Abstract
Background
Patients with gastrointestinal cancer have a higher risk of malnutrition and postoperative infection.
Objective
To investigate the nutritional status of patients with gastrointestinal cancers and factors for postoperative infections.
Method
Based on the nutritional risk status, 294 patients with gastrointestinal tumours were divided into a nutritional risk group and a non-nutritional risk group, and the differences between the two groups were compared.
Results
Among the included patients, 128 were at preoperative nutritional risk (43.54%); there were significant differences between the two groups in terms of age (66.25 ± 11.73 vs. 58.36 ± 10.41 years, P < 0.001), percentage of gastric cancers (39.84% vs. 28.92%, P = 0.049), percentage of stage IV tumours (60.16% vs. 45.18%, P = 0.011), total protein (64.90 ± 6.82 vs. 67.21 ± 7.41 g/L, P = 0.007), albumin (38.32 ± 4.74 vs. 41.61 ± 5.10 g/L, P < 0.001) and haemoglobin (112.72 ± 22.63 vs. 125.11 ± 22.79 g/L, P < 0.001). Multivariate logistic regression analysis showed that risk factors for postoperative infections in patients included age ≥ 60 years (odds ratio [OR] = 2.266 95%CI = 1.357–4.134), Nutrition Risk Screening (NRS)-2002 score ≥ 3 (OR = 2.183, 95%CI = 1.218–4.102), alcohol history (OR = 2.505, 95%CI = 1.370–4.683), comorbid diabetes mellitus (OR = 2.110, 95%CI = 1.381–4.023) and surgical time ≥ 6 h (OR = 2.446, 95%CI = 1.359–4.758).
Conclusion
Patients with gastrointestinal cancers are at high incidence of preoperative nutritional risk, and those with an NRS-2002 score of > 3, history of alcohol consumption and surgical time of > 6 h have a higher risk of postoperative infections.
Keywords: patients with gastrointestinal cancers, nutritional risk, postoperative infections
Introduction
The World Health Organization reports cancer as the second leading cause of death worldwide. Approximately one-sixth of the population die of cancer, of which colorectal cancer and gastric cancer are the third and fourth most common fatal malignant tumours, respectively [1]. In 2018, colorectal cancer accounted for 10.0% and gastric cancer for 5.7% of the new cases of tumours, with colorectal cancer accounting for 9.0% of tumour deaths and gastric cancer for 8.2% [2]. Compared with patients with non-digestive system tumours, nutritional risk is more common in patients with digestive system tumours [3]. The growth of tumours affects the normal digestive function of the gastrointestinal tract. Abnormal tumour nutrient metabolism, anorexia and other factors further affect the nutritional status of patients with gastrointestinal tumours. In digestive system tumours, the incidence of nutritional risk in patients with gastric cancer is 59.6%, followed by the incidence of nutritional risk in patients with colorectal cancer at 49.3% [4]. At present, the ideal treatment for gastrointestinal cancer is surgery-based comprehensive treatment [5]. Surgical treatment will further affect the nutritional status of patients, especially those with poor preoperative nutritional status. Postoperative poor recovery of gastrointestinal function, postoperative stress and other problems lead to postoperative nutritional deficiency [6–8]. Postoperative nutritional deficiency leads to higher surgery-related complications [9].
Postoperative infection is one of the common postoperative complications in patients with gastrointestinal tumours, and the incidence is high. It brings secondary damage to the patient and prolongs the length of hospital stay. Furthermore, it increases the difficulty of postoperative management of patients for medical staff, and even has a certain impact on the quality of medical care. The study by Martos-Benítez et al. [10] showed that 14.2% of cancer patients have postoperative infections. Common postoperative infections in patients with gastrointestinal tumours include abdominal infection, surgical incision infection, pulmonary infection and urinary tract infection [11].
At present, there exist reports on risk factors related to postoperative infection in patients with gastrointestinal tumours. However, there are relatively few studies on the big data related to the postoperative infection and the nutritional status of patients, and the research is mostly limited to the comparison of postoperative infection in patients with different nutritional support methods. Therefore, this study not only explores the nutritional status of patients with gastrointestinal tumours but also analyses the factors that may cause postoperative infection, providing a scientific basis for the prevention and control of postoperative infection in patients with gastrointestinal tumours.
