Skip to main content

Advertisement

SpringerLink
Log in

Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Preoperative nutritional assessment of cancer patients is important to reduce postoperative complications. Several studies have reported the Geriatric Nutritional Risk Index (GNRI) to be useful in assessing underlying diseases and long-term outcomes of hospitalized patients. The present study aimed to evaluate the impact of preoperative GNRI on short- and long-term outcomes in elderly gastric cancer patients who underwent laparoscopic gastrectomy.

Methods

We retrospectively reviewed consecutive patients aged ≥ 65 years who underwent laparoscopy-assisted gastrectomy and had R0 resection for histologically confirmed gastric adenocarcinoma. The cutoff value for preoperative GNRI was determined to be 85.7 based on the incidence of postoperative complications. Patients were categorized into two groups: low GNRI group and normal GNRI group.

Results

Univariate analyses of the 303 patients revealed that the incidence of postoperative complications was significantly associated with the American Society of Anesthesiologists Physical Status classification (ASA-PS), C-reactive protein (CRP), GNRI (p < 0.001), and operative procedure. Multivariate analyses revealed that preoperative GNRI (odds ratio [OR] 2.716; 95% confidence interval [CI] 1.166–6.328; p = 0.021) and operative procedure (OR 2.459; 95% CI 1.378–4.390; p = 0.002) were independently associated with the incidence of postoperative complications.

Univariate analyses showed that overall survival (OS) was significantly associated with ASA-PS, tumor size, tumor differentiation, pathological tumor node metastasis (TNM) stage, carcinoembryonic antigen (CEA), CRP, GNRI, and postoperative complications. Multivariate analysis demonstrated that ASA-PS (hazard ratio [HR], 3.755; 95% CI 2.141–6.585; p < 0.001), tumor differentiation (HR 1.898; 95% CI 1.191–3.025; p = 0.007), CEA (HR 1.645; 95% CI 1.024–2.643; p = 0.040), and GNRI (HR 2.093; 95% CI 1.105–3.963; p = 0.023) independently predicted OS.

Conclusion

GNRI is an important predictor of postoperative complications and overall survival in elderly gastric cancer patients. It is a reliable and cost-effective prognostic indicator that should be routinely evaluated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Laky B, Janda M, Kondalsamy-Chennakesavan S, Cleghorn G, Obermair A (2010) Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: a cohort study. BMC Cancer 25(10):232. https://doi.org/10.1186/1471-2407-10-232

    Article  Google Scholar 

  2. Ho JW, Wu AH, Lee MW, Lau SY, Lam PS, Lau WS, Kwok SS, Kwan RY, Lam CF, Tam CK, Lee SO (2015) Malnutrition risk predicts surgical outcomes in patients undergoing gastrointestinal operations: results of a prospective study. Clin Nutr 34(4):679–684. https://doi.org/10.1016/j.clnu.2014.07.012

    Article  PubMed  Google Scholar 

  3. 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. Ann Surg Oncol 25(4):974–983. https://doi.org/10.1245/s10434-018-6342-8

    Article  PubMed  Google Scholar 

  4. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C (2005) Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 82(4):777–783

    Article  CAS  PubMed  Google Scholar 

  5. Abd-El-Gawad WM, Abou-Hashem RM, El Maraghy MO, Amin GE (2014) The validity of Geriatric Nutrition Risk Index: simple tool for prediction of nutritional-relatedcomplication of hospitalized elderly patients. Comparison with Mini Nutritional Assessment. Clin Nutr 33(6):1108–1116. https://doi.org/10.1016/j.clnu.2013.12.005

    Article  PubMed  Google Scholar 

  6. Sze S, Zhang J, Pellicori P, Morgan D, Hoye A, Clark AL (2017) Prognostic value of simple frailty and malnutrition screening tools in patients with acute heart failure due to left ventricular systolic dysfunction. Clin Res Cardiol 106(7):533–541. https://doi.org/10.1007/s00392-017-1082-5

    Article  CAS  PubMed  Google Scholar 

  7. Wang H, Hai S, Zhou Y, Liu P, Dong BR (2018) The Geriatric Nutritional Risk Index predicts mortality in nonagenarians and centenarians receiving home care. Asia Pac J Clin Nutr 27(1):78–83. https://doi.org/10.6133/apjcn.022017.10

