Impact of preoperative nutritional status on postoperative complications in patients undergoing extreme sphincter-preserving surgery following neoadjuvant therapy: a study based on DACCA database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Qinchen ¹ , XIA Zhenman ² , LIN Yuxin ² , Ayizibakezi·Maimutawula ² , TAN Kun ³ ,  WANG Xiaodong ⁴ , LI Li ⁵

1. Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
3. Sichuan Provincial Health Information Center, Chengdu 610041, P. R. China;
4. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R.China;
5. Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WANG Xiaodong, Email: wangxiaodong@wchscu.cn

Keywords：

rectal cancer; neoadjuvant therapy; extreme sphincter-preserving surgery; nutritional risk; postoperative complications; prognosis; DACCA database

DOI：

10.7507/1007-9424.202405058

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Objective To understand the impact of preoperative nutritional status on the postoperative complications for patients with low/ultra-low rectal cancer undergoing extreme sphincter-preserving surgery following neoadjuvant therapy. Methods The patients with low/ultra-low rectal cancer who underwent extreme sphincter-preserving surgery following neoadjuvant therapy from January 2009 to December 2020 were retrospectively collected using the Database from Colorectal Cancer (DACCA), and then who were assigned into a nutritional risk group (the score was low than 3 by the Nutrition Risk Screening 2002) and non-nutritional risk group (the score was 3 or more by the Nutrition Risk Screening 2002). The postoperative complications and survival were analyzed for the patients with or without nutritional risk. The postoperative complications were defined as early-term (complications occurring within 30 d after surgery), middle-term (complications occurring during 30–180 d after surgery), and long-term (complications occurring at 180 d and more after surgery). The survival indicators included overall survival and disease-specific survival. Results A total of 680 patients who met the inclusion criteria for this study were retrieved from the DACCA database. Among them, there were 500 (73.5%) patients without nutritional risk and 180 (26.5%) patients with nutritional risk. The postoperative follow-up time was 0–152 months (with average 48.9 months). Five hundreds and forty-three survived, including 471 (86.7%) patients with free-tumors survival and 72 (13.3%) patients with tumors survival. There were 137 deaths, including 122 (89.1%) patients with cancer related deaths and 15 (10.9%) patients with non-cancer related deaths. There were 48 (7.1%) cases of early-term postoperative complications, 51 (7.5%) cases of middle-term complications, and 17 (2.5%) cases of long-term complications. There were no statistical differences in the incidence of overall complications between the patients with and without nutritional risk (χ²=3.749, P=0.053; χ²=2.205, P=0.138; χ²=310, P=0.578). The specific complications at different stages after surgery (excluding the anastomotic leakage complications in the patients with nutritional risk was higher in patients without nutritional risk, P=0.034) had no statistical differences between the two groups (P>0.05). The survival curves (overall survival and disease-specific survival) using the Kaplan-Meier method had no statistical differences between the patients with and without nutritional risk (χ²=3.316, P=0.069; χ²=3.712, P=0.054). Conclusions From the analysis results of this study, for the rectal cancer patients who underwent extreme sphincter-preserving surgery following neoadjuvant therapy, the patients with preoperative nutritional risk are more prone to anastomotic leakage within 30 d after surgery. Although other postoperative complications and long-term survival outcomes have no statistical differences between patients with and without nutritional risk, preoperative nutritional management for them cannot be ignored.

Citation： XU Qinchen, XIA Zhenman, LIN Yuxin, Ayizibakezi·Maimutawula, TAN Kun, WANG Xiaodong, LI Li. Impact of preoperative nutritional status on postoperative complications in patients undergoing extreme sphincter-preserving surgery following neoadjuvant therapy: a study based on DACCA database. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(7): 815-820. doi: 10.7507/1007-9424.202405058 Copy

