Current status of perioperative nutritional intervention and exercise in gastric cancer surgery: A review

Abstract

Although it is steadily declining in incidence, gastric cancer remains one of the most common and deadly neoplasms worldwide. 1 Gastrectomy with sufficient lymph node dissection is recommended for patients with gastric cancer in whom endoscopic resection is not indicated. 2 However, gastric cancer surgery may be associated with several complications. Recent studies have reported that postoperative surgical complications affect the long-term oncological outcomes of gastric cancer. [3][4][5] Therefore, it is necessary to take measures to prevent postoperative complications.Various patient-related factors, such as age, sex, and performance status, influence the development of postoperative complications after gastrectomy for gastric cancer. 6,7 Among these factors, perioperative malnutrition and sarcopenia are strongly related to developing postoperative complications and poor survival outcomes. 8-10 Impaired nutritional status is common in cancers of the gastrointestinal tract, where the prevalence of malnutrition ranges from 20% to 70%. 11 In gastric cancer patients, insufficient oral intake related to disease-specific symptoms can induce more severe nutritional depletion than in other cancer patients, and this may result in an increased prevalence of sarcopenia.

Understanding Cancer Cachexia and Its Implications in Upper Gastrointestinal Cancers

“…Trials of nutritional and exercise-based interventions, in isolation, for patients undergoing resection of upper GI cancer have yielded inconsistent results [ 95 , 96 ]. As Fearon suggested over a decade ago; cachexia is a multi-factorial syndrome that likely requires a multimodal intervention [ 97 ].…”

The Cancer Cachexia Index Can Be Used to Prognostically Predict Patients with Gastric Cancer Undergoing Gastrectomy

“…Surgical field complications such as leakage, pancreatic fistula, and abscesses had similar rates between the two groups. This was possibly attributable to the development of new devices [30, 31] and advanced perioperative management in Japan in recent decades [32, 33]. However, major grade 3 CD complications (and more) tended to be more frequent in the low CXI group.…”

Usefulness of the cachexia index as a prognostic indicator for patients with gastric cancer

“…Patients with low CXI may need intensive nutritional and exercise guidance to improve skeletal muscle mass and prevent malnutrition before surgery. Although nutritional interventions has been less effective in the presence of malnutrition, loss of muscle mass, or sarcopenia with high inflammatory cytokines, 26 combination of nutritional and physical intervention may have possibility to improve these status compared with nutritional or physical intervention alone 27 . A study indicated that among sarcopenia patients with gastric cancer, 18% of those patients was improved to be nonsarcopenic after 3 weeks of preoperative exercise and nutritional support 28 .…”

“…with high inflammatory cytokines, 26 combination of nutritional and physical intervention may have possibility to improve these status compared with nutritional or physical intervention alone. 27 A study indicated that among sarcopenia patients with gastric cancer, 18% of those patients was improved to be nonsarcopenic after 3 weeks of preoperative exercise and nutritional support. 28 Moreover, another study showed that preoperative nutrition and exercise intervention in patients with gastric cancer have improved NLR, resulting in decreased secretion of cytokines and chemokines, which play important roles in cancer progression.…”