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Previous issue date: 2013-06-07 / Introduction: Malnutrition adversely affects the patients who have gone through oncological surgery, leading to greater surgical morbidity and mortality. However, there is still the need to establish a golden rule for nutritional evaluation as a predictive factor in the morbimortality of these patients. The objective of this study was to analyze and compare the capacity of nutritional assessment methods in the prognosis of complications in patients submitted to gastric cancer gastrectomy.
Methods: The method used was the prospective observational study of 66 gastric cancer patients who were submitted to gastrectomies. Assessment was made through the following nutritional evaluation methods: Subjective Global Assessment of Nutritional Status (SGA), Objective Nutritional Evaluation (ONE) and the Nutritional Risk Index (NRI). Beyond the surgical risk by means of a prognostic index of Sheffield (SPI). The results were compared to surgical morbimortality, total duration of hospitalization and stay in the Intensive Care Unit (ICU). The stage of the disease was based on the American classification for gastric cancer. For the estatiscal analyses were used Kaplan-Meier method, log-rank test, t test or non-parametric Kruskal-Wallis test. Associations were evaluated by the Pearson chi-square test, or by the Fisher exact test whenever recommended.
Results: Malnutrition was present in 80.7%, 66.7% and 85% in the SGA, ONE and NRI, respectively. The SPI demonstrated a high surgical risk in 92% of patients. There was a slight agreement in the SGA and NRI (Kappa=0.30). The SGA results showed that the malnourished patient (p<0.05) remained in the hospital for a longer period time. Most of the patients (62.9%) were at an advanced stage of the disease which was associated to an increase in complications (p<0.01) and isolated cases of pneumonia that were associated with lymphopenia (p<0.05). Conclusion: The SGA and the NRI were the methods that had the closest agreement in the results. The SGA was the only method that demonstrated an association between malnutrition and longer stay in hospital. Pneumonia was observed in the presence of advanced tumors and lymphopenia, thus increasing the duration of hospitalization and stay in the ICU (p<0.05). / Introdução: A desnutrição afeta adversamente o paciente cirúrgico oncológico, levando-o a maiores morbidades e mortalidade operatórias. Porém, ainda há necessidade de se estabelecer um padrão ouro de avaliação nutricional como fator preditivo de morbimortalidade nesses pacientes. O objetivo deste estudo foi analisar e comparar a capacidade dos métodos de avaliação nutricional no prognóstico de complicações de pacientes submetidos a gastrectomias por câncer gástrico. Métodos: Estudo observacional prospectivo envolvendo 66 pacientes com câncer gástrico e submetidos a gastrectomias. Foram analisados os métodos de avaliação nutricional subjetiva global (ANSG), avaliação nutricional objetiva (ANO) e o índice de risco nutricional (IRN), além do risco cirúrgico por meio do índice prognóstico de Sheffield (IPS). Os resultados foram comparados com a morbimortalidade cirúrgica, tempo de internação total e em UTI. O estadio da doença foi obtido pela classificação americana para câncer gástrico. Resultados: A desnutrição esteve presente em 80,7%, 66,7% e 85% nas ANSG, ANO e IRN, respectivamente. O IPS demonstrou alto risco cirúrgico em 92% dos pacientes. Houve concordância leve entre a ANSG e IRN (Kappa=0,30). A ANSG demonstrou maior tempo de internação hospitalar nos desnutridos (p<0,05). A maioria dos pacientes (62,9%) apresentaram-se com estágio avançado e associado à maior incidência de complicações (p<0,01) e isoladamente a pneumonia esteve associada com a linfopenia (p<0,05). Conclusão: ANSG e o IRN foram os métodos que tiveram uma concordância mais próxima. A ANSG foi o único método que demonstrou associação entre desnutrição e maior tempo de internação hospitalar. A pneumonia foi observada no tumor avançado e na presença de linfopenia, aumentando os dias de internação hospitalar e em UTI (p<0,05).
| Identifer | oai:union.ndltd.org:IBICT/oai:localhost:tede/179 |
| Date | 07 June 2013 |
| Creators | Silva, Luciana de Souza Penhalbel |
| Contributors | Borim, Aldenis Albaneze, Basile, Livia Gussoni, Guimarães, Sergio Mussi |
| Publisher | Faculdade de Medicina de São José do Rio Preto, Programa de Pós-Graduação em Ciências da Saúde, FAMERP, BR, Medicina Interna; Medicina e Ciências Correlatas |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da FAMERP, instname:Faculdade de Medicina de São José do Rio Preto, instacron:FAMERP |
| Rights | info:eu-repo/semantics/openAccess |
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