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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2023.tde-31052023-111733
Document
Author
Full name
Maria Manuela Ferreira Alves de Almeida
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2023
Supervisor
Committee
Júnior, Ulysses Ribeiro (President)
Forones, Nora Manoukian
Takeda, Flavio Roberto
Torrinhas, Raquel Susana Matos de Miranda
Title in Portuguese
Avaliação de longo prazo do estado nutricional de pacientes tratados com ressecção cirúrgica para câncer de esôfago e estômago
Keywords in Portuguese
Composição corporal
Desnutrição
Esofagectomia
Estado nutricional
Gastrectomia
Músculo
Abstract in Portuguese
INTRODUÇÃO: O tratamento cirúrgico dos pacientes com câncer de estômago e esôfago pode causar impacto no estado nutricional dos pacientes. No primeiro ano de cirurgia a porcentagem de perda de peso é de 7% a 15%. Portanto, avaliar o estado nutricional após a cirurgia pode auxiliar na escolha de tratamentos a serem realizados e do suporte nutricional que interferirá na condição geral e na qualidade de vida destes pacientes. OBJETIVO: Avaliar o estado nutricional de pacientes com câncer de estômago e de esôfago submetidos à ressecção cirúrgica potencialmente curativa há pelo menos 2 anos e sem evidência de doença. MÉTODOS: Estudo desenvolvido no Instituto do Câncer do Estado de São Paulo (ICESP-HCFMUSP) em pacientes de ambos os sexos, com tumor primário de esôfago e estômago submetidos à gastrectomia e esofagectomia há pelo menos 2 anos, sem evidência de doença. Foram coletados dados de avaliação nutricional prévios à cirurgia e após 2 anos da intervenção, aferidas altura, peso atual, circunferência da panturrilha, calculada porcentagem de perda de peso e índice de massa corporal, aplicado questionário de avaliação nutricional subjetiva e realizado exames de bioimpedância elétrica e força da preensão manual. RESULTADOS: Incluíram-se no estudo 92 pacientes, 67,4% do sexo masculino, 70,7% idosos, 50,0% apresentavam estádio III e IV e 65,2% submetidos à gastrectomia (56,7% destes à gastrectomia total). A avaliação antes da cirurgia mostrou que 43,5% dos pacientes estavam em risco nutricional, destes, 27,5% eram desnutridos. Após o período de 2 anos, 32,6% dos pacientes estavam desnutridos. Através da avaliação objetiva, 50,0% apresentaram-se com déficit de massa magra pela circunferência da panturrilha e 42,7% pela bioimpedância elétrica. Déficit de força correspondeu a 20,7% da amostra. Não houve diferença estatisticamente significante nos pacientes que foram submetidos à gastrectomia ou esofagectomia. Houve diferença significativa comparando as variáveis do perfil nutricional e a classificação da idade, e a variável de déficit de força e o tipo de cirurgia (minimamente invasiva ou não). CONCLUSÕES: Pacientes submetidos à esofagectomia e gastrectomia devem ser avaliados quanto aos aspectos nutricionais no pós-operatório de longo prazo, pois além do avançar da idade, o tratamento cirúrgico realizado pode contribuir para a depleção da massa magra. A avaliação nutricional de rotina permite a identificação da perda de massa magra e direcionamento para suporte nutricional associado ao programa de exercícios físicos, o que possivelmente melhorará a qualidade de vida desses pacientes
Title in English
Long-term assessment of the nutritional status of patients treated with surgical resection for esophageal and stomach câncer
Keywords in English
Body composition
Esophagectomy
Gastrectomy
Malnutrition
Muscles
Nutritional status
Abstract in English
INTRODUCTION: Surgical treatment of patients with stomach and esophageal cancer can impact the nutritional status of patients. In the first year of surgery, the percentage of weight loss may vary from 7% to 15%. Therefore, the nutritional status assessment after surgery impacts treatment choices and nutritional support which may interfere in the general condition and quality of life of these patients. OBJECTIVE: To assess the nutritional status of patients with stomach and esophageal cancer undergoing potentially curative surgery for at least 2 years and with no evidence of illness. METHODS: the study was developed at the Cancer Institute of the State of São Paulo (ICESP-HCFMUSP) in patients of both sexes, with primary tumor in esophagus and stomach who were submitted to gastrectomy or esophagectomy for at least 2 years and with no evidence of disease. Data were collected from nutritional assessment prior to surgery and 2 years after the intervention, it was measured height, current weight, calf circumference, percentage of weight loss and body mass index.It was applied a subjective nutritional assessment questionnaire and also, it was performed a bioelectrical impedance analysis and handgrip strength test. RESULTS: the present study included 92 patients, of which 67.4% were male, 70.7% were elderly, 50.0% had cancer stage III or IV and 65.2% underwent gastrectomy (56.7% of these underwent total gastrectomy). The assessment before surgery showed that 43.5% of patients were at nutritional risk, of these, 27.5% were malnourished. After the 2 year period, 32.6% of patients were malnourished. The objective nutritional assessment showed muscle mass deficit in 50.0% of the patients when evaluated by the calf circumference and 42.7% of the patients through electrical bioimpedance. Whereas, 20.7% of the sample showed deficit in handgrip strength. There was no statistically significant difference in patients who underwent gastrectomy or esophagectomy. There was a significant difference comparing the nutritional profile variables and age classification, and the strength deficit variable and the type of surgery (minimally invasive or not). CONCLUSIONS: Patients undergoing esophagectomy and gastrectomy should be assessed for nutritional aspects in the long-term postoperative period, because in addition to advancing age, the surgical treatment can contribute to the depletion of lean mass. Routine nutritional assessment allows the identification of lean mass loss and the implementation of nutritional support which it can be associated with a physical exercise program that may possibly improve the quality of life of these patients
 
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Publishing Date
2023-06-02
 
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