2005, Number 3
Predictive value in the subjective global assessment, in the surgical behavior of post-operatory colorectal cancer
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ABSTRACTThe nutritional status of a patient with a malignant colorectal disease (MCD) can affect not only the results of the surgical intervention, but also the extent of the surgical procedure to be carried upon the patient. A working hypothesis was advanced that some patients with MCD in which a potentially curable surgery (resection of the tumor, followed -or not- by restitution of the bowel continuity) would be the treatment of choice, might be derived instead to palliative procedures because of existing nutritional derangement. To prove this hypothesis, 79 patients were recruited among those admitted to the “Hermanos Ameijeiras” Hospital and operated upon after being diagnosed with a MCD, between December 2002 and June 2004. The following indicators were obtained from each patient during the preoperatory workup: Height, current weight, serum albumin. The body mass index (BMI) was calculated in each instance. The subjective global assessment form [Detsky AS, McLaughlin JR, Baker JP et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987:11:8-13] was administered to each of the patients following admission, according to the procedure drafted by the local Nutritional Support Group, and conducted by one of the members of the Group. The acting surgeons were unaware of the SGA results. The nutritional status of the patient was independently established after a BMI value ‹ 18.5 kg/m2 and/or a serum albumin value ‹ 35 g/L. Associations between: (1) SGA score and the nutritional status of the patient, (2) SGA score and the surgical conduct adopted (Potentially curable/Palliative), (3) SGA score and the occurrence of post-surgical complications, and (4) SGA score and the occurrence of post-surgical deaths, were assessed. Upon concluding this study the following results were obtained: (1) SGA score was not associated with the nutritional status of the patient; (2) Surgical conduct was associated with SGA score: potentially curable surgeries were more frequent among patients scoring A after SGA administration (64.2%). In contrast, palliative procedures were prevalent among patients with SGA scores B or C (66.7%) (p ‹ 0.05); (3) SGA score was not associated with the occurrence of post-surgical complications; (4) SGA score was not associated with the occurrence of post-surgical deaths. Nutritional derangement could act as a factor conditioning what surgical conduct to perform in a patient with MCD.
Canter RJ, Williams NN. Surgical treatment of colon and rectal cancer. Hematol Oncol Clin North Am 2002; 16: 907-26.
Detsky AS, McLaughiln JR, Baker JP et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987; 11: 8-13.
Hirsch S, de Obaldia N, Peterman M et al. Subjective global assessment of nutritional status: further validation. Nutrition 1991; 7: 35-7.
Coppini LZ, Waitzberg DL, Ferrini MT et al. Comparison of the subjective global nutrition assessment x objective nutrition, evaluation. Rev Assoc Med Bras 1995; 41: 6-10.
Detsky AS, Baker JP, O’Rourke K et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal survey. JPEN J Parenter Enteral Nutr 1987; 11: 440-6.
Fleiss JL. Statistical methods for rates and proportions. John Wiley and Sons New York 1981.
Martínez CH, Santana PS. Manual de Procedimientos Bioestadísticos. Editorial de Ciencias Médicas. La Habana: 1990.
Gómez C, Luengo LM, Cos AI et al. Subjective global assessment in neoplastic patients. Nutrición Hospitalaria (España) 2003; 18: 353-7.
Bowers JM, Dols CL. Subjective global assessment in HIV-infected patients. J Assoc Nurses AIDS Care 1996; 7: 83-9.
Hasse J, Strong S, Gorman MA, Liepa G. Subjective global assessment: alternative nutrition-assessment technique for liver-transplant candidates. Nutrition 1993; 9: 339-43.
Enia G, Sicuso C, Alati G, Zoccali C. Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant 1993; 8: 1094-8.
Barbosa SMC, de Barros AJ. Subjective nutrition assessment: Part 1-A review of its validity after two decades of use. Arq Gastroenterol (Brasil) 2002; 39: 181-7.
Barbosa SMC, de Barros AJ. Subjective global assessment: Part 2. Review of its adaptations and utilization in different clinical specialties. Arq Gastroenterol (Brasil) 2002; 39: 248-52.
McMillan DC, Waters WS, O’Gorman P et al. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer 2001; 39: 210-3.
Gupta D, Lammersfeld CA, Vashi PG et al. Prognostic significance of subjective global assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr 2004 [Publicación electrónica precedente a la aparición en papel].
Basse L, Hjort JD, Billesbolle P et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000; 32: 51-7.
Keswani SG, Boyle MJ, Maxwell JP 4th et al. Colorectal cancer in patients younger than 40 years of age. Am Surg 2002; 68: 871-6.
Watters JM. Surgery in the elderly. Can J Surg 2002; 45: 104-8.
Termuhlen PM, Kemeny MM. Surgery in the older patient. Oncology (Huntingt) 2002; 16: 183-9.
Waters DL, Baumgartner RN, Garry PJ. Sarcopenia: current perspectives. J Nutr Health Aging 2000; 4: 133-9.