    Article  PubMed  Google Scholar 

  8. Yamana I, Takeno S, Shibata R, Shiwaku H, Maki K, Hashimoto T, Shiraishi T, Iwasaki A, Yamashita Y (2015) Is the geriatric nutritional risk index a significant predictor of postoperative complications in patients with esophageal cancer undergoing esophagectomy? Eur Surg Res 55(1–2):35–42. https://doi.org/10.1159/000376610

    Article  PubMed  Google Scholar 

  9. Kubo N, Sakurai K, Tamura T, Toyokawa T, Tanaka H, Muguruma K, Yashiro M, Ohira M (2019) The impact of geriatric nutritional risk index on surgical outcomes after esophagectomy in patients with esophageal cancer. Esophagus 16(2):147–154. https://doi.org/10.1007/s10388-018-0644-6

    Article  PubMed  Google Scholar 

  10. Funamizu N, Nakabayashi Y, Iida T, Kurihara K (2018) Geriatric nutritional risk index predicts surgical site infection after pancreaticoduodenectomy. Mol Clin Oncol 9(3):274–278. https://doi.org/10.3892/mco.2018.1671

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gertsen EC, Brenkman HJF, Seesing MFJ, Goense L, Ruurda JP, van Hillegersberg R, Audit DUGC, (DUCA) Group (2019) Introduction of minimally invasive surgery for distal and total gastrectomy: a population-based study. Eur J Surg Oncol 45(3):403–409. https://doi.org/10.1016/j.ejso.2018.08.015

    Article  CAS  PubMed  Google Scholar 

  12. Sawazaki S, Numata M, Morita J, Maezawa Y, Amano S, Aoyama T, Tamagawa H, Sato T, Oshima T, Mushiake H, Yukawa N, Shiozawa M, Rino Y, Masuda M (2018) Safety of laparoscopic surgery for colorectal cancer in patients with severe comorbidities. Anticancer Res 38(6):3767–3772. https://doi.org/10.21873/anticanres.12659

    Article  PubMed  Google Scholar 

  13. Isani MA, Schlieve C, Jackson J, Elizee M, Asuelime G, Rosenberg D, Kim ES (2018) Is less more? Laparoscopic versus open Ladd's procedure in children with malrotation. J Surg Res 229:351–356. https://doi.org/10.1016/j.jss.2018.04.016

    Article  PubMed  Google Scholar 

  14. Yoshida K, Honda M, Kumamaru H, Kodera Y, Kakeji Y, Hiki N, Etoh T, Miyata H, Yamashita Y, Seto Y, Kitano S, Konno H (2017) Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: a retrospective cohort study based on a nationwide registry database in Japan. Ann Gastroenterol Surg 2(1):55–64. https://doi.org/10.1002/ags3.12054

    Article  PubMed  PubMed Central  Google Scholar 

  15. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20(1):1–19. https://doi.org/10.1007/s10120-016-0622-4

    Article  Google Scholar 

  16. Sobin L, Gospodarowicz M, Wittekind C (eds) (2010) International Union against Cancer (UICC). TNM classification of malignant tumors, 7th edn. Wiley-Blackwell, New York

    Google Scholar 

  17. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  18. Matsumura T, Mitani Y, Oki Y, Fujimoto Y, Ohira M, Kaneko H, Kawashima T, Nishio M, Ishikawa A (2015) Comparison of Geriatric Nutritional Risk Index scores on physical performance among elderly patients with chronic obstructive pulmonary disease. Heart Lung 44(6):534–538. https://doi.org/10.1016/j.hrtlng.2015.08.004

    Article  PubMed  Google Scholar 

  19. Kuo IC, Huang JC, Wu PY, Chen SC, Chang JM, Chen HC (2017) A low geriatric nutrition risk index is associated with progression to dialysis in patients with chronic kidney disease. Nutrients. https://doi.org/10.3390/nu9111228

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wada H, Dohi T, Miyauchi K, Doi S, Naito R, Konishi H, Tsuboi S, Ogita M, Kasai T, Hassan A, Okazaki S, Isoda K, Suwa S, Daida H (2017) Prognostic impact of the geriatric nutritional risk index on long-term outcomes in patients who underwent percutaneous coronary intervention. Am J Cardiol 119(11):1740–1745. https://doi.org/10.1016/j.amjcard.2017.02.051

    Article  PubMed  Google Scholar 

  21. Abd-El-Gawad WM, Abou-Hashem RM, El Maraghy MO, Amin GE (2014) The validity of Geriatric Nutrition Risk Index: simple tool for prediction of nutritional-related complication of hospitalized elderly patients. Comparison with Mini Nutritional Assessment. Clin Nutr 33(6):1108–1116. https://doi.org/10.1016/j.clnu.2013.12.005

