.CrossRefPubMed Shaw C, Fleuret C, Pickard JM, et al. Comparison of a novel, simple nutrition screening tool for adult oncology inpatients and the malnutrition screening tool (mst) against the patient-generated subjective global assessment (pg-sga). Support Care Cancer. 2015;23:47–54.CrossRefPubMed
6.
Zurück zum Zitat Kondrup J, Allison SP, Elia M, et al. Espen guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415–21.CrossRefPubMed Kondrup J, Allison SP, Elia M, et al. Espen guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415–21.CrossRefPubMed
7.
Zurück zum Zitat Castillo-Martínez L, Castro-Eguiluz D, Copca-Mendoza ET, et al. Nutritional assessment tools for the identification of malnutrition and nutritional risk associated with cancer treatment. Rev Invest Clin. 2018;70:121–5.PubMed Castillo-Martínez L, Castro-Eguiluz D, Copca-Mendoza ET, et al. Nutritional assessment tools for the identification of malnutrition and nutritional risk associated with cancer treatment. Rev Invest Clin. 2018;70:121–5.PubMed
8.
Zurück zum Zitat Pikul J, Sharpe MD, Lowndes R, et al. Degree of preoperative malnutrition is predictive of postoperative morbidity and mortality in liver transplant recipients. Transplantation. 1994;57:469–72.CrossRefPubMed Pikul J, Sharpe MD, Lowndes R, et al. Degree of preoperative malnutrition is predictive of postoperative morbidity and mortality in liver transplant recipients. Transplantation. 1994;57:469–72.CrossRefPubMed
9.
Zurück zum Zitat Oh TK, Lee J, Hwang JW, et al. Value of preoperative modified body mass index in predicting postoperative 1-year mortality. Sci Rep. 2018;8:4614.CrossRefPubMedPubMedCentral Oh TK, Lee J, Hwang JW, et al. Value of preoperative modified body mass index in predicting postoperative 1-year mortality. Sci Rep. 2018;8:4614.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Caras RJ, Lustik MB, Kern SQ, et al. Preoperative albumin is predictive of early postoperative morbidity and mortality in common urologic oncologic surgeries. Clin Genitourin Cancer. 2017;15:e255–62.CrossRefPubMed Caras RJ, Lustik MB, Kern SQ, et al. Preoperative albumin is predictive of early postoperative morbidity and mortality in common urologic oncologic surgeries. Clin Genitourin Cancer. 2017;15:e255–62.CrossRefPubMed
11.
Zurück zum Zitat Oñate-Ocaña LF, Aiello-Crocifoglio V, Gallardo-Rincón D, et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol. 2007;14:381–9.CrossRefPubMed Oñate-Ocaña LF, Aiello-Crocifoglio V, Gallardo-Rincón D, et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol. 2007;14:381–9.CrossRefPubMed
12.
Zurück zum Zitat Cengiz O, Kocer B, Sürmeli S, et al. Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma? Med Sci Monit. 2006;12:Cr240–7. Cengiz O, Kocer B, Sürmeli S, et al. Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma? Med Sci Monit. 2006;12:Cr240–7.
13.
Zurück zum Zitat Lis CG, Grutsch JF, Vashi PG, et al. Is serum albumin an independent predictor of survival in patients with breast cancer? JPEN J Parenter Enteral Nutr. 2003;27:10–5.CrossRefPubMed Lis CG, Grutsch JF, Vashi PG, et al. Is serum albumin an independent predictor of survival in patients with breast cancer? JPEN J Parenter Enteral Nutr. 2003;27:10–5.CrossRefPubMed
14.
Zurück zum Zitat Wu N, Zhu Y, Kadel D, et al. The prognostic influence of body mass index, resting energy expenditure and fasting blood glucose on postoperative patients with esophageal cancer. BMC Gastroenterol. 2016;16:142.CrossRefPubMedPubMedCentral Wu N, Zhu Y, Kadel D, et al. The prognostic influence of body mass index, resting energy expenditure and fasting blood glucose on postoperative patients with esophageal cancer. BMC Gastroenterol. 2016;16:142.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Okamura Y, Maeda A, Matsunaga K, et al. Negative impact of low body mass index on surgical outcomes after hepatectomy for hepatocellular carcinoma. J Hepatobiliary Pancreat Sci. 2012;19:449–57.CrossRefPubMed Okamura Y, Maeda A, Matsunaga K, et al. Negative impact of low body mass index on surgical outcomes after hepatectomy for hepatocellular carcinoma. J Hepatobiliary Pancreat Sci. 2012;19:449–57.CrossRefPubMed
16.
Zurück zum Zitat Mintziras I, Wächter S, Manoharan J, et al. Postoperative morbidity following pancreatic cancer surgery is significantly associated with worse overall patient survival; systematic review and meta-analysis. Surg Oncol. 2021;38:101573.CrossRefPubMed Mintziras I, Wächter S, Manoharan J, et al. Postoperative morbidity following pancreatic cancer surgery is significantly associated with worse overall patient survival; systematic review and meta-analysis. Surg Oncol. 2021;38:101573.CrossRefPubMed
17.
