The Importance of the Nutritional Factor and the Stage of the Disease in Postoperative Fistula in Patients with Gastric Cancer

In gastric cancer there are multiple local and general risk factors for the occurrence of postoperative fistulas. In the present study, we proposed to analyse the role of the preoperative nutritional state and nutritional therapy along with the disease stage, the age and the sex of patients in the occurrence of fistulas. Material and method: This retrospective study included 158 patients operated for gastric cancer in Surgery Department of Bucharest Oncology institute between January 2010 and December 2016 in which we analysed the incidence of anastomotic fistula according to the nutritional status, disease status, age and sex of the patients. The global incidence of fistulas was of 11%, out of which 8 % were fistulas of the duodenal stump and 3.19% fistulas of the eso-jejunal anastomosis. Out of the 30 patients with weight loss and parenteral nutrition in the preop period, we had 4 fistulas (13%), and out of the 36 patients with weight loss and nutritional measures in the postop we had 5 fistulas (14%), also, out of the 24 patients with weight loss and without nutritional intervention, we had 5 fistulas (21%), finally, out of the 68 patients without weight loss we had fistulas in 4 patients (6%).. The incidence of fistulas was 5% in patients with stage I, II and III and 24% in stage IV patients. The distribution of fistulas according to the age of the patients showed a much higher incidence of fistulae in patients over 70 years old. The number of postoperative fistulas was higher in the advanced stages of the disease (p=0.027) and in patients over 70 years old (p=0.047) and the differences were statistically significant. The difference between the number of fistulae occurred in patients who had weight loss but did not receive nutritional support from those who received this support was not statistically significant (p 0.001).