Effectiveness of a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer

Abstract