Valor predictivo de la encuesta subjetiva global en la conducta quirúrgica y la evolución posoperatoria del cáncer colorrectal

The nutritional status of a patient with a malignant colorectal disease (MCD) can affect not only the results of the surgical intervention, but also the extent of the surgical procedure to be carried upon the patient. A working hypothesis was advanced that some patients with MCD in which a potentially curable surgery (resection of the tumor, followed -or notby restitution of the bowel continuity) would be the treatment of choice, might be derived instead to palliative procedures because of existing nutritional derangement. To prove this hypothesis, 79 patients were recruited among those admitted to the “Hermanos Ameijeiras” Hospital and operated upon after being diagnosed with a MCD, between December 2002 and June 2004. The following indicators were obtained from each patient during the preoperatory workup: Height, current weight, serum albumin. The body mass index (BMI) was calculated in each instance. The subjective global Revista Mexicana de Coloproctologia 2005;11(3):114-122 MG 115 edigraphic.com INTRODUCCION El cancer colorrectal es la afeccion maligna mas comun del tubo digestivo: en las mujeres ocupa el segundo lugar en frecuencia, solo superado por el cancer de mama. En hombres, el cancer colorrectal ocupa el tercer lugar, precedido de los carcinomas de pulmon y prostata. El cancer colorrectal es causa importante de morbimortalidad: el enfermo puede complicarse y morir por la presencia de la masa tumoral, o debido a los efectos de la terapeutica medico-quirurgica adoptada. La enfermedad colorrectal maligna (ECM) se asocia con trastornos nutricionales importantes. La desnutricion puede afectar al 20-30% de los pacientes con ECM, en dependencia del (los) indicador(es) empleados en su reconocimiento [Llovera Ruiz JA. Efectividad de un protocolo de intervencion nutrimental en la cirugia radical del cancer colorrectal. Trabajo de Terminacion de Residencia en Coloproctologia. Hospital Clinico-Quirurgico “Hermanos Ameijeiras”. Ciudad Habana: 2000; Carmona Riesgo J. Apoyo nutrimental de los pacientes con enfermedad colorrectal maligna. Trabajo de Terminacion de Residencia en Coloproctologia. Hospital Clinico-Quirurgico “Hermanos Ameijeiras”. Ciudad Habana: 2002]. La desnutricion asociada a la ECM incide negativamente en la evolucion posquirurgica de estos pacientes: los pacientes desnutridos exhiben mayores tasas de complicaciones y muertes despues de realizado el acto quirurgico, cuando se les compara con otros no desnutridos. El estado nutricional del paciente con una ECM podria afectar tambien el alcance del proceder quirurgico a realizar en el acto operatorio: el estado nutricional assessment form [Detsky AS, McLaughlin JR, Baker JP et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987:11:8-13] was administered to each of the patients following admission, according to the procedure drafted by the local Nutritional Support Group, and conducted by one of the members of the Group. The acting surgeons were unaware of the SGA results. The nutritional status of the patient was independently established after a BMI value < 18.5 kg/m2 and/ or a serum albumin value < 35 g/L. Associations between: (1) SGA score and the nutritional status of the patient, (2) SGA score and the surgical conduct adopted (Potentially curable/Palliative), (3) SGA score and the occurrence of post-surgical complications, and (4) SGA score and the occurrence of post-surgical deaths, were assessed. Upon concluding this study the following results were obtained: (1) SGA score was not associated with the nutritional status of the patient; (2) Surgical conduct was associated with SGA score: potentially curable surgeries were more frequent among patients scoring A after SGA administration (64.2%). In contrast, palliative procedures were prevalent among patients with SGA scores B or C (66.7%) (p < 0.05); (3) SGA score was not associated with the occurrence of post-surgical complications; (4) SGA score was not associated with the occurrence of post-surgical deaths. Nutritional derangement could act as a factor conditioning what surgical conduct to perform in a patient with MCD.