Study participants and methods
Participants
Two hundred ninety-four patients with gastrointestinal cancers admitted to TISCO General Hospital between January 2022 and December 2022 were selected as the participants, and their clinical data were retrospectively analysed. Based on the 2002 Nutritional Risk Screening scale (NRS-2002), the patients were divided into the nutritional risk group (n = 128) and the non-nutritional risk group (n = 166). The inclusion criteria were as follows: patients (1) who met the preoperative diagnostic criteria for gastrointestinal cancers by pathological examination; (2) aged over 18 years; (3) with complete admission nutritional risk screening data; (4) who met the surgical indications and underwent surgery, and who received neoadjuvant chemotherapy before operation; and (5) with complete clinical records. The exclusion criteria were as follows: patients (1) with severe preoperative infections; (2) with serious comorbid pathology (history of myocardial infarction, stroke, poorly controlled hypertension insulin-dependent diabetes mellitus); (3) who died during the perioperative period; and (4) with an Eastern Cooperative Oncology Group score of < 3. The study was approved by the Ethics Committee of TISCO General Hospital (ethical batch number: K202406). All patients enrolled in the study signed an informed consent form.
Study methods
General data
A general data sheet of the patients was developed by reviewing the literature and included the following. (1) Age, gender, smoking history, alcohol history (consuming alcohol > 1 time per week in the past 1 year), presence of comorbid diabetes mellitus, tumour location, tumour staging and time of surgery. Tumour staging was performed with reference to the 8th edition of TNM staging criteria issued by the International Union Against Cancer and the American Joint Committee on Cancer published in 2016 and implemented in 2018. (2) Laboratory indicators (within 48 h of admission): total protein (TP), serum albumin (ALB) and haemoglobin (Hb).
Nutritional status
The NRS-2002 scale was used to screen for nutritional risk [12]. The scale consists of three parts: impaired nutritional status score, disease severity score and age score. The first two parts include three grades of 1–3 points, and the highest score is taken according to the scoring criteria. The final score is the sum of three items, up to 7 points. If the final score is > 3 points, it is considered to indicate nutritional risk.
Postoperative infections
Postoperative infections of patients were assessed according to the Diagnostic Criteria for Hospital Infections issued in 2001 [13]. Data on the incidence of infection complications were collected as the postoperative infection group on the 3rd, 5th, 7th, 30th and 90th day after operation and on the day of discharge.
Statistical analysis
All data in this study were statistically processed using SPSS 26.0 statistical software (IBM, Armonk, NY, USA). Measurement data satisfying normality were expressed as mean ± standard deviation (x ± s), and a t-test was used for comparison of differences between groups. Count data were expressed as (n[%]), and differences between groups were compared using the chi-square (χ2) test. Logistic regression analysis was used for multifactor analysis, with the test level set at α = 0.05.
Results
General data of patients
A total of 294 patients with gastrointestinal cancers admitted to our hospital between January 2022 and December 2022 were recruited, of which 158 (53.74%) were men and 136 (46.26%) were women, with a mean age of 62.25 ± 11.21 years. Among them, there were 99 cases (33.67%) of stage I–III gastric tumours, 43 cases (14.63%) of stage I–III colorectal tumours and 152 cases (51.70%) of stage IV colorectal tumours. In terms of surgery, 30 patients underwent distal gastrectomy, 69 patients underwent total gastrectomy, 104 patients underwent right hemicolectomy and 91 patients underwent low anterior resection. Moreover, 181 (61.56%) patients had a smoking history and 113 (38.44%) had no history of smoking, 130 (44.22%) patients had an alcohol history and 164 (55.78%) had no alcohol history, 34 (11.56%) patients had comorbid diabetes mellitus and 103 (35.03%) cases involved a surgical time of > 6 h. Finally, TP, ALB and Hb levels were 66.05 ± 7.13, 39.95 ± 4.95 and 118.91 ± 22.74 g/L, respectively.
Analysis of the nutritional status of patients with gastrointestinal cancers
As shown in Table 1, the 294 patients were categorised into the nutritional risk group (n = 128) and the non-nutritional risk group (n = 166) based on NRS-2002 scale measurements. There were statistically significant differences between the two groups in terms of age (66.25 ± 11.73 vs. 58.36 ± 10.41 years, t = 6.114, P < 0.001), percentage of gastric cancers (39.84% vs. 28.92%, χ2 = 3.864, P = 0.049), percentage of stage IV tumours (60.16% vs. 45.18%, χ2 = 6.491, P = 0.011), TP (64.90 ± 6.82 vs. 67.21 ± 7.41 g/L, t = 2.737, P = 0.007), ALB (38.32 ± 4.74 vs. 41.61 ± 5.10 g/L, t = 5.691, P < 0.001) and Hb (112.72 ± 22.63 vs. 125.11 ± 22.79 g/L, t = 4.641, P < 0.001).
