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World J Gastroenterol. Feb 28, 2008; 14(8): 1248-1251
Published online Feb 28, 2008. doi: 10.3748/wjg.14.1248
Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery
Varut Lohsiriwat, Darin Lohsiriwat, Wiroon Boonnuch, Vitoon Chinswangwatanakul, Thawatchai Akaraviputh, Narong Lert-akayamanee
Varut Lohsiriwat, Darin Lohsiriwat, Wiroon Boonnuch, Vitoon Chinswangwatanakul, Thawatchai Akaraviputh, Narong Lert-akayamanee, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Lohsiriwat V is the principle investigator who contributed to the acquisition of data and analysis as well as manuscript preparation; Lohsiriwat D, Boonnuch W and Lert-akayamanee N conceived the study and critically revised the manuscript; Chinswangwatanakul V and Akaraviputh T participated in the design of the study and data collection.
Correspondence to: Varut Lohsiriwat, MD, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Prannok Rd, Bangkok Noi, Bangkok 10700, Thailand. bolloon@hotmail.com
Telephone: +66-2-4198077
Fax: +66-2-4115009
Received: October 17, 2007
Revised: December 7, 2007
Published online: February 28, 2008
Abstract

AIM: To determine the relationship between pre-operative hypoalbuminemia and the development of complications following rectal cancer surgery, as well as postoperative bowel function and hospital stay.

METHODS: The medical records of 244 patients undergoing elective oncological resection for rectal adenocarcinoma at Siriraj Hospital during 2003 and 2006 were reviewed. The patients had pre-operative serum albumin assessment. Albumin less than 35 g/L was recognized as hypoalbuminemia. Postoperative outcomes, including mortality, complications, time to first bowel movement, time to first defecation, time to resumption of normal diet and length of hospital stay, were analyzed.

RESULTS: The patients were 139 males (57%) and 105 females (43%) with mean age of 62 years. Fifty-six patients (23%) had hypoalbuminemia. Hypoalbuminemic patients had a significantly larger tumor size and lower body mass index compared with non-hypoalbuminemic patients (5.5 vs 4.3 cm; P < 0.001 and 21.9 vs 23.2 kg/m2; P = 0.02, respectively). Thirty day postoperative mortality was 1.2%. Overall complication rate was 25%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (37.5% vs 21.3%; P = 0.014). In univariate analysis, hypoalbuminemia and ASA status were two risk factors for postoperative complications. In multivariate analysis, hypoalbuminemia was the only significant risk factor (odds ratio 2.22, 95% CI 1.17-4.23; P < 0.015). Hospitalization in hypoalbuminemic patients was significantly longer than that in non-hypoalbuminemic patients (13 vs 10 d, P = 0.034), but the parameters of postoperative bowel function were not significantly different between the two groups.

CONCLUSION: Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following rectal cancer surgery.

Keywords: Hypoalbuminemia; Rectal cancer; Outcomes; Morbidity; Postoperative bowel function