Prognostic Nutritional Index as an Indicator of Postoperative Morbidity in Patients Undergoing Perioperative Chemotherapy and Surgery for Carcinoma Stomach

Carcinoma stomach is the 5th most common malignancy diagnosed all around the world. Carcinoma stomach puts significant morbidity on the patient due to nutritional and immunological aspects secondary to the disease. Perioperative chemotherapy and surgery is the current treatment strategy of the treatment but is complicated by the occurrence of significant postoperative morbidity. We conducted a prospective study on the impact of the Prognostic Nutritional Index (PNI) as a predictor of postoperative morbidity after perioperative chemotherapy in patients with carcinoma stomach in a tertiary cancer care centre. Of the 44 patients, 25% developed Clavien-Dindo grade III or above complications. Advanced nodal stage and lymphovascular invasion in the pathology specimen were associated with an increased incidence of major postoperative complications (p 0.014). There was a significant reduction in PNI after chemotherapy from 49.88 to 47.37 (p 0.011). While PNI in the prechemotherapy or post-chemotherapy period was not associated with major postoperative complications (p-value 0.273 and 0.391, respectively), a reduction in PNI was significantly associated with Clavien-Dindo grade III or above complications (p 0.049). An ROC curve was plotted to find a reduction of 6.45 in PNI which was significantly associated with major complications. A two-step evaluation of PNI prior to chemotherapy and prior to surgery will help identify patients at risk of developing major postoperative complications and optimization strategies can be taken prior to surgery in such high-risk individuals.