Nutritional assessment using prealbumin as an objective criterion to determine whom should not undergo primary radical cytoreductive surgery for ovarian cancer

BackgroundThe purpose of this study was to determine if serum prealbumin could be used to objectively determine which patients could not safely undergo cytoreductive surgery.MethodsPatients with suspected ovarian cancer in a 24-month period underwent nutritional assessment during their preoperative workup and were followed for development of postoperative complications.ResultsOne hundred and eight of 114 patients underwent surgical cytoreduction. Of the 108 surgical patients, 88 patients had prealbumin levels < 18 mg/dl and 24 patients had prealbumin levels < 10 mg/dl. Postoperative complications increased with lower prealbumin levels. All complications occurred in group of patients with prealbumin < 18 mg/dl (P = 0.013). A significantly increased number of complications occurred in patients with prealbumin < 10 mg/dl (61.5% vs. 6.4%, P < 0.001, RR 9.6). All postoperative mortality in this series occurred in patients with prealbumin < 10 mg/dl (23.1% vs. 0%, P < 0.001). Patients whose prealbumin started low but was able to be raised to > 10 mg/dl by TPN did not have significantly increased complications or EBL compared to patients whose initial prealbumin was > 10 mg/dl (18.2% vs. 4.8%, P = 0.95 and 570 vs. 600 ml, P = 0.87).ConclusionsSignificantly more blood loss, morbidity, and mortality occurred in patients with abnormal preoperative prealbumin. This was especially true in patients with a prealbumin < 10 mg/dl. With these significantly increased risks, patients with extremely poor nutritional status (prealbumin < 10 mg/dl) may be better served by neoadjuvant chemotherapy with interval cytoreductive surgery if nutrition improves.