Table 1.
Analysis of the nutritional status of patients with gastrointestinal cancers
| Item | Nutritional risk group (n = 128) | Non-nutritional risk group (n = 166) | t/χ2 | P | |
|---|---|---|---|---|---|
| Gender [cases(%)] | Male | 70(54.69) | 88(53.01) | 0.082 | 0.775 |
| Female | 58(45.31) | 78(46.99) | |||
| Age (years) | 66.25 ± 11.73 | 58.36 ± 10.41 | 6.114 | <0.001 | |
| Tumor site [cases(%)] | Stomach | 51(39.84) | 48(28.92) | 3.864 | 0.049 |
| Colorectum | 77(60.16) | 118(71.08) | |||
| Tumor stage [cases(%)] | Stage IV | 77(60.16) | 75(45.18) | 6.491 | 0.011 |
| Stage I-III | 51(39.84) | 91(54.82) | |||
| Smoking history [cases(%)] | Yes | 81(63.28) | 100(60.24) | 0.282 | 0.595 |
| No | 47(36.72) | 66(39.76) | |||
| Alcohol history [cases(%)] | Yes | 59(46.09) | 71(42.77) | 0.323 | 0.570 |
| No | 69(53.91) | 95(57.23) | |||
| Comorbid diabetes mellitus [cases(%)] | Yes | 14(10.94) | 20(12.05) | 0.087 | 0.768 |
| No | 114(89.06) | 146(87.95) | |||
| Surgical time [cases(%)] | ≥ 6 h | 50(39.06) | 53(31.93) | 1.616 | 0.204 |
| <6 h | 78(60.94) | 113(68.07) | |||
| Total protein (g/L) | 64.90 ± 6.82 | 67.21 ± 7.41 | 2.737 | 0.007 | |
| Albumin (g/L) | 38.32 ± 4.74 | 41.61 ± 5.10 | 5.691 | <0.001 | |
| Hemoglobin (g/L) | 112.72 ± 22.63 | 125.11 ± 22.79 | 4.641 | <0.001 |
Postoperative infection sites of patients with gastrointestinal cancers
As shown in Table 2 and 69 patients developed postoperative infections with sites including the respiratory tract, surgical incision, intra-abdominal tissue, blood, digestive tract and urinary tract. Among them, respiratory tract infection was the most frequent, accounting for 49.28%, followed by surgical incision infection (17.39%), intra-abdominal tissue (11.59%) and blood infection (8.70%).
Table 2.
Infection site distribution and composition ratio
| Infection site | Number of infected cases (n = 69) | Composition ratio (%) |
|---|---|---|
| Respiratory tract (cases) | 34 | 49.28 |
| Surgical incision (cases) | 12 | 17.39 |
| Intra-abdominal tissue (cases) | 8 | 11.59 |
| Blood (cases) | 6 | 8.70 |
| Digestive tract (cases) | 5 | 7.25 |
| Urinary tract (cases) | 3 | 4.35 |
| Other sites (cases) | 1 | 1.45 |
Univariate analysis of postoperative infections in patients with gastrointestinal cancers
As shown in Table 3, postoperative infections occurred in 69 patients and were associated with age ≥ 60 years (63.95% vs. 78.26%, χ2 = 5.154, P = 0.023), alcohol history (44.22% vs. 65.22%, χ2 = 9.870, P = 0.002), comorbid diabetes mellitus (11.56% vs. 23.19%, χ2 = 6.357, P = 0.012), surgical time ≥ 6 h (35.03% vs. 59.42%, χ2 = 13.886, P<0.001) and NRS-2002 score ≥ 3 (43.54% vs. 69.57%, χ2 = 15.157, P<0.001), with statistically significant differences.
Table 3.
