J.Jpn. Surg. Soc.. 83(1): 66-77, 1982

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Original article

NUTRITIONAL ASSESSMENT OF GASTRIC CANCER PATIENTS: ESTIMATION OF RISK OF POSTOPERATIVE COMPLICATION FROM PREOPERATIVE NUTRITIONAL STATES.

In 143 (phase I) and 73 (phase II) gastric cancer patients the followings were examined preoperatively, weight as percentage of ideal body weight ; weight as percentage of normal pre-cancer body weight (%uswt) ; triceps skinfold thickness ; serum albumin (Alb) ; serum transferrin ; serum iron ; serum zinc (Zn) ; total protein (T.P.) ; mid-arm muscle circumference ; creatinine height index ; total lymphocyte count (Lymph. count) ; PHA skin test ; PPD skin test and age (AGE).
The following results were obtained
(1) Preoperative nutritional parameters tended to be inversely proportional to the clinical stage of gastric cancer, being good for Stage I and proceeding to poor for Stages II, III, IV and the recurrent cases.
(2) Among the 143 phase Ip atients, there were significant differences in AGE, T.P., Alb, %uswt, and Zn between the patients with and without postoperative complications.
(3) From the analysis of preoperative nutritional states and postoperative complications,the index which predicts the risk of postoperative complication was obtained.
Nutritional surgical risk index (NRI)=10.7×Alb+0.0039×Lymph. count+0.11×Zn-0.044×AGE.
Patients were classified as high risk (NRI≦55), and low risk (NRI>60) according to NRI.
(4) The validity of NRI was ascertained by the 73 phase II patients. Significant difference was seen in the incidence of postoperative complications between high risk and low risk patients.
(5) Significant improvement of NRI with preoperative intravenous hyperalimentations reduced postoperative complications greatly in high risk patients.

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