[The assessment of the nutritional status in patients with a resectable digestive tumor]

Tumoural disease leads to multifactorial cancerous cachexia. There are still few data available on the onset of this syndrome in operable patients, despite the repercussions on prognosis and the indication of nutritional support.

In this prospective study, we are considering the assessment of nutritional status in the light of the Chang protocol in with gastrointestinal tumours patients, as well as the possible differences depending on the location of the tumour, its progress, and the onset of septic complications. With this approach, we attempt to specify the indication of postoperative nutritional support.

The nutritional assessment protocol existing in the Department was reviewed as applied to 105 patients affected by oesophageal, gastric, pancreatic and colo-rectal cancer. This protocol included the ideal weight percentage (%IW), tricipital fold (TSF), arm muscle circumference (AMC), total albumin and lymphocytes (Chang protocol), as well as urea nitrogen. The database used was created in File Maker Pro running on a Macintosh computer and supported by the StatView programme for the statistical analysis of the results.

There were 61 colo-rectal, 18 gastric, 17 oesophageal and 9 pancreatic carcinomas. There was some degree of malnutrition in 52.4% of patients but it was not severe in any case. An outstanding result is the percentage of ideal weight in excess of 100% on average in all of the groups, with little variation in the arm muscle circumference, as is the lower tricipital fold in the oesophageal and pancreatic cases. Albumin was significantly lower in gastric carcinoma cases and lymphocytes showed a correlation with the progress of the tumour and also with the onset of septic complications. The excretion of urea nitrogen did not reveal significant differences. In stages I and II, the patients were normally nourished or with marasmus, so that the only malnutrition found was of the kwashiorkor type and combined with stages III and IV.

There is 52.4% of malnutrition in our surgically resectable digestive oncology patients using the Chang protocol, not susceptible of preoperative renourishment. This is found irregularly depending on the location and stage of the tumour. The total lymphocytes prior to surgery represented an independent variable which correlated with septic complications.