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1
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National Program of Malnutrition Assessment in Patients with Cancer of the Gastrointestinal and Respiratory Tract in Poland

100%
Talarek M., Szawłowski A.
Polish Journal of Surgery
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2007
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vol. 79
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issue 3
190-195
EN
The aim of the study was assessment of the prevalence of malnutrition in hospitalized patients with cancer of the gastrointestinal and respiratory tract.Material and methods. The study was conducted between February and April of 2005 in 37 centers. Assessment of nutritional status was made according to a Subjective Global Assessment (SGA) and a Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire.Results. Nutritional status was evaluated in 2553 patients with cancer of the gastrointestinal tract (64.9%), respiratory tract (29.8%) and other cancer (5.2%). Hypoalbuminemia was found in 37.3% of patients. In 22% of patients, the body mass index (BMI) was below normal. According to the SGA scale, nutritional status was A in 51.1% of patients, B in 39.3%, and C in 9.7%. Nutritional status in patients with cancer of the gastrointestinal tract was A in 48.0%, B in 40.8%, and C in 11.2%. Nutritional status in patients with cancer of the respiratory tract was A in 55.4%, B in 37.4%, and C in 7.2%. Malnutrition was not found in 64.2% of patients with large bowel cancer but, in contrast, was found in 70.7% of patients with cancer of the upper part of the gastrointestinal tract. There were differences depending on kind of hospitalization: planned (A - 53.1%, B - 38.3%, C - 8.6%) or emergency (A - 27.4%, B - 46.3%, C - 26.2%). In 31.7% of cases, divergence between the SGA and PG-SGA scale was noted. Mostly, the divergence consisted in underestimation of malnutrition. According to the PG-SGA scale, nutritional treatment is indicated in 75.5% of patients; according to SGA scale, only in 49.0%.Conclusions. 1. According to SGA scale, malnutrition was diagnosed in 49.0% of patients hospitalized because of cancer, in 52% of patients with cancer of the gastrointestinal tract and 44.6% with cancer of the respiratory tract. 2. According to the PG-SGA scale, there is a need for nutritional treatment in 75.5% of patients hospitalized because of cancer of the gastrointestinal or respiratory tract. 3. Use of the scored PG-SGA allows for identification of malnourished patients in whom, according to SGA, malnutrition is not diagnosed.
2
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Recommendations of the Polish Society of Oncological Surgery and Polish Association of Surgeons Prophylaxis and Antithrombotic Treatment in Patients with Malignant Neoplasms: Based on the American College of Chest Physicians (ACCP) guidelines from 2004, Polish Consensus Conference, Cracow 2005, and Recommendations of the Polish Society of Oncological Surgery - 2007

81%
Fijałkowska A., Szawłowski A., Wojtukiewicz M., Zawilska K.
Polish Journal of Surgery
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2008
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vol. 80
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issue 5
288-293
3
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Recommendations of Association of Polish Surgeons and Polish Society of Oncological Surgery Gastrointestinal Fistulae in Patients Treated for Malignancy - Diagnostics and Treatment

52%
Szawłowski A., Pertkiewicz M., Drews M., Dziki A., Krasnodębski I., Kulig J., Lampe P., Stojcev Z., Wallner G., Zegarski W.
Polish Journal of Surgery
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2008
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vol. 80
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issue 12
694-711
EN
Postoperative gastrointestinal fistulae occur more often in patients undergoing surgical treatment for oncological reasons than non-oncological reasons. Fistula is associated with a number of serious sequelae and complications: fluid and electrolyte abnormalities, acid-base abnormalities, local and systemic infection and progressive cachexia that increase morbidity, treatment duration and mortality. Development of fistula additionally delays or prevents specific treatment in oncology. For a patient, a fistula is associated with both physical and mental suffering resulting from concern over further therapy.Although the introduction of advanced surgical techniques, intensive postoperative care, total parenteral nutrition and modern enteral nutrition, resulted in decreased postoperative mortality, however the number of patients with gastrointestinal fistulae hospitalized in the departments of surgery is not decreasing. This may result from the fact that many patients still present for treatment in the advanced phase of their malignancy (clinical stage III/IV according to International Union Against Cancer - UICC) and consequently in worse general status, which poses a high risk of postoperative complications and requires more extensive procedures in progressively older patients. Thus gastrointestinal fistulae still remain a serious clinical problem. Main components of treatment of fistulae include: adequate draining, fighting of infections, artificial nutrition and drugs that decrease gastrointestinal secretion (e.g. somatostatin) that are intended to create conditions for spontaneous fistula healing. Some cases may require an early or late surgical intervention.
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