Univariate analysis of postoperative infections in patients with gastrointestinal cancers
| Item | Number of investigated cases (n = 294) | Number of infected cases (n = 69) | χ2 | P | |
|---|---|---|---|---|---|
| Gender [cases(%)] | Male | 158(53.74) | 36(52.17) | 0.055 | 0.814 |
| Female | 136(46.26) | 33(47.83) | |||
| Age (years) | ≥ 60 | 188(63.95) | 54(78.26) | 5.154 | 0.023 |
| <60 | 106(36.05) | 15(21.74) | |||
| Tumor site [cases(%)] | Stomach | 99(33.67) | 23(33.33) | 0.003 | 0.957 |
| Colorectum | 195(66.33) | 46(66.67) | |||
| Tumor stage [cases(%)] | Stage IV | 152(51.70) | 38(55.07) | 0.255 | 0.614 |
| Stage I-III | 142(48.30) | 31(44.93) | |||
| Surgery type | distal gastrectomy | 30(10.20) | 9(13.04) | ||
| total gastrectomy | 69(23.47) | 13(18.84) | |||
| right colectomy | 104(35.37) | 26(37.68) | 1.037 | 0.792 | |
| low anterior resection | 91(30.96) | 21(30.43) | |||
| Smoking history [cases(%)] | Yes | 181(61.56) | 36(52.17) | 2.050 | 0.152 |
| No | 113(38.44) | 33(47.83) | |||
| Alcohol history [cases(%)] | Yes | 130(44.22) | 45(65.22) | 9.870 | 0.002 |
| No | 164(55.78) | 24(34.78) | |||
| Comorbid diabetes mellitus [cases(%)] | Yes | 34(11.56) | 16(23.19) | 6.357 | 0.012 |
| No | 260(88.44) | 53(76.81) | |||
| Surgical time [cases(%)] | ≥ 6 h | 103(35.03) | 41(59.42) | 13.886 | <0.001 |
| <6 h | 191(64.97) | 28(40.58) | |||
| Total protein (g/L) | ≥ 63 | 213(72.45) | 48(69.57) | 0.230 | 0.632 |
| <63 | 81(27.55) | 21(30.43) | |||
| Albumin (g/L) | ≥ 35 | 249(84.69) | 53(76.81) | 2.484 | 0.115 |
| <35 | 45(15.31) | 16(23.19) | |||
| Hemoglobin (g/L) | ≥ 115 (female) or 130 (male) | 170(57.82) | 39(56.52) | 0.039 | 0.844 |
| < 115 (female ) or 130 (male) | 124(42.18) | 30(43.48) | |||
| NRS 2002 [cases(%)] | ≥ 3 | 128(43.54) | 48(69.57) | 15.157 | <0.001 |
| <3 | 166(56.46) | 21(30.43) |
Multivariate analysis of postoperative infections in patients with gastrointestinal cancers
Taking postoperative infections in patients with gastrointestinal cancers as dependent variables (0 = not occurred, 1 = occurred), the items that showed positive results in the above univariate analysis were subjected to multivariate analysis with the following values: age ≥ 60 years (0 = no, 1 = yes), alcohol history (0 = no, 1 = yes), comorbid diabetes mellitus (0 = no, 1 = yes), surgical time ≥ 6 h (0 = no, 1 = yes) and NRS-2002 score ≥ 3 (0 = no, 1 = yes). Variables were included using an ‘enter’ method, and the results are shown in Table 4. Age ≥ 60 years (odds ratio [OR] = 2.266, 95%CI = 1.357–4.134), NRS-2002 score ≥ 3 (OR = 2.183, 95%CI = 1.218–4.102), alcohol history (OR = 2.505, 95%CI = 1.370 ~ 4.683), comorbid diabetes mellitus (OR = 2.110, 95%CI = 1.381–4.023) and surgical time ≥ 6 h (OR = 2.446, 95%CI = 1.359–4.758) were independent influencing factors for postoperative infection in patients with gastrointestinal cancers, the final model has statistical significance (P < 0.05).
Table 4.
