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Ta publikacja jest chroniona prawem autorskim. Dostęp z komputerów Biblioteki Medycznej UJ CM.
Ta publikacja jest chroniona prawem autorskim. Dostęp z komputerów Biblioteki Medycznej UJ CM.

Tytuł: The evaluation of clinical value of parenteral and enteral nutrition in surgical patients' treatment with cancer of digestive system

Abstrakt:

According to the World Report on Cancer presented in 2003 by the International Agency for Research on Cancer (IARC) working inside the WHO, cancer caused the death of 6.2 millions of people in 2000. 5.3 millions of men and 4.7 millions of women suffered from malignant neoplasms. The speed of cancer development is so big that this number might be 50% bigger in 2020 leading to 15 millions of new cases (1). Malignant diseases comprise the second most frequent cause of deaths in Poland (2). Malnutrition is a phenomenon related to cancer diseases of digestive tract inseparably. Literature (49,50-54, 58,59,63,71,93,146,147) shows that prevalence of malnutrition in patients admitted to hospitals is between 30 to 50%. Location of tumor in higher parts of the alimentary tract leads to faster development of hypoalimentation. Shike (75), Szczygiel (76) and Fraczek (16) agree that malnourished patients amount to 80% of all patients with esophagus cancer, 60% stomach cancer and 10 to 15% colon cancer. Malnutrition is diagnosed and treated very rarely though it comprises one of the factors responsible for frequent complications and longer hospitalization. Current research tendencies concentrate on the analysis of malnutrition effects in patients treated surgically and validity of introduction of nutritional therapy. The objective of this work was to evaluate nutrition status of patients with diagnosed cancer of stomach, pancreas and colon before surgery, to describe relation between nutrition status and the radical grade of operation, and also relation of nutrition factors and applied nutritional therapy with frequency of postoperative complications in patients receiving surgical treatment because of cancer of stomach, pancreas and colon. The study utilized clinical records of 915 patients with diagnosed cancer of stomach (n = 282), pancreas (n = 108) and colon (n = 525), who underwent surgery in the First Chair of General Surgery and Clinic of Gastroenterology Surgery Collegium Medicum UJ between 2000 and 2003. Four indicators for nutritional status assessment were chosen; albumin level in blood serum, total number of lymphocytes in 1 cubic millimeter, percentage of body mass loss, and Body Mass Index. Methods of descriptive statistics were used in this study. 95% CI confidence intervals were examined. Mean values were compared with the t Student test. Frequency of events was compared using the χ2 test. Also the analysis of linear correlation and logistic regression were used. Results reaching the significance level p<0.05 were considered as statistically significant. The whole statistics was done using Excel Software. Based on the results from clinical records review a conclusion was made that about 40% of patients with cancer of stomach, pancreas and colon presented elements of malnutrition status on their admission day, and the highest ratio was observed in the groups of patients with stomach and pancreas cancer. The analysis of four chosen nutrition status indicators showed that Body Mass Index was not a reliable indicator of malnutrition of patients with alimentary tract carcinoma. Ratio of malnourished patients, who underwent surgery R0, R1 was lower than those with R2 or nonresection in each studied group. There is a significantly smaller number of patients with elements of malnutrition among those subjected to R0, R1 surgery than R2 and nonresection (p=0.00005). In the pancreas and colon cancer groups these differences are not significant (p=0.08 and p=0.44 respectively). Postoperative complications were observed in each studied group. The biggest ratio of complications concerned the pancreas cancer group (61.11%), then stomach cancer (39.36%) and colon cancer group (37.9%). ; The relation between nutrition status of patients with stomach, pancreas and colon cancer on their admission day with prevalence of postoperative complications were studied using three indicators: percentage body mass loss, albumin level and total number of lymphocytes. It was observed that patients with stomach cancer, with body mass loss (p=0.005) and lower level of albumins (p=0.001) were at bigger risk of postoperative complications. However, patients with colon cancer and higher albumin level before surgery suffered from less frequent postoperative complications (p=0.001). Malnutrition status affected death probability (p=0.01) in this group of patients. More postoperative complications were observed in the groups of malnourished patients with stomach and pancreas cancer. Each group of patients received nutritional therapy. 225(79.8%) patients from the stomach cancer group, 69(63.9%) patients from the pancreas cancer group and 228(43.4%) patients from the colon cancer group received that therapy . The model of nutritional therapy used in this study allowed us to achieve similar ratio of postoperative complications in R0 and R1 surgery independently of nutrition status indicators.

Stopień studiów:

2 - studia doktoranckie

Dyscyplina:

nauki o żywieniu ; chirurgia

Instytucja nadająca tytuł:

Wydział Lekarski

Promotor:

Antoni Czupryna

Data wydania:

2006

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ZB-104247

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Biblioteka Medyczna Uniwersytetu Jagiellońskiego - Collegium Medicum

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Data ostatniej modyfikacji:

11 lut 2020

Data dodania obiektu:

21 lis 2012

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