Kolorektal Kanser Hastalarında Preoperatı̇f Nütrı̇syonel Durum, Vücut Kompozı̇syonu ve Sı̇stemı̇k İnflamatuar Yanıtın Postoperatı̇f Sonuçlar Üzerı̇ne Etkı̇sı̇

Abstract

Yıldız Kopuz, T.N., Effect of Preoperative Nutritional Status, Body Composition and Systemic Inflammatory Response on Postoperative Outcomes in Colorectal Cancer Patients, Hacettepe University Graduate School of Health Sciences Nutrition and Dietetics Program, Doctor of Philosophy Thesis, Ankara, 2024. Colorectal cancer is a common malignancy worldwide with high mortality rates and surgery is the main approach to treatment. The aim of this study was to investigate the effects of preoperative nutritional status, body composition, systemic inflammatory response and dietary inflammatory index on postoperative outcomes. The study was conducted at Ankara Bilkent City Hospital. A total of 121 colorectal cancer patients, 76 males and 45 females, who had not received neoadjuvant therapy and had no metastasis, were included in the study. Preoperative nutritional status was assessed by Global Leadership Initiative on Malnutrition (GLIM) criteria and Patient-Generated Subjective Global Assessment (PG-SGA); systemic inflammatory response by Neutrophil Lymphocyte Ratio (NLR), Delta Neutrophil Index (DNI) and Prognostic Nutritional Index (PNI); and body composition by computed tomography (CT). Visceral and subcutaneous obesity were defined through body composition analysis based on CT images. Sarcopenia was determined according to the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, and the energy-adjusted Dietary Inflammatory Index (E-DII) was calculated from 24-hour dietary intake records. The postoperative outcome parameters of the study include complications, length of hospital stay, and quality of life. The mean age of the patients was 62.3±12.1 years, 32.2% developed complications and 51.2% had prolonged hospitalization. In the preoperative period, malnutrition was detected in 45.5% of the patients according to the GLIM criteria, sarcopenia in 15.7%, visceral obesity in 54.5%, and subcutaneous obesity in 53.7%. In malnourished individuals, the frequency of complications and prolonged hospital stays was higher, while quality of life was lower compared to nonmalnourished individuals (p<0.05). In sarcopenic individuals, the frequency of both complications and prolonged hospital stays was higher compared to non-sarcopenic individuals (p<0.05). In contrast, the frequency of complications was lower in individuals with visceral obesity compared to those without visceral obesity (p<0.05). No significant difference was found in postoperative outcomes between individuals with subcutaneous obesity and those without subcutaneous obesity (p>0.05). Additionally, in individuals with NLR ≥3, postoperative complications and prolonged hospital stays increased (p<0.05). The PNI was positively correlated with preoperative and postoperative overall quality of life, physical, role, and cognitive functions (p<0.05). In multivariate logistic regression analysis, malnutrition (OR: 3.95, p<0.05), sarcopenia (OR: 3.97, p<0.05), and the E-DII (OR: 4.96, p<0.05) were identified as independent risk factors for postoperative complications. For prolonged hospital stays, open surgical operation (OR: 2.96, p<0.05), the development of complications (OR: 16.99, p<0.001), and sarcopenia (OR: 6.89, p<0.05) were determined as independent risk factors. The assessment of preoperative nutritional factors in colorectal cancer surgery is critical for timely intervention and a multidisciplinary approach.