Multivariate Logistic analysis of postoperative infections in patients with gastrointestinal cancers
| Relevant factors | Standard error | Wald χ2 | P | OR value | 95%CI |
|---|---|---|---|---|---|
| Age ≥ 60 years | 0.289 | 6.607 | 0.003 | 2.266 | 1.357 ~ 4.134 |
| NRS 2002 score ≥ 3 | 0.341 | 6.282 | 0.002 | 2.183 | 1.218 ~ 4.102 |
| Alcohol history | 0.334 | 7.315 | 0.005 | 2.505 | 1.370 ~ 4.683 |
| Comorbid diabetes mellitus | 0.325 | 5.689 | 0.024 | 2.110 | 1.381 ~ 4.023 |
| Length of surgery ≥ 6 h | 0.335 | 7.351 | 0.006 | 2.446 | 1.359 ~ 4.758 |
Discussion
The incidence of preoperative nutritional risk in this study was 43.54%. Other studies have returned figures of 34.3–79.5% [14, 15]. By analysing the influencing factors of postoperative nutritional status and infection status in patients with gastric cancer, it was found that advanced age, drinking history, diabetes comorbidity, operation time and NRS-2002 score ≥ 3 were risk factors for postoperative infection in patients with gastrointestinal cancer.
The age difference between the nutritional risk group and the non-nutritional risk group was statistically significant. Elderly patients (aged > 60 years) with gastrointestinal cancer were prone to nutritional risk. Therefore, while controlling and preventing disease progression in elderly patients, medical staff should also advise them to eat a high-energy-density diet that is easier to digest and absorb [16, 17]. In addition, the tumour location between the nutritional risk group and the non-nutritional risk group was also different, which may be closely related to the anatomical location of the digestive tract. The incidence of nutritional risk in patients with gastric cancer is much higher than that in patients with colorectal cancer [18]. Patients with stage IV gastrointestinal cancers were prone to have symptoms of gastrointestinal obstruction, such as dysphagia, feeding obstruction, nausea, vomiting and abdominal pain, resulting in higher nutritional risk.
In this study, 69 cases of postoperative infection occurred in 294 patients with gastrointestinal tumours. Among them, respiratory tract infection was the first site of infection, accounting for 49.28%, which was consistent with other reports in the literature [19]. The reason for this may be related to tracheal intubation anaesthesia; the condition requires an indwelling gastric tube, destroys the throat mucosa, affects the cough and makes the respiratory secretions not easy to discharge, leading to pulmonary infection. The older the age of patients with gastrointestinal cancer is, the greater the possibility of postoperative infection [20]. This may be related to factors such as decreased nutrient absorption and metabolic capacity, increased risk of malnutrition and impaired immune function. Elderly patients are often accompanied by other chronic diseases. Patients with a preoperative NRS-2002 score of > 3 have a higher risk of postoperative infection, and patients with preoperative nutritional risk will have their nutritional status further affected. Furthermore, during the period of continuous deterioration of postoperative nutritional status, the patient’s resistance to infection is weakened [21]. The patients in this study with a history of drinking have a greater risk of postoperative infection. Amri R et al. [22] found that the postoperative infection rate of patients with alcoholism or drinking history was higher than that of patients without drinking history. Alcohol suppression intervention for patients with high daily alcohol consumption may reduce the incidence of postoperative infection [23]. Prolonging the operation time will also increase the possibility of infection. Long-term exposure of abdominal organs and wounds to the outside air increases the possibility of infection caused by external microorganisms invading the wound [24]. Diabetes is an important risk factor for postoperative infection in patients with gastric cancer. Available evidence shows that stricter postoperative blood glucose control can better reduce the incidence of postoperative infection compared with routine blood glucose control [25]. In addition, the presence of diabetes can also lead to a decrease in fibroblast production and a decrease in the rate of wound healing, thereby increasing the likelihood of wound infection [26].
This study has some limitations. First, there was selection bias in the recruitment of the participants in this study, meaning the scope of the application of the findings is smaller. Second, factors affecting nutritional status and postoperative infections in patients with gastrointestinal cancers were not adequately covered; for example, factors such as treatment regimen and length of hospital stay were not considered. To address this, large-sample, multicentre studies should be conducted to provide a more robust basis.
Conclusion
Patients with gastrointestinal cancers have a high incidence of preoperative nutritional risk, and those with nutritional risk are also prone to postoperative infections. For this reason, enhanced perioperative nutritional management of patients should be provided by clinical staff, and attention should also be paid to the situation of postoperative infections in patients in view of taking appropriate preventive measures against the risk factors of postoperative infections.
