Impact of nutritional status and body composition on postoperative outcomes after pelvic exenteration for locally advanced and locally recurrent rectal cancer.
Journal
BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685
Informations de publication
Date de publication:
06 09 2021
06 09 2021
Historique:
received:
15
06
2021
accepted:
22
08
2021
entrez:
21
10
2021
pubmed:
22
10
2021
medline:
25
12
2021
Statut:
ppublish
Résumé
Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent (LRRC) rectal cancer provides radical resection and local control, but is associated with considerable morbidity. The aim of this study was to determine risk factors, including nutritional status and body composition, for postoperative morbidity and survival after pelvic exenteration in patients with LARC or LRRC. Patients with LARC or LRRC who underwent total or posterior pelvic exenteration in a tertiary referral centre from 2003 to 2018 were analysed retrospectively. Nutritional status was assessed using the Malnutrition Universal Screening Tool (MUST). Body composition was estimated using standard-of-care preoperative CT of the abdomen. Logistic regression analyses were performed to identify risk factors for complications with a Clavien-Dindo grade of III or higher. Risk factors for impaired overall survival were calculated using Cox proportional hazards analysis. In total, 227 patients who underwent total (111) or posterior (116) pelvic exenteration were analysed. Major complications (Clavien-Dindo grade at least III) occurred in 82 patients (36.1 per cent). High risk of malnutrition (MUST score 2 or higher) was the only risk factor for major complications (odds ratio 3.99, 95 per cent c.i. 1.76 to 9.02) in multivariable analysis. Mean follow-up was 44.6 months. LRRC (hazard ratio (HR) 1.61, 95 per cent c.i. 1.04 to 2.48) and lymphovascular invasion (HR 2.20, 1.38 to 3.51) were independent risk factors for impaired overall survival. A high risk of malnutrition according to the MUST is a strong risk factor for major complications in patients with LARC or LRRC undergoing exenteration surgery.
Sections du résumé
BACKGROUND
Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent (LRRC) rectal cancer provides radical resection and local control, but is associated with considerable morbidity. The aim of this study was to determine risk factors, including nutritional status and body composition, for postoperative morbidity and survival after pelvic exenteration in patients with LARC or LRRC.
METHODS
Patients with LARC or LRRC who underwent total or posterior pelvic exenteration in a tertiary referral centre from 2003 to 2018 were analysed retrospectively. Nutritional status was assessed using the Malnutrition Universal Screening Tool (MUST). Body composition was estimated using standard-of-care preoperative CT of the abdomen. Logistic regression analyses were performed to identify risk factors for complications with a Clavien-Dindo grade of III or higher. Risk factors for impaired overall survival were calculated using Cox proportional hazards analysis.
RESULTS
In total, 227 patients who underwent total (111) or posterior (116) pelvic exenteration were analysed. Major complications (Clavien-Dindo grade at least III) occurred in 82 patients (36.1 per cent). High risk of malnutrition (MUST score 2 or higher) was the only risk factor for major complications (odds ratio 3.99, 95 per cent c.i. 1.76 to 9.02) in multivariable analysis. Mean follow-up was 44.6 months. LRRC (hazard ratio (HR) 1.61, 95 per cent c.i. 1.04 to 2.48) and lymphovascular invasion (HR 2.20, 1.38 to 3.51) were independent risk factors for impaired overall survival.
CONCLUSION
A high risk of malnutrition according to the MUST is a strong risk factor for major complications in patients with LARC or LRRC undergoing exenteration surgery.
Identifiants
pubmed: 34672343
pii: 6406859
doi: 10.1093/bjsopen/zrab096
pmc: PMC8529522
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.
