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.

1.
Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients.
Clin Nutr
. 2017 Feb;36(1):11–48.
2.
Kyle UG, Kossovsky MP, Karsegard VL, Pichard C. Comparison of tools for nutritional assessment and screening at hospital admission: a population study.
Clin Nutr
. 2006 Jun;25(3):409–17.
3.
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002.
Clin Nutr
. 2003 Aug;22(4):415–21.
4.
Fruchtenicht AV, Poziomyck AK, Kabke GB, Loss SH, Antoniazzi JL, Steemburgo T, et al. Nutritional risk assessment in critically ill cancer patients: systematic review.
Rev Bras Ter Intensiva
. 2015 Jul-Sep;27(3):274–83.
5.
Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, González P, González B, Mancha A, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population.
Nutr Hosp
. 2005 Jan-Feb;20(1):38–45.
6.
de Ulíbarri Pérez JI, Fernández G, Rodríguez Salvanés F, Díaz López AM. Nutritional screening; control of clinical undernutrition with analytical parameters.
Nutr Hosp
. 2014 Jan;29(4):797–811.
7.
Liang RF, Li JH, Li M, Yang Y, Liu YH. The prognostic role of controlling nutritional status scores in patients with solid tumors.
Clin Chim Acta
. 2017 Nov;474:155–8.
8.
Zhang Y, Zhang X. Controlling nutritional status score, a promising prognostic marker in patients with gastrointestinal cancers after surgery: A systematic review and meta-analysis.
Int J Surg
. 2018 Jul;55:39–45.
9.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
BMJ
. 2009 Jul;339:b2535.
10.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience.
Ann Surg
. 2009 Aug;250(2):187–96.
11.
Wells GS, O’Connell D, Peterson J, Welch V, Wells G, Shea B, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. Available from: www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
12.
Toyokawa T, Kubo N, Tamura T, Sakurai K, Amano R, Tanaka H, et al. The pretreatment Controlling Nutritional Status (CONUT) score is an independent prognostic factor in patients with resectable thoracic esophageal squamous cell carcinoma: results from a retrospective study.
BMC Cancer
. 2016 Sep;16(1):722.
13.
Yoshida N, Baba Y, Shigaki H, Harada K, Iwatsuki M, Kurashige J, et al. Preoperative Nutritional Assessment by Controlling Nutritional Status (CONUT) is Useful to estimate Postoperative Morbidity After Esophagectomy for Esophageal Cancer.
World J Surg
. 2016 Aug;40(8):1910–7.
14.
Kuroda D, Sawayama H, Kurashige J, Iwatsuki M, Eto T, Tokunaga R, et al. Controlling Nutritional Status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection.
Gastric Cancer
. 2018 Mar;21(2):204–12.
15.
Iseki Y, Shibutani M, Maeda K, Nagahara H, Ohtani H, Sugano K, et al. Impact of the Preoperative Controlling Nutritional Status (CONUT) Score on the Survival after Curative Surgery for Colorectal Cancer.
PLoS One
. 2015 Jul;10(7):e0132488.
16.
Tokunaga R, Sakamoto Y, Nakagawa S, Ohuchi M, Izumi D, Kosumi K, et al. CONUT: a novel independent predictive score for colorectal cancer patients undergoing potentially curative resection.
Int J Colorectal Dis
. 2017 Jan;32(1):99–106.
17.
Harimoto N, Yoshizumi T, Sakata K, Nagatsu A, Motomura T, Itoh S, et al. Prognostic Significance of Preoperative Controlling Nutritional Status (CONUT) Score in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma.
World J Surg
. 2017 Nov;41(11):2805–12.
18.
Takagi K, Umeda Y, Yoshida R, Nobuoka D, Kuise T, Fushimi T, et al. Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma.
Dig Surg
. 2019;36(3):226–32.
19.
Harimoto N, Yoshizumi T, Inokuchi S, Itoh S, Adachi E, Ikeda Y, et al. Prognostic Significance of Preoperative Controlling Nutritional Status (CONUT) Score in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma: A Multi-institutional Study.