Author contributions
Yang ZY and Yang F made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Data availability
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki and approved by the Research Ethics Committee of General hospital of TISCO (ethical batch number: K202406), and informed consent was obtained from all participants. All methods were carried out in accordance with relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Clinical trial number
Not applicable.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Shah SC, Itzkowitz SH. <ArticleTitle Language=“En”>Colorectal Cancer in Inflammatory Bowel Disease: mechanisms and management. Gastroenterology. 2022;162(3):715–e7303. 10.1053/j.gastro.2021.10.035. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, Znaor A, Bray F. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144(8):1941–53. 10.1002/ijc.31937. Epub 2018 Dec 6. PMID: 30350310. [DOI] [PubMed] [Google Scholar]
- 3.He F, Wang LL, Meng XS, Wu Y, Ye LJ, Zhang PH. Nutritional status of patients with tumor and its effect on clinical outcomes. Electron J Metabolism Nutr Cancer. 2016;3(3):166–9. 10.16689/j.cnki.cn11-9349/r.2016.03.009. [Google Scholar]
- 4.Lin L, Zhang JC, Xie F, Peng F, Huang XM. Application of Nutritional Risk Screening 2002 and Patient-generated Subjective Global Assessment in Nutritional Assessment Among Digestive Tumor Patients. Food Nutr China. 2018;24(3):78–82. 10.3969/j.issn.1006-9577.2018.03.018. [Google Scholar]
- 5.Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19. 10.1007/s10120-016-0622-4. Epub 2016 Jun 24. PMID: 27342689; PMCID: PMC5215069. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Shpata V, Prendushi X, Kreka M, Kola I, Kurti F, Ohri I. Malnutrition at the time of surgery affects negatively the clinical outcome of critically ill patients with gastrointestinal cancer. Med Arch. 2014;68(4):263–7. 10.5455/medarh.2014.68.263-267. Epub 2014 Jul 31. PMID: 25568549; PMCID: PMC4240570. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Zheng X, Ruan X, Wang X et al. Bayesian Diagnostic Test Evaluation and True Prevalence Estimation of Malnutrition in Gastric Cancer Patients. Clin Nutr ESPEN. 2024; 59:436 – 43. 10.1016/j.clnesp.2023.12.019. PMID: 38220406. [DOI] [PubMed]
- 8.Zuo J, Zhou D, Zhang L et al. Phase Angle - a Screening Tool for Malnutrition, Sarcopenia, and Complications in Gastric Cancer. Clin Nutr ESPEN. 2024; 59:334 – 42. 10.1016/j.clnesp.2023.12.004. PMID: 38220395. [DOI] [PubMed]
- 9.Li Z-Z, Yan X-L, Jiang H-J et al. Sarcopenia Predicts Postoperative Complications and Survival in Colorectal Cancer Patients with Glim-Defined Malnutrition: Analysis from a Prospective Cohort Study. Eur J Surg Oncol. 2024; 50(1):107295. 10.1016/j.ejso.2023.107295. PMID: 38016248. [DOI] [PubMed]
- 10.Martos-Benítez FD, Gutiérrez-Noyola A, Echevarría-Víctores A. Postoperative complications and clinical outcomes among patients undergoing thoracic and gastrointestinal cancer surgery: A prospective cohort study. Rev Bras Ter Intensiva 2016 Jan-Mar;28(1):40–8. 10.5935/0103-507X.20160012. PMID: 27096675; PMCID: PMC4828090. [DOI] [PMC free article] [PubMed]
- 11.Zhang DZ, Wang LL, Chen BH, Sun PS, Fang XJ, Yan ZQ, Zhang B. Risk factors for postoperative infections in patients with colorectal cancer and distribution of pathogens. Chin J Nosocomiology. 2017;27(5):1105–8. 10.11816/cn.ni.2016-162665. [Google Scholar]
- 12.Dou L, Wang X, Cao Y et al. Relationship between Postoperative Recovery and Nutrition Risk Screened by NRS 2002 and Nutrition Support Status in Patients with Gastrointestinal Cancer. Nutr Cancer. 2020;72(1):33–40. doi: 10.1080/01635581.2019.1612927. Epub 2019 May 11. PMID: 31079488. [DOI] [PubMed]
