Postoperative Malnutrition and Early Pulmonary Metastasis in an Older Patient With Uterine Leiomyosarcoma: A Case Report

Although the surgical treatment of older cancer patients requires a multifaceted evaluation and appropriate intervention, many problems remain. In this case, we evaluated an 87-year-old patient with stage IB uterine leiomyosarcoma and an appendiceal tumor. The evaluation included a general preoperative examination, geriatric assessment, Clinical Risk Analysis Index for vulnerability screening, and assessment of nutritional status using the prognostic nutritional index (PNI). The patient was deemed operable and underwent a total hysterectomy and appendectomy. The tumor was completely resected with no unexpected complications. However, the patient developed a paralytic ileus in the early postoperative period. The PNI worsened, and the patient remained in a malnourished state. On postoperative day 17, the patient developed pleural effusion and multiple pulmonary metastases, leading to a transition to best supportive care. This case highlights the critical importance of postoperative nutritional status in older cancer patients.