Nutritional and non-nutritional factors associated with postoperative septic complications in gastric cancer

P.g3 Effects of preoPe&ive parenteral nutrition on gastric cancer cell prollferatiin: intercomparison between antibromo deoxiuridine monoclonal antibody (BRDURD LI) and DNA flow cytometry (DNA-FM) methods F. Pacel~i’,L. Teodonq M. L. Trinca? G. t?. Doglietto’, R. Beiantone’, M. &sso/a’, J. Hemme?, F. Cructii’ ‘Insfit. of Surgical Pathology, Universita’ Cattoiica Sacm &ore, Rome, ltaly *Div. of Physics and Bbchemical Sciences, ENEA-Casaccia, Rome, ha/y 3Dept. Maxi//ofacia/ Sqery, Univ. of U/m, U/m, FRG. Aim of the study was to determine whether preoperative nutriiional support (PNS) may alter tumor Kinetic behavior. Nine malnourished patients with stomach cancer were studied. Five patients (PNS group) underwent PNS pOKcaVkg/day -2Wmq/kg/day of nitrogen) for a mean of 16 days (min. 9-max. 313) as supplement to their oral diet; 4 patients [control group) received the standard hospital diet. All patients underwent biopsies of normal and malignant gastric tissue at the staging endoscopy and at surgery. Cell kinetic changes were evaluated both with antibromodeoxiuridine monoclonal antibody (BRDUAD LI) and DNA flow cytometry (DNA FCM). Results of citokineti study are reported in the following table. PN6QRoUP

WNlRDLQROUP

-suroay 1.70*1.47

1.16*1.35

-Dcy 1.26t1.16

surorrv 0.41~0.31

DNA FC M BRWRD U

6.26t2.56 1.64f1.63

5.5Mo.77 1.45+0.91

4X23.20 1.39r1.24

5.27tl.36 0.46f0.M)

DNA FCM

7.20X.12

6.30?2.30

BRWAD

LI

NORMAL

luMCM 11.4s7.17

9.72f4.01

From the results of this study it seems that there is not any appreciable tumor cell proliferation increase due to PNS in malnourished patients affected by gastric cancer. A larger sample of patients must be studied to confirm these preliminary results.

PM Nutritional and non-nutritiinal factors associated with postoperative septic complications in gastric cancer M. Bossolat, A. Sitges-Serra: R. Bellantonet, G. t?. Dogtiettot, M.J. Gil: M. Segura: f. face//it, F. Crucittif ‘Autonomous Univ. ofSarce//ona and tCatho/ic Univ. of Rome

Dept.ofSurmof

Numerous “nutrftional” and “non nutritional” factors are associated with post-operative complications but few studies evaluated them together. We therefore prospectively studii the influence of weight loss, albumin, lymphocytes and haemoglobin levels, age, tumor stage and diameter, amount and timing of transfusion in the development of septic complications in patients who underwent surgery for gastric cancer. One hundred and eighty patients were studied. The presence of any of the following complications was noted: wound infection (WI), pulmonary infection (PI), intra-abdominal abscess (IA), positive blood culture (BC), death. The statistical significance (p value) of crosstable analysis of grouped variables and the analysis by presence of complications (Anova) are shown below. Weightloss Albumin LYmph~vt~ Haemcglobn Age Tranaufskc fyes/no) Transf.(no/pepet) Trmsf.(no/posl) Transl. f.cm-per/post

m

A

n.s. ".S. ".S. n.s. "S. n.s. ".s. 0.06 n.s.

"S. n.s. "S "S. n.s. n.s. n.s. O.cwl OK01

!A n.s. n.s. ".S. n.s. 0.05 n.s. n.s. O.ooOl 0.0032

PI4 n.s. n.s. "S. n.s. 0.01 n.5. n.s. O.CC01 o.wo6

PI

WI

Dnth n.s. n.s. n.s n.s. o.cQ3 0.03 "S. O.CCill o.wo4

46

: wel!a loss (%I Ak&in (gr/dl) 3.6 Lymphcqtes(r?/mm3) 1668 Hsemoplobinlor.fi 119 Age&& 64.3

‘-

?4+!?6;

IA

mm

10 3.6t' 3.6 3.& 3.6 1603t 1694 17987 1661 120t 119 1lM 126 67.$t 63.9 6&t 63.6

Pn 10.1t 3.5t' 1934t 125t 71.4'

n0yrrf.m 9.6 15.4t 3.6 3.3t' 1910 1469t 119 119t 63.9 738:

D&h 10 3.6 1675 119 638

m

12t 3% 1689t

123

7;;;

tp=n.s.;‘pc005;#pca.01 Age and administration of blood after surgery were significant risk factors for the development of p.o. septic complications. Pre or peroperative transfusions, anemia and nutrition related factors appeared of minor importance.

P.65

Ambulatory artificial nutrition in cancer patients

S. Frobmiilfer, P. S&lag Department of Surgery, Section of Surgical Oncoicgy, University of Heidelberg, FRG To improve the quality of life and to shorten the clinical stay of chronically ill cancer patients the research project ‘Mobile Home Care of Cancer Patients’ was perfoned at the University of Heidelberg since November 1966. Its primary goal was the transfer of oncological therapies from the hospital to the homes of the patients. To achieve the goal of customized patient-oriented cancer care without jeopardizing the standards of today’s oncological therapy a treatment team of two physicians and two nurses was settled. This team regarded itself as a link between cancer centre, general practioner, community nursing services and the patients and their families. The psychic and social needs of the patients were taken special care of. Twenty-eight patients out of a total of 162 patients were included into the Mobile Home Care Project because their treatment required artificial nutrition. They suffered from gastrointestinal tract or head and neck cancer. The majority (22 pts) could be treated by enteral feeding via nasogastric or nasojejunal tubes (16 pts), percutaneous endoscopic gastrostomy (2 pts), catheterjejunostomy (4 pts). Six patients received parenteral nutrition via Hickman-catheters or venous port-systems. The total treatment time was 1916 days. Fourteen patients required additional oncological therapies e.g. chemotherapy. Complications were rare. We observed 3 catheter-infections, one tube-occlusion, one aspiration pneumonia and one case with recurrent diarrhea. The experiences with ambulatory artifiial nutrition within the framework of the Mobile Home Care Project demonstrate the possibility to transfer these therapies to the homes of the patients and to integrate other oncological treatment modalities. Concomitant psychological evaluation found an improvement of quality of life. The analysis of the costs revealed a cost reduction of more than 40% compared to hospital treatment. In all ambulatory artificial nutrition in oncology contributes to improving the situation in cancer care.

P.06 Effects of branched-chain amino acids on protein metabolism of tumor-bearing rats. M. Soda, N. Kqiitani, K. Yoshizane, H. Naniwa, Y. Tamesada, S. Teramoto and Y. Komoto Department of Surgery, Otfayama University Medical School, Okayama, Japan. The aim of this study was to compare the effects of two types of BCAA i.e. Leu-enriched and Val-enriched formula on energy and protein metabolism during TPN in tumor-bearing rats. Methods: Tumor-bearing Donryu rats were fed by TPN for 6 days and divided into two groups according to different amino acids, Leu-enriched (2:l:l = Leu:lle:Val) and Val-enriched (1:1:2 = Leu:lle:Val) formula. 14C-labelled BCAA were injected on 3rd and 6th day and 14C02 production, isotope content of plasma, urine, various organs and tumor were examined.