- 13.Ministry of Health of the People’s Republic of China. Diagnostic Criteria for Hospital Infection (Trial). Natl Med J China. 2001;81(5):314–20. 10.3760/j:issn:0376-2491.2001.05.027. [Google Scholar]
- 14.Yang D, Zheng Z, Zhao Y, et al. Patient-generated subjective global assessment versus nutritional risk screening 2002 for gastric cancer in Chinese patients. Future Oncol. 2020;16(3):4475–83. 10.2217/fon-2019-0539. Epub 2019 Dec 3. PMID: 31793364. [DOI] [PubMed] [Google Scholar]
- 15.Wang Y, Zheng J, Gao Z, et al. Investigation on nutritional risk assessment and nutritional support status of surgical patients with colorectal cancer. J BUON. 2018 Jan-Feb;23(1):62–7. PMID: 29552761. [PubMed]
- 16.Huang Zijing W, Ying Z, Li, et al. Incidence of sarcopenia and its influencing factors among patients with malignant gastrointestinal cancer[J]. J Nurs Sci. 2023;38(5):50–3. 10.3870/j.issn.1001-4152.2023.05.050. [Google Scholar]
- 17.Zheng C, Ge Q, Luo C, et al. Enteral nutrition improves the prognosis and immune nutritional status of patients in the cardiothoracic surgery recovery unit: A propensity score-matched analysis. Clin Nutr. 2022;41(12):2699–705. 10.1016/j.clnu.2022.10.012. Epub 2022 Oct 26. PMID: 36343561. [DOI] [PubMed] [Google Scholar]
- 18.Du Yanping L, Lingling H, Qing, et al. Nutritional risk screening and nutrition assessment for gastrointestinal cancer patients[J]. Chin J Gastrointest Surg. 2012;15(5):460–3. 10.3760/cma.j.issn.1671-0274.2012.05.015. [PubMed] [Google Scholar]
- 19.Yuan YH, Yang YH, Fan WZ, Li ZX. Risk factors analysis of nosocomial infection in patients with tumor. Practical Pharm Clin Remedies. 2017;20(2):196–8. 10.14053/j.cnki.ppcr.201702019. [Google Scholar]
- 20.Bai D, Xiang W, Chen XZ, Hu JK. [Risk factors of postoperative pulmonary infection of gastric cancer and perioperative intervention measures]. Zhonghua Wei Chang Wai Ke Za Zhi. 2021;24(2):185–90. 10.3760/cma.j.issn.441530-20200611-00353. Chinese. [DOI] [PubMed] [Google Scholar]
- 21.Cai Y, Xue M, Wang CY, Zhou YG, Zhao ZP, Meng Q. The forecast of life expectancy in 2030 and international comparisons. Chin J Health Inf Manage. 2017;14(1):82–7. 10.3969/j.issn.1672-5166.2017.01.018. [Google Scholar]
- 22.Amri R, Dinaux AM, Kunitake H, Bordeianou LG, Berger DL. Risk Stratification for Surgical Site Infections in Colon Cancer. JAMA Surg. 2017;152(7):686–90. 10.1001/jamasurg.2017.0505. PMID: 28403477; PMCID: PMC5547926. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Shabanzadeh DM, Sørensen LT. Alcohol Consumption Increases Post-Operative Infection but Not Mortality: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt). 2015;16(6):657–68. 10.1089/sur.2015.009. Epub 2015 Aug 5. PMID: 26244748. [DOI] [PubMed] [Google Scholar]
- 24.Babic A, Bao Y, Qian ZR, Yuan C, Giovannucci EL, Aschard H, Kraft P, Amundadottir LT, Stolzenberg-Solomon R, Morales-Oyarvide V, Ng K, Stampfer MJ, Ogino S, Buring JE, Sesso HD, Gaziano JM, Rifai N, Pollak MN, Anderson ML, Cochrane BB, Luo J, Manson JE, Fuchs CS, Wolpin BM. Pancreatic Cancer Risk Associated with Prediagnostic Plasma Levels of Leptin and Leptin Receptor Genetic Polymorphisms. Cancer Res. 2016;76(24):7160–7. 10.1158/0008-5472.CAN-16-1699. Epub 2016 Oct 25. PMID: 27780823; PMCID: PMC5181854. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48. Epub 2016 Aug 6. PMID: 27637832. [DOI] [PubMed] [Google Scholar]
- 26.Kong MG, Jang SY, Jang J, Cho HJ, Lee S, Lee SE, Kim KH, Yoo BS, Kang SM, Baek SH, Choi DJ, Jeon ES, Kim JJ, Cho MC, Chae SC, Oh BH, Lim S, Park SK, Lee HY. Impact of diabetes mellitus on mortality in patients with acute heart failure: a prospective cohort study. Cardiovasc Diabetol. 2020;19(1):49. 10.1186/s12933-020-01026-3. PMID: 32359358; PMCID: PMC7196232. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.