1.	Donnelly M, Ryan OK, Ryan ÉJ, et al. Total neoadjuvant therapy versus standard neoadjuvant treatment strategies for the management of locally advanced rectal cancer: network meta-analysis of randomized clinical trials. Br J Surg, 2023, 110(10): 1316-1330.
2.	Yao H, Yang Z, Gao J, et al. Safety and efficacy evaluation of long course neoadjuvant chemoradiotherapy plus tislelizumab followed by total mesorectal excision for locally advanced rectal cancer: short-term results of a multicenter, phase Ⅱ study. J Clin Oncol, 2022, 40 Suppl 16: e15599. doi: 10.1200/JCO.2022.40.16_suppl.e15599.
3.	Wolf JH, Ahuja V, D’Adamo CR, et al. Preoperative nutritional status predicts major morbidity after primary rectal cancer resection. J Surg Res, 2020, 255: 325-331.
4.	Weimann A. Influence of nutritional status on postoperative outcome in patients with colorectal cancer - the emerging role of the microbiome. Innov Surg Sci, 2017, 3(1): 55-64.
5.	Barbosa LR, Lacerda-Filho A, Barbosa LC. Immediate preoperative nutritional status of patients with colorectal cancer: a warning. Arq Gastroenterol, 2014, 51(4): 331-336.
6.	Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003, 22(3): 321-336.
7.	Martínez-Ortega AJ, Piñar-Gutiérrez A, Serrano-Aguayo P, et al. Perioperative nutritional support: A review of current literature. Nutrients, 2022, 14(8): 1601. doi: 10.3390/nu14081601.
8.	Bach SP, Gilbert A, Brock K, et al. Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study. Lancet Gastroenterol Hepatol, 2021, 6(2): 92-105.
9.	Jie B, Jiang ZM, Nolan MT, et al. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition, 2012, 28(10): 1022-1027.
10.	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(3): 235-239.
11.	Deschepper M, Duprez V, Lapauw B, et al. Application of NRS2002 to detect malnutrition in a tertiary care centre: agreement between nurse and dietician’s screening steps and relation with clinical outcomes. Eur J Clin Nutr, 2023, 77(6): 692-697.
12.	Tesar M, Kozusnikova V, Martinek L, et al. Preoperative nutritional support for patients undergoing elective colorectal cancer surgery—does it really work?. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2023, 167(2): 145-151.
13.	Vitaloni M, Caccialanza R, Ravasco P, et al. The impact of nutrition on the lives of patients with digestive cancers: a position paper. Support Care Cancer, 2022, 30(10): 7991-7996.
14.	Sakai A, Iijima H, Ebisumoto K, et al. Prognostic Value of Inflammatory and Nutritional Biomarkers of Immune Checkpoint Inhibitor Treatment for Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck. Cancers (Basel), 2023, 15(7): 2021. doi: 10.3390/cancers15072021.

1. Donnelly M, Ryan OK, Ryan ÉJ, et al. Total neoadjuvant therapy versus standard neoadjuvant treatment strategies for the management of locally advanced rectal cancer: network meta-analysis of randomized clinical trials. Br J Surg, 2023, 110(10): 1316-1330.
2. Yao H, Yang Z, Gao J, et al. Safety and efficacy evaluation of long course neoadjuvant chemoradiotherapy plus tislelizumab followed by total mesorectal excision for locally advanced rectal cancer: short-term results of a multicenter, phase Ⅱ study. J Clin Oncol, 2022, 40 Suppl 16: e15599. doi: 10.1200/JCO.2022.40.16_suppl.e15599.
3. Wolf JH, Ahuja V, D’Adamo CR, et al. Preoperative nutritional status predicts major morbidity after primary rectal cancer resection. J Surg Res, 2020, 255: 325-331.
4. Weimann A. Influence of nutritional status on postoperative outcome in patients with colorectal cancer - the emerging role of the microbiome. Innov Surg Sci, 2017, 3(1): 55-64.
5. Barbosa LR, Lacerda-Filho A, Barbosa LC. Immediate preoperative nutritional status of patients with colorectal cancer: a warning. Arq Gastroenterol, 2014, 51(4): 331-336.
6. Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003, 22(3): 321-336.
7. Martínez-Ortega AJ, Piñar-Gutiérrez A, Serrano-Aguayo P, et al. Perioperative nutritional support: A review of current literature. Nutrients, 2022, 14(8): 1601. doi: 10.3390/nu14081601.
8. Bach SP, Gilbert A, Brock K, et al. Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study. Lancet Gastroenterol Hepatol, 2021, 6(2): 92-105.
9. Jie B, Jiang ZM, Nolan MT, et al. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition, 2012, 28(10): 1022-1027.
10. 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(3): 235-239.
11. Deschepper M, Duprez V, Lapauw B, et al. Application of NRS2002 to detect malnutrition in a tertiary care centre: agreement between nurse and dietician’s screening steps and relation with clinical outcomes. Eur J Clin Nutr, 2023, 77(6): 692-697.
12. Tesar M, Kozusnikova V, Martinek L, et al. Preoperative nutritional support for patients undergoing elective colorectal cancer surgery—does it really work?. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2023, 167(2): 145-151.
13. Vitaloni M, Caccialanza R, Ravasco P, et al. The impact of nutrition on the lives of patients with digestive cancers: a position paper. Support Care Cancer, 2022, 30(10): 7991-7996.
14. Sakai A, Iijima H, Ebisumoto K, et al. Prognostic Value of Inflammatory and Nutritional Biomarkers of Immune Checkpoint Inhibitor Treatment for Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck. Cancers (Basel), 2023, 15(7): 2021. doi: 10.3390/cancers15072021.

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Impact of preoperative nutritional status on postoperative complications in patients undergoing extreme sphincter-preserving surgery following neoadjuvant therapy: a study based on DACCA database

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