The Controlling Nutritional Status Score and Postoperative Complication Risk in Gastrointestinal and Hepatopancreatobiliary Surgical Oncology: A Systematic Review and Meta-Analysis

Abstract

The controlling nutritional status (CONUT) score is associated with prognosis in gastrointestinal (GI) cancer patients, but the clinical significance of the CONUT score for postoperative short-term outcome remains controversial. The aim of this study was to investigate the impact of the CONUT score on postoperative outcomes in patients with GI and hepatopancreatobiliary (HPB) cancers. We conducted a systematic literature search of Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. Meta-analyses were performed to estimate the pooled risk ratio (RR) for postoperative complications in patients with lower ­CONUT score versus higher CONUT score. Furthermore, we explored the most appropriate cutoff value of the CONUT score to predict postoperative complications. Ten retrospective studies (5,138 patients) were included in this meta-analysis. Patients with higher CONUT score had an increased risk of mortality (RR 5.38, 95% CI 2.19–13.2, p < 0.001, I² = 0%), postoperative major complications (RR 1.56, 95% CI 1.05–2.33, p= 0.03, I² = 79%), and overall complications (RR 1.38, 95% CI 1.16–1.63, p < 0.001, I² = 6%). We found that the cutoff of CONUT ≤4 vs. CONUT ≥5 had the highest pooled RR compared with other cutoff values (RR 4.79, 95% CI 0.97–23.5, p= 0.05, I² = 91%). In conclusion, the present study suggests that the preoperative CONUT score was associated with an increased risk of mortality and complications in GI and HPB surgical oncology. Patients with higher CONUT score as compared with those having a lower score had approximately a fivefold mortality risk and an increased risk up to 55% on major and overall complications after GI and HPB surgery. Our analysis indicates that the appropriate cutoff value of the CONUT score to predict postoperative major complications would be between 4 and 5. The preoperative evaluation of the CONUT score would be helpful for predicting the risk of postoperative outcomes.

Prognostic significance of the controlling nutritional status (CONUT) score in patients with colorectal cancer: A systematic review and meta-analysis

“…Two studies reported the association between the CONUT score and complications in multivariable analyses [10,18], in contrast no association between the CONUT score and postoperative infectious diseases was shown [14,15]. Recent meta-analyses have indicated that patients with higher CONUT score had an increased risk of complications as well as mortality after gastroenterological and hepatopancreatobiliary surgery [6][7][8]. Therefore, the CONUT score might be helpful in predicting complication risks in CRC surgery.…”

“…The queries were constructed using suitable terms concerning the CONUT score and CRC (Supplementary Table 1). The methods of our systematic literature review strategy have been described previously [6][7][8]. No ethical approval or informed consent statement was required for this review article.…”

“…Due to its simplicity and efficiency in evaluating patients' nutritional status, which is calculated using three values such as serum albumin level, total cholesterol level and total lymphocyte count [4], it is potentially broadly applicable. Recently the clinical evidence of the CONUT score for short-term and long-term outcomes has increased in gastroenterological and hepatopancreatobiliary surgical oncology [5][6][7][8]. The impact of the CONUT score on outcomes in patients undergoing surgery for colorectal cancer (CRC) was first reported in 2015 [9].…”

Controlling nutritional status score predicts postoperative complications after hip fracture surgery

“…CONUT was developed by Ignacio de Uli'Barri et al in 2005 as a screening tool for malnutrition among general hospitalized patients [9]. A recent systematic review and meta-analysis showed that preoperative CONUT score was associated with increased risk of mortality and complications in surgical patients with gastrointestinal and hepatopancreatobiliary cancers [11]. Another retrospective study found that CONUT score was useful for predicting long-term mortality in hospitalized patients with heart failure [15].…”

Prognostic Significance of Preoperative Controlling Nutritional Status Score in Patients Who Underwent Hepatic Resection for Hepatocellular Carcinoma

“…44 Harimoto et al 42 CONUT scores are poor. 48,49 However, these studies had limitations. First, the number of included papers was relatively small, and included few HCC meta-analyses mostly conducted in Japan and China.…”