Zurück zum Zitat Lång M, Niskanen M, Miettinen P, et al. Outcome and resource utilization in gastroenterological surgery. Br J Surg. 2001;88:1006–14.CrossRefPubMed Lång M, Niskanen M, Miettinen P, et al. Outcome and resource utilization in gastroenterological surgery. Br J Surg. 2001;88:1006–14.CrossRefPubMed
18.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Kawai M, Harada M, Motoike Y, et al. Impact of serum albumin levels on supratherapeutic pt-inr control and bleeding risk in atrial fibrillation patients on warfarin: a prospective cohort study. Int J Cardiol Heart Vasc. 2019;22:111–6.PubMedPubMedCentral Kawai M, Harada M, Motoike Y, et al. Impact of serum albumin levels on supratherapeutic pt-inr control and bleeding risk in atrial fibrillation patients on warfarin: a prospective cohort study. Int J Cardiol Heart Vasc. 2019;22:111–6.PubMedPubMedCentral
20.
Zurück zum Zitat Dahlberg S, Schött U, Kander T. The effect of vitamin k on prothrombin time in critically ill patients: an observational registry study. J Intensive Care. 2021;9:11.CrossRefPubMedPubMedCentral Dahlberg S, Schött U, Kander T. The effect of vitamin k on prothrombin time in critically ill patients: an observational registry study. J Intensive Care. 2021;9:11.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Yang R, Zhang X, Wei W, et al. Relationship between acquired deficiency of vitamin K-dependent clotting factors and hemorrhage. J Huazhong Univ Sci Technolog Med Sci. 2010;30:312–7.CrossRefPubMed Yang R, Zhang X, Wei W, et al. Relationship between acquired deficiency of vitamin K-dependent clotting factors and hemorrhage. J Huazhong Univ Sci Technolog Med Sci. 2010;30:312–7.CrossRefPubMed
22.
Zurück zum Zitat Bayewitz A, Scorziello B, Maala C, et al. The effect of preoperative vitamin K on the INR in bridging therapy. Int J Hematol. 2015;101:264–7.CrossRefPubMed Bayewitz A, Scorziello B, Maala C, et al. The effect of preoperative vitamin K on the INR in bridging therapy. Int J Hematol. 2015;101:264–7.CrossRefPubMed
23.
Zurück zum Zitat Prasad GV, Abidi SM, McCauley J, et al. Vitamin K deficiency with hemorrhage after kidney and combined kidney-pancreas transplantation. Am J Kidney Dis. 1999;33:963–5.CrossRefPubMed Prasad GV, Abidi SM, McCauley J, et al. Vitamin K deficiency with hemorrhage after kidney and combined kidney-pancreas transplantation. Am J Kidney Dis. 1999;33:963–5.CrossRefPubMed
24.
Zurück zum Zitat Sungurtekin H, Sungurtekin U, Balci C, et al. The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr. 2004;23:227–32.CrossRefPubMed Sungurtekin H, Sungurtekin U, Balci C, et al. The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr. 2004;23:227–32.CrossRefPubMed
25.
Zurück zum Zitat Schiesser M, Müller S, Kirchhoff P, et al. Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Clin Nutr. 2008;27:565–70.CrossRefPubMed Schiesser M, Müller S, Kirchhoff P, et al. Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Clin Nutr. 2008;27:565–70.CrossRefPubMed
26.
Zurück zum Zitat Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22:235–9.CrossRefPubMed Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22:235–9.CrossRefPubMed
27.
Zurück zum Zitat Bozzetti F, Braga M, Gianotti L, et al. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet. 2001;358:1487–92.CrossRefPubMed Bozzetti F, Braga M, Gianotti L, et al. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet. 2001;358:1487–92.CrossRefPubMed
28.
Zurück zum Zitat Braga M, Gianotti L, Vignali A, et al. Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery. 2002;132:805–14.CrossRefPubMed Braga M, Gianotti L, Vignali A, et al. Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery. 2002;132:805–14.CrossRefPubMed
29.
Zurück zum Zitat de la Fuente SG, Bennett KM, Scarborough JE. Functional status determines postoperative outcomes in elderly patients undergoing hepatic resections. J Surg Oncol. 2013;107:865–70.CrossRefPubMed de la Fuente SG, Bennett KM, Scarborough JE. Functional status determines postoperative outcomes in elderly patients undergoing hepatic resections. J Surg Oncol. 2013;107:865–70.CrossRefPubMed
30.
Zurück zum Zitat Hobeika C, Fuks D, Cauchy F, et al. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg. 2020;107:268–77.CrossRefPubMed Hobeika C, Fuks D, Cauchy F, et al. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg. 2020;107:268–77.CrossRefPubMed
31.
Zurück zum Zitat Goh BKP, Syn N, Lee SY, et al. Impact of liver cirrhosis on the difficulty of minimally-invasive liver resections: a 1:1 coarsened exact-matched controlled study. Surg Endosc. 2021;35:5231–8.CrossRefPubMed Goh BKP, Syn N, Lee SY, et al. Impact of liver cirrhosis on the difficulty of minimally-invasive liver resections: a 1:1 coarsened exact-matched controlled study. Surg Endosc. 2021;35:5231–8.CrossRefPubMed
32.