    Article  PubMed  Google Scholar 

  22. Poziomyck AK, Weston AC, Lameu EB, Cassol OS, Coelho LJ, Moreira LF (2012) Preoperative nutritional assessment and prognosis in patients with foregut tumors. Nutr Cancer 64(8):1174–1181. https://doi.org/10.1080/01635581.2012.721157

    Article  PubMed  Google Scholar 

  23. Lai CC, You JF, Yeh CY, Chen JS, Tang R, Wang JY, Chin CC (2011) Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis 26(4):473–481. https://doi.org/10.1007/s00384-010-1113-4

    Article  PubMed  Google Scholar 

  24. Ri M, Miyata H, Aikou S, Seto Y, Akazawa K, Takeuchi M, Matsui Y, Konno H, Gotoh M, Mori M, Motomura N, Takamoto S, Sawa Y, Kuwano H, Kokudo N (2015) Effects of body mass index (BMI) on surgical outcomes: a nationwide survey using a Japanese web-based database. Surg Today 45(10):1271–1279. https://doi.org/10.1007/s00595-015-1231-2

    Article  PubMed  Google Scholar 

  25. Chen L, Hasni MS, Jondal M, Yakimchuk K (2017) Modification of anti-tumor immunity by tolerogenic dendritic cells. Autoimmunity 50(6):370–376. https://doi.org/10.1080/08916934.2017.1344837

    Article  CAS  PubMed  Google Scholar 

  26. Bárta I, Smerák P, Polívková Z, Sestáková H, Langová M, Turek B, Bártová J (2006) Current trends and perspectives in nutrition and cancer prevention. Neoplasma 53(1):19–25

    PubMed  Google Scholar 

  27. Márton S, Garai J, Molnár V, Juhász V, Bogár L, Köszegi T, Falusi B, Ghosh S (2011) Kinetics of inflammatory markers following cancer-related bowel and liver resection. Ups J Med Sci 116(2):124–128. https://doi.org/10.3109/03009734.2010.519446

    Article  PubMed  PubMed Central  Google Scholar 

  28. Krzystek-Korpacka M, Matusiewicz M, Diakowska D, Grabowski K, Blachut K, Kustrzeba-Wojcicka I, Terlecki G, Gamian A (2008) Acute-phase response proteins are related to cachexia and accelerated angiogenesis in gastroesophageal cancers. Clin Chem Lab Med 46(3):359–364. https://doi.org/10.1515/CCLM.2008.089

    Article  CAS  PubMed  Google Scholar 

  29. Antonelli M, Kushner I (2017) It's time to redefine inflammation. FASEB J 31(5):1787–1791. https://doi.org/10.1096/fj.201601326R

    Article  CAS  PubMed  Google Scholar 

  30. Patterson BM, Cornell CN, Carbone B, Levine B, Chapman D (1992) Protein depletion and metabolic stress in elderly patients who have a fracture of the hip. J Bone Joint Surg Am 74(2):251–260

    Article  CAS  PubMed  Google Scholar 

  31. Shoji F, Matsubara T, Kozuma Y, Haratake N, Akamine T, Takamori S, Katsura M, Toyokawa G, Okamoto T, Maehara Y (2019) Relationship between preoperative sarcopenia status and immuno-nutritional parameters in patients with early-stage non-small cell lung cancer. Anticancer Res 37(12):6997–7003

    Google Scholar 

Download references

Funding

This study received no external funding.

Author information

Authors and Affiliations

  1. Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan

    Noriyuki Hirahara, Yoshitsugu Tajima, Yusuke Fujii, Shunsuke Kaji, Yasunari Kawabata, Ryoji Hyakudomi, Tetsu Yamamoto & Takahito Taniura

Authors
  1. Noriyuki Hirahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshitsugu Tajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yusuke Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shunsuke Kaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasunari Kawabata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryoji Hyakudomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tetsu Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takahito Taniura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Noriyuki Hirahara.

Ethics declarations

Disclosures

Drs. Noriyuki Hirahara, Yoshitsugu Tajima, Yusuke Fujii, Shunsuke Kaji, Tetsu Yamamoto, Ryoji Hyakudomi, Takahito Taniura, and Yasunari Kawabata have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirahara, N., Tajima, Y., Fujii, Y. et al. Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients. Surg Endosc 35, 1202–1209 (2021). https://doi.org/10.1007/s00464-020-07487-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07487-7

Keywords

Search

Navigation