[Relation between preoperative prognostic Onodera's Index and postsurgery complications in the R0 gastric carcinoma...

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Nutrition

Background:

• Asian literature suggests a low prognostic nutritional index (PNI) correlates with higher complication rates after radical gastric cancer surgery.
• Data on this association in Western populations is limited.
• This study investigates the link between preoperative PNI and surgical complications in R0 gastric cancer resection.

Purpose of the Study:

• To determine the relationship between a low preoperative prognostic nutritional index (PNI) and the frequency of surgical complications.
• To assess the association between a low preoperative PNI and the severity of surgical complications.
• To validate these findings in a Western cohort undergoing R0 gastric cancer resection.

Main Methods:

• A retrospective review of 124 patients with R0 gastric cancer resection.
• Patients were categorized based on preoperative prognostic nutritional index (PNI): PNI <45 (low) vs. PNI ≥45.
• Multivariate analysis adjusted for age, ASA score, hemoglobin, pTNM stage, neoadjuvant therapy, and gastrectomy type. Complication severity was graded using the Clavien-Dindo classification.

Main Results:

• Patients with a PNI <45 exhibited a significantly higher complication rate (37.7% vs. 12.7%, OR=4.17, p=0.001), confirmed by multivariate analysis (OR=4.17, p=0.005).
• A low PNI was also associated with a higher rate of severe complications and mortality (20.8% vs. 5.6%, OR=4.39, p=0.011).
• Mild complications occurred in 11.3%, severe in 9.7%, and mortality in 2.4% of all cases.

Conclusions:

• A low preoperative prognostic nutritional index (PNI) is an independent risk factor for complications following R0 gastric cancer resection in Western countries.
• Patients with a PNI <45 experience significantly more severe complications.
• Preoperative PNI assessment is valuable for risk stratification in gastric cancer surgery.