Zurück zum Zitat Caldwell SH, Hoffman M, Lisman T, et al. Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management. Hepatology. 2006;44:1039–46.CrossRefPubMed Caldwell SH, Hoffman M, Lisman T, et al. Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management. Hepatology. 2006;44:1039–46.CrossRefPubMed
34.
Zurück zum Zitat Goh BKP, Teo JY, Lee SY, et al. Critical appraisal of the impact of individual surgeon experience on the outcomes of laparoscopic liver resection in the modern era: collective experience of multiple surgeons at a single institution with 324 consecutive cases. Surg Endosc. 2018;32:1802–11.CrossRefPubMed Goh BKP, Teo JY, Lee SY, et al. Critical appraisal of the impact of individual surgeon experience on the outcomes of laparoscopic liver resection in the modern era: collective experience of multiple surgeons at a single institution with 324 consecutive cases. Surg Endosc. 2018;32:1802–11.CrossRefPubMed
35.
Zurück zum Zitat Kaibori M, Kubo S, Nagano H, et al. Higher complication rate in hepatocellular carcinoma patients undergoing prophylactic cholecystectomy with curative hepatic resection. Hepatogastroenterology. 2014;61:2028–34.PubMed Kaibori M, Kubo S, Nagano H, et al. Higher complication rate in hepatocellular carcinoma patients undergoing prophylactic cholecystectomy with curative hepatic resection. Hepatogastroenterology. 2014;61:2028–34.PubMed
36.
Zurück zum Zitat Li T, Wang SK, Zhi XT, et al. Cholecystectomy is associated with higher risk of early recurrence and poorer survival after curative resection for early stage hepatocellular carcinoma. Sci Rep. 2016;6:28229.CrossRefPubMedPubMedCentral Li T, Wang SK, Zhi XT, et al. Cholecystectomy is associated with higher risk of early recurrence and poorer survival after curative resection for early stage hepatocellular carcinoma. Sci Rep. 2016;6:28229.CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Lai SW. Pathologic evaluation of gallbladder in patients who underwent cholecystectomy and hepatic resection for hepatocellular carcinoma. Am J Med Sci. 2011;341:305–7.CrossRefPubMed Lai SW. Pathologic evaluation of gallbladder in patients who underwent cholecystectomy and hepatic resection for hepatocellular carcinoma. Am J Med Sci. 2011;341:305–7.CrossRefPubMed
38.
Zurück zum Zitat Hallet J, Mahar AL, Nathens AB, et al. The impact of perioperative blood transfusions on short-term outcomes following hepatectomy. Hepatobiliary Surg Nutr. 2018;7:1–10.CrossRefPubMedPubMedCentral Hallet J, Mahar AL, Nathens AB, et al. The impact of perioperative blood transfusions on short-term outcomes following hepatectomy. Hepatobiliary Surg Nutr. 2018;7:1–10.CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat Kuroda S, Tashiro H, Kobayashi T, et al. No impact of perioperative blood transfusion on recurrence of hepatocellular carcinoma after hepatectomy. World J Surg. 2012;36:651–8.CrossRefPubMed Kuroda S, Tashiro H, Kobayashi T, et al. No impact of perioperative blood transfusion on recurrence of hepatocellular carcinoma after hepatectomy. World J Surg. 2012;36:651–8.CrossRefPubMed
40.
Zurück zum Zitat Latchana N, Hirpara DH, Hallet J, et al. Red blood cell transfusion in liver resection. Langenbecks Arch Surg. 2019;404:1–9.CrossRefPubMed Latchana N, Hirpara DH, Hallet J, et al. Red blood cell transfusion in liver resection. Langenbecks Arch Surg. 2019;404:1–9.CrossRefPubMed
41.
Zurück zum Zitat Lu Q, Zhang J, Gao WM, et al. Intraoperative blood transfusion and postoperative morbidity following liver resection. Med Sci Monit. 2018;24:8469–80.CrossRefPubMedPubMedCentral Lu Q, Zhang J, Gao WM, et al. Intraoperative blood transfusion and postoperative morbidity following liver resection. Med Sci Monit. 2018;24:8469–80.CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat Vamvakas EC, Blajchman MA. Transfusion-related immunomodulation (trim): an update. Blood Rev. 2007;21:327–48.CrossRefPubMed Vamvakas EC, Blajchman MA. Transfusion-related immunomodulation (trim): an update. Blood Rev. 2007;21:327–48.CrossRefPubMed
Metadaten
Titel
Effect of Preoperative Malnutrition Based on Albumin and BMI on Hepatocellular Carcinoma Surgery and Prediction of Risk Factors of Complications
verfasst von
Weiqiang Jin
Shiming Jiang
Anke Chen
Yong Chen
Publikationsdatum
02.01.2024
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Cancer / Ausgabe 2/2024
Print ISSN: 1941-6628
Elektronische ISSN: 1941-6636
DOI
https://doi.org/10.1007/s12029-023-01008-0

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