Références
Int J Colorectal Dis. 2011 Apr;26(4):473-81
pubmed: 21190025
Eur J Surg Oncol. 2016 Sep;42(9):1322-30
pubmed: 27156145
Lancet. 2009 Mar 7;373(9666):811-20
pubmed: 19269519
Br J Surg. 2015 Nov;102(12):1448-58
pubmed: 26375617
J Clin Oncol. 2013 Apr 20;31(12):1539-47
pubmed: 23530101
Ann Surg. 2015 Feb;261(2):345-52
pubmed: 24651133
World J Surg. 2002 Jan;26(1):59-66
pubmed: 11898035
Ann Surg Oncol. 2015 Aug;22(8):2663-8
pubmed: 25564158
N Engl J Med. 2001 Aug 30;345(9):638-46
pubmed: 11547717
Lancet. 1994 Sep 10;344(8924):707-11
pubmed: 7915774
Clin Nutr. 2015 Aug;34(4):700-4
pubmed: 25171837
Eur J Surg Oncol. 2016 Nov;42(11):1654-1659
pubmed: 27554247
Am J Clin Nutr. 2019 Dec 1;110(6):1327-1334
pubmed: 31529042
J Gastrointest Surg. 2004 Dec;8(8):1061-7
pubmed: 15585394
Eur J Surg Oncol. 2018 Oct;44(10):1548-1554
pubmed: 30075979
BMC Cancer. 2019 Jan 22;19(1):98
pubmed: 30670009
Gastroenterology. 2018 Aug;155(2):391-410.e4
pubmed: 29750973
Surgery. 2011 Sep;150(3):505-14
pubmed: 21878237
Clin Cancer Res. 2007 Nov 15;13(22 Pt 1):6617-23
pubmed: 18006762
JAMA Surg. 2018 Dec 1;153(12):e183567
pubmed: 30285063
Sci Rep. 2020 Jul 1;10(1):10744
pubmed: 32612136
Ann Surg Oncol. 2018 Jun;25(6):1454-1455
pubmed: 29616422
Clin Nutr. 2018 Oct;37(5):1728-1735
pubmed: 28756039
Tech Coloproctol. 2018 Nov;22(11):835-845
pubmed: 30506497
BJS Open. 2019 Mar 06;3(4):516-520
pubmed: 31388644
Cancer Epidemiol Biomarkers Prev. 2017 Jul;26(7):1008-1015
pubmed: 28506965
Tech Coloproctol. 2020 Sep;24(9):959-964
pubmed: 32564236
Colorectal Dis. 2012 Sep;14(9):1076-83
pubmed: 22107085
J Cancer. 2019 May 21;10(10):2243-2249
pubmed: 31258728
Trials. 2016 Jan 13;17:24
pubmed: 26762365
Age Ageing. 2019 Jan 1;48(1):16-31
pubmed: 30312372
Eur J Surg Oncol. 2007 May;33(4):452-8
pubmed: 17071043
Ann Surg. 2019 Feb;269(2):315-321
pubmed: 28938268
World J Surg. 2009 Jul;33(7):1502-8
pubmed: 19421811
Ann Surg Oncol. 2015 Oct;22(11):3625-31
pubmed: 25672564
Ann Surg. 2021 Jan 11;:
pubmed: 33443905
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
JAMA Oncol. 2019 Dec 1;5(12):1749-1768
pubmed: 31560378
Dis Colon Rectum. 2002 Aug;45(8):1078-84
pubmed: 12195193
J Cachexia Sarcopenia Muscle. 2017 Apr;8(2):285-297
pubmed: 27897414
Arch Surg. 2005 Mar;140(3):278-83, discussion 284
pubmed: 15781793
Int J Surg. 2020 Jun;78:91-96
pubmed: 32335238
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
Dis Colon Rectum. 2013 Apr;56(4):519-31
pubmed: 23478621
Dis Colon Rectum. 2015 Jun;58(6):547-55
pubmed: 25944426
Tech Coloproctol. 2019 Sep;23(9):877-885
pubmed: 31486988
J Clin Oncol. 2017 Aug 10;35(23):2631-2638
pubmed: 28657814