Longitudinal Dynamic in Weight Loss Impacts Clinical Outcomes for Veterans Undergoing Curative Surgery for Colorectal Cancer.

Federal practitioner : for the health care professionals of the VA, DoD, and PHS Pub Date : 2023-05-01 Epub Date: 2023-05-13 DOI:10.12788/fp.0377

Urvashi M Joshi, David Ratz, Timothy L Frankel, Irina Dobrosotskaya

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Abstract

Background: Definitions of malnutrition imperfectly reflect nutritional status or predict perioperative consequences. We sought to identify predictive nutritional trends by examining the effect of preoperative weight on postoperative outcomes in patients with colorectal cancer (CRC).

Methods: This retrospective review examined 148 patients with CRC treated with curative-intent surgery at the Veterans Affairs Ann Arbor Healthcare System in Michigan from January 1, 2015 to December 31, 2019. We evaluated weight dynamics of patients, starting 1 year before cancer diagnosis until 1 year after surgery. We evaluated the association of these weight dynamics with surgical outcomes. Primary outcomes observed were hospital readmission and length of stay (LOS), chemotherapy completion, and delayed recovery defined as abnormal clinical developments.

Results: There were 115 patients in the colon cancer (CC) cohort and 33 in the rectal cancer (RC) cohort. Low preoperative albumin (< 3.5 g/dL) was present in 25 patients with CC (22%) and 11 patients with RC (33%). Six-month preoperative weight loss of at least 3% occurred in 32 patients with CC (36%). Delayed recovery was observed in 35 patients with CC (30%) and 21 patients with RC (64%). Nutrition consultation rates for the CC and RC groups were 15% and 36%, respectively, before the operation; 95% and 100%, respectively, for postoperative inpatients; and 12% and 73%, respectively, for postoperative outpatients. Six-month preoperative weight loss of ≥ 3% was significantly associated with delayed recovery (P < .001) and 60-day readmissions (P = .015) but not increased LOS or chemotherapy noncompletion.

Conclusions: A ≥ 3% weight loss 6 months preceding curative surgery for CRC was associated with adverse outcomes. An intensive nutrition prehabilitation program initiated at the time of cancer diagnosis is needed and may reduce associated complications.

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减肥的纵向动态影响接受癌症治疗性手术的退伍军人的临床结果。

背景：营养不良的定义不能完全反映营养状况或预测围手术期的后果。我们试图通过检查术前体重对结直肠癌癌症（CRC）患者术后结果的影响来确定预测营养趋势。方法：这项回顾性审查检查了2015年1月1日至2019年12月31日在密歇根州退伍军人事务安阿伯医疗保健系统接受管理性手术的148名结直肠癌患者。我们评估了从癌症诊断前1年到手术后1年患者的体重动态。我们评估了这些体重动态与手术结果的关系。观察到的主要结果是再次入院和住院时间（LOS）、化疗完成和被定义为异常临床发展的延迟恢复。结果：癌症（CC）队列中有115例患者，癌症（RC）队列中33例患者。25例CC患者（22%）和11例RC患者（33%）术前白蛋白水平较低（<3.5 g/dL）。32例CC患者（36%）术前6个月体重减轻至少3%。在35例CC患者（30%）和21例RC患者（64%）中观察到延迟恢复。CC组和RC组术前营养咨询率分别为15%和36%；术后住院患者分别为95%和100%；术后门诊患者分别为12%和73%。术前6个月体重减轻≥3%与恢复延迟（P<.001）和60天再次入院（P=.015）显著相关，但与LOS增加或化疗未完成无关。结论：CRC根治性手术前6个月体重减轻≥3%与不良后果相关。需要在癌症诊断时启动强化营养康复计划，并可减少相关并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Federal practitioner : for the health care professionals of the VA, DoD, and PHS

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