scholarly journals Needle Catheter Jejunostomy in Patients Undergoing Surgery for Upper Gastrointestinal and Pancreato-Biliary Cancer–Impact on Nutritional and Clinical Outcome in the Early and Late Postoperative Period

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2564 ◽  
Author(s):  
Maria Wobith ◽  
Lena Wehle ◽  
Delia Haberzettl ◽  
Ali Acikgöz ◽  
Arved Weimann
Keyword(s):  
Weight Loss ◽  
Clinical Outcome ◽  
Enteral Nutrition ◽  
Nutritional Status ◽  
Biliary Cancer ◽  
Postoperative Course ◽  
Catheter Jejunostomy ◽  
Upper Gastrointestinal ◽  
Late Postoperative Period

The metabolic risk for patients undergoing abdominal cancer resection increases in the perioperative period and malnutrition may be observed. In order to prevent further weight loss, the guidelines recommend for high-risk patients the placement of a needle catheter jejunostomy (NCJ) for supplementing enteral feeding in the early and late postoperative period. Our aim was to evaluate the safety of NCJ placement and its potential benefits regarding the nutritional status in the postoperative course. We retrospectively analyzed patients undergoing surgery for upper gastrointestinal cancer, such as esophageal, gastric, and pancreato-biliary cancer, and NCJ placement during the operation. The nutritional parameters body mass index (BMI), perioperative weight loss, phase angle measured by bioelectrical impedance analysis (BIA) and the clinical outcome were assessed perioperatively and during follow-up visits 1 to 3 months and 4 to 6 months after surgery. In 102 patients a NCJ was placed between January 2006 and December 2016. Follow-up visits 1 to 3 months and 4 to 6 months after surgery were performed in 90 patients and 88 patients, respectively. No severe complications were seen after the NCJ placement. The supplementing enteral nutrition via NCJ did not improve the nutritional status of the patients postoperatively. There was a significant postoperative decline of weight and phase angle, especially in the first to third month after surgery, which could be stabilized until 4–6 months after surgery. Placement of NCJ is safe. In patients with upper gastrointestinal and pancreato-biliary cancer, supplementing enteral nutrition during the postoperative course and continued after discharge may attenuate unavoidable weight loss and a reduction of body cell mass within the first six months.

Nutritional Status Deteriorates Postoperatively Despite Preoperative Nutritional Support

2016 ◽  
Vol 68 (4) ◽  
pp. 291-297 ◽  
Author(s):  
Fabian Grass ◽  
Michael Benoit ◽  
Pauline Coti Bertrand ◽  
Josep Sola ◽  
Markus Schäfer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Nutritional Status ◽  
Body Mass ◽  
Nutritional Support ◽  
Infectious Complications ◽  
Index Hospitalization ◽  
Upper Arm ◽  
Independent Risk Factors

Background/Aims: The aim of the current study was to assess the postoperative evolution of nutritional status and to relate it with postoperative outcomes. Methods: Demographic, surgical and nutritional parameters were assessed 10 days preoperatively (d-10) and 30 days postoperatively (d30) in 146 patients. Risk factors responsible for perioperative (>5% between d-10 and d30) weight loss were identified. Overall, severe (Clavien 3-5) and infectious complications were compared in patients with and without perioperative weight loss (>5%). Results: Nutritional status worsened beyond the postoperative period as reflected by decreasing weight (67 ± 13 kg at d-10 vs. 63 ± 13 kg at d30, p < 0.001), body mass index (23.4 ± 4 vs. 22.2 ± 4 kg/m2, p < 0.001) and mid upper-arm muscle circumference (MAMC, 241 ± 32 vs. 232 ± 30 mm, p < 0.001). Fifty-two patients (46%) lost >5% of their body weight between d-10 and d30. Patients who presented overall (63 vs. 36%, p = 0.004) and major (27 vs. 10%, p = 0.016) postoperative complications were at significantly higher risk to deteriorate postoperative nutritional status. Multivariate analysis identified low preoperative lean body mass (OR 3.2; 95% CI 1.2-8.9, p = 0.023) and low preoperative MAMC (OR 2.5; 95% CI 0.9-6.8, p = 0.066) as independent risk factors for perioperative weight loss. Conclusions: These data suggest continuing nutritional follow-up after the index hospitalization.

Nutritional status of patients undergoing upper gastrointestinal cancer surgery: A cross-sectional study at a single centre

2021 ◽  
Vol 148 (12) ◽  
pp. 158-164
Author(s):  
Tran Hieu Hoc ◽  
Nguyen Duy Hieu ◽  
Pham Van Phu ◽  
Tran Thu Huong ◽  
Tran Que Son
Keyword(s):  
Weight Loss ◽  
Nutritional Status ◽  
Gastrointestinal Cancer ◽  
Daily Intake ◽  
Cancer Surgery ◽  
Energy Deficit ◽  
Cross Sectional ◽  
Upper Gastrointestinal Cancer ◽  
Digestive Cancers ◽  
Upper Gastrointestinal

Malnutrition is closely related to the outcome of disease treatment, especially in digestive cancer surgery. The aim of this study was to assess the nutritional condition of pre-operative patients with upper digestive cancers (including stomach and oesophagus) at the Department of General Surgery, Bach Mai Hospital in 2016. We conducted a cross-sectional descriptive analysis of 76 malignancies of the upper gastrointestinal tract with surgical treatments. The results revealed that the weight loss rate of hospitalized patients with gastric cancer and esophageal cancer was 76.6% and 66.7%, respectively. The rate of weight loss above 10% of body weight was 19.7%. The prevalence of chronic energy deficit was 29.9%. The risk of malnutrition according to SGA was 77.6%, of which mild to moderate and severe was 67.2% and 10.4%, respectively. The rate of low blood albumin level (less than 35 g/L) was 36.5%. The average net nutritional value was 1146.3 ± 592.7 Kcal (range 246.7 – 3653.5), which equals to 55.7% of the necessary daily intake. Protein, lipid, and glucid contents reached 73.4%, 57.8%, and 52.1% of the recommended levels, respectively. Conclusion: malnutrition was still prevalent among patients undergoing upper gastrointestinal cancer surgery, and pre-operative nutritional status does not achieve recommended levels.

The Use of Clinical Parameters as Adjuncts to Endoscopic Evaluation of Mural Thickening on Conventional Computed Tomography in Diagnosing Malignancy

2021 ◽  
pp. 1-7
Author(s):  
Noel E. Donlon ◽  
Michael E. Kelly ◽  
Muneeb Zafar ◽  
Patrick A. Boland ◽  
Cian Davis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Weight Loss ◽  
Clinical Parameters ◽  
Endoscopic Evaluation ◽  
Diagnostic Dilemma ◽  
Gastrointestinal Malignancies ◽  
Red Flag ◽  
Endoscopic Investigation ◽  
Upper Gastrointestinal

<b><i>Background:</i></b> Mural thickening (MT) on computed tomography (CT) poses a diagnostic dilemma in the absence of clear reporting guidelines. The aim of this study was to analyse CT reports, identifying patients in whom gastrointestinal wall MT was observed, and to correlate these reports with subsequent endoscopic evaluation. <b><i>Methods:</i></b> Patients with MT who had follow-up endoscopy were included in the study (<i>n</i> = 308). The cohort was subdivided into upper gastrointestinal mural thickening (UGIMT) &amp; lower gastrointestinal mural thickening (LGIMT). <b><i>Results:</i></b> In total, 55.71% (<i>n</i> = 122) of colonoscopies and 61.8% (<i>n</i> = 55) of gastroscopies were found to be normal. Haemoglobin (HB) level in combination with MT was a predictor of neoplasia in both arms (<i>p</i> = 0.04 UGIMT cohort, <i>p</i> &#x3c; 0.001 LGIMT cohort). In addition to this, age was a significant correlative parameter in both UGIMT and LGIMT cohorts (<i>p</i> = 0.003, <i>p</i> &#x3c; 0.001 respectively). Dysphagia and weight loss were associated with UGI malignancies (38 and 63% respectively) and rectal bleeding was correlative in 20% of patients with LGI malignancies. <b><i>Conclusion:</i></b> HB, advancing age, and red flag symptoms are potentially useful adjuncts to MT in predicting upper and lower gastrointestinal malignancies. We propose the adoption of a streamlined pathway to delineate patients who should undergo endoscopic investigation following CT identification of MT.

P58 IMPACT OF SYSTEMATIC ENTERAL NUTRITION IN OESOPHAGEAL OR OESOGASTRIC JUNCTION (OG) CANCERS INVOLVED IN A CURATIVE STRATEGY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Marin Hélène ◽  
Warlaumont Maxime ◽  
Pieesen Guillaume
Keyword(s):  
Weight Loss ◽  
Enteral Nutrition ◽  
Control Group ◽  
Perioperative Chemotherapy ◽  
Severe Dysphagia ◽  
On Demand ◽  
Significant Difference ◽  
Therapeutic Sequence ◽  
The Impact

Abstract Aim In the absence of severe dysphagia or major weight loss, most patients treated for OG cancer do not have enteral nutrition (EN) instituted before neoadjuvant treatment. The aim of this work was to compare the impact of a systematic NE (NES) or on demand (NED) on the course of the therapeutic sequence, the post-operative follow-up: post-operative complications of grade Clavien-Dindo> II and Complication Comprehensive Index (CCI); and oncologic results (median follow-up: 36 months). Background & Methods Among 682 patients with OG cancer operated between 2007 and 2015, 313 patients with <20% weight loss and no severe dysphagia (Atkinson <IV) were included. Control group with NES (n = 140) and group with NED (n = 173) were compared with propensity score adjustment. Results In the NES group, the tumor stage was more advanced (clinical stage III: 78.6% vs 61.4% p = 0.001) and the more frequent undernutrition (28.6% vs 14.6% p = 0.002). After adjustment, there was no significant difference between the two groups regarding the risk of severe complications (25.7% vs 24.9% p = 0.682), the median CCI (20.9 vs 20.9, p = 0.08) and 90-day mortality (4.3% vs. 5.2% p = 0.706). In case of perioperative chemotherapy, the rate of patients benefiting from the complete therapeutic sequence was higher in the NES group (80.4% vs 62.2% p = 0.0192 ie OR = 2.5). Overall survival was similar between the 2 groups (p = 0.509). Conclusion In OG cancers, systematic NE does not modify the operative and oncological follow-ups with respect to an on-demand NE, but more frequently makes it possible to achive the therapeutic sequence in the case of perioperative chemotherapy.

scholarly journals Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3349
Author(s):  
Irene Deftereos ◽  
Justin M. C. Yeung ◽  
Janan Arslan ◽  
Vanessa M. Carter ◽  
Elizabeth Isenring ◽  
...  
Keyword(s):  
Weight Loss ◽  
Nutritional Status ◽  
Regression Coefficient ◽  
Point Prevalence ◽  
Unintentional Weight Loss ◽  
Point Prevalence Study ◽  
Poor Appetite ◽  
Preoperative Nutrition ◽  
Nutrition Impact Symptoms ◽  
Upper Gastrointestinal

Background: Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications. Methods: Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications. Results: This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2–4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications. Conclusions: Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes.

Predicting the risk of becoming lost to follow-up in a lifestyle weight-loss intervention

2013 ◽  
Author(s):  
Danielle M. Lespinasse ◽  
Kristen E. Medina ◽  
Stacey N. Maurer ◽  
Samantha A. Minski ◽  
Renee T. Degener ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Loss Intervention ◽  
Lost To Follow Up

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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