Influence of preoperative short-term parenteral nutrition support on clinical prognosis of radical
gastrectomy for patients with gastric cancer: A single-center propensity score matching analysis
SHEN Ningzhe1, LIU Shengqun1, QIAN Xinyan1, ZHANG Junhao1, HUANG Zhenxuan1, YANG Xinxin2, CHEN Hao1, 3,CHEN Xiaodong1, 3.
1.The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou 325035, China; 2.Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China; 3.Department of Gastrointestinal Surgery, the First
Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
SHEN Ningzhe,LIU Shengqun,QIAN Xinyan, et al. Influence of preoperative short-term parenteral nutrition support on clinical prognosis of radical
gastrectomy for patients with gastric cancer: A single-center propensity score matching analysis[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2024, 54(5): 345-354.
Abstract：Objective: To investigate the effect of short-term (1-6 days) preoperative parenteral nutrition (PN) support on postoperative complications and overall survival (OS) in patients undergoing radical surgery for gastric cancer. Methods: The research retrospectively collected clinical data from 862 patients who underwent radical surgery for gastric cancer at the First Affiliated Hospital of Wenzhou Medical University from July 2014 to February 2019. According to whether or not they received preoperative short-term PN support, the patients were categorized into the non-PN group and the PN group. Following 1:1 propensity score matching (PSM),the two groups of patients were compared in baseline characters, postoperative complications, and OS before and after PSM using inter-group comparisons, multivariate analysis and subgroup analysis. Results: A total of 358 pairs of patients were successfully matched. The hospitalization cost of the PN group was significantly higher than that of the non-PN group (P<0.001), whereas the length of postoperative hospital stay (LOS) and the readmission rate within 30 days were similar between the two groups (both P>0.05). There was no significant difference in the rates of overall postoperative complications, infectious and noninfectious complications between the two groups (all P>0.05). The results of logistic regression analysis showed that Charlson comorbidity index (CCI) 2-6 (OR=2.206, 95%CI=1.391-3.499, P=0.003) and Roux-en-Y digestive tract reconstruction modality (OR=1.810, 95%CI=1.189-2.756, P=0.005) were independent risk factors for postoperative complications,and laparoscope surgery (OR=0.637, 95%CI=0.424-0.955, P=0.029) was an independent protective factor for postoperative complications. The results of the subgroup analysis showed that none of the short-term preoperative PN support was beneficial for postoperative complications (all P>0.05). The survival analysis results showed that the difference in postoperative OS between the two groups was not statistically significant (P>0.05). The results of Cox regression analysis showed that age≥70 years (HR=1.412, 95%CI=1.060-1.881, P=0.018), Rouxen-Y digestive tract reconstruction mode (HR=1.776, 95%CI=1.281-2.462, P<0.001), combined organ resection (HR=1.784, 95%CI=1.157-2.750, P=0.009), and TNM stages II (HR=2.176, 95%CI=1.321-3.587, P<0.001) and III (HR=4.575, 95%CI=3.015-6.942, P<0.001) were independent risk factors for postoperative OS. Subgroup analysis showed that no short-term preoperative PN support benefited postoperative OS (all P>0.05).Conclusion: Preoperative short-term PN support cannot significantly improve the clinical prognosis of gastric cancer patients and thus PN is not to be recommended for patients able to tolerate oral feeding.