Ann Surg Oncol
. 2018 Oct;25(11):3316–23.
20.
Miyata T, Yamashita YI, Higashi T, Taki K, Izumi D, Kosumi K, et al. The Prognostic Impact of Controlling Nutritional Status (CONUT) in Intrahepatic Cholangiocarcinoma Following Curative Hepatectomy: A Retrospective Single Institution Study.
World J Surg
. 2018 Apr;42(4):1085–91.
21.
Kato Y, Yamada S, Suenaga M, Takami H, Niwa Y, Hayashi M, et al. Impact of the Controlling Nutritional Status Score on the Prognosis After Curative Resection of Pancreatic Ductal Adenocarcinoma.
Pancreas
. 2018 Aug;47(7):823–9.
22.
Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013 Nov;217(5):833–42.e1–3.
23.
Sato M, Tateishi R, Yasunaga H, Horiguchi H, Yoshida H, Matsuda S, et al. Mortality and morbidity of hepatectomy, radiofrequency ablation, and embolization for hepatocellular carcinoma: a national survey of 54,145 patients.
J Gastroenterol
. 2012 Oct;47(10):1125–33.
24.
Kimura W, Miyata H, Gotoh M, Hirai I, Kenjo A, Kitagawa Y, et al. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy.
Ann Surg
. 2014 Apr;259(4):773–80.
25.
Sun K, Chen S, Xu J, Li G, He Y. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis.
J Cancer Res Clin Oncol
. 2014 Sep;140(9):1537–49.
26.
Simonsen C, de Heer P, Bjerre ED, Suetta C, Hojman P, Pedersen BK, et al. Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical Oncology: A Meta-analysis.
Ann Surg
. 2018 Jul;268(1):58–69.
27.
Levolger S, van Vugt JL, de Bruin RW, IJzermans JN. Systematic review of sarcopenia in patients operated on for gastrointestinal and hepatopancreatobiliary malignancies.
Br J Surg
. 2015 Nov;102(12):1448–58.
28.
Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer.
Future Oncol
. 2010 Jan;6(1):149–63.
29.
Lv GY, An L, Sun XD, Hu YL, Sun DW. Pretreatment albumin to globulin ratio can serve as a prognostic marker in human cancers: a meta-analysis.
Clin Chim Acta
. 2018 Jan;476:81–91.
30.
Mann CD, Palser T, Briggs CD, Cameron I, Rees M, Buckles J, et al. A review of factors predicting perioperative death and early outcome in hepatopancreaticobiliary cancer surgery.
HPB (Oxford)
. 2010 Aug;12(6):380–8.
31.
Kenjo A, Miyata H, Gotoh M, Kitagawa Y, Shimada M, Baba H, et al. Risk stratification of 7,732 hepatectomy cases in 2011 from the National Clinical Database for Japan.
J Am Coll Surg
. 2014 Mar;218(3):412–22.
32.
Takeuchi H, Miyata H, Gotoh M, Kitagawa Y, Baba H, Kimura W, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database.
Ann Surg
. 2014 Aug;260(2):259–66.
33.
Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN guideline: clinical nutrition in surgery.
Clin Nutr
. 2017 Jun;36(3):623–50.
34.
Nagai S, Abouljoud MS, Kazimi M, Brown KA, Moonka D, Yoshida A. Peritransplant lymphopenia is a novel prognostic factor in recurrence of hepatocellular carcinoma after liver transplantation.
Transplantation
. 2014 Mar;97(6):694–701.
35.
Wang Q, Lau WY, Zhang B, Zhang Z, Huang Z, Luo H, et al. Preoperative total cholesterol predicts postoperative outcomes after partial hepatectomy in patients with chronic hepatitis B- or C-related hepatocellular carcinoma.
Surgery
. 2014 Feb;155(2):263–70.
36.
Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement.
Clin Nutr
. 2015 Jun;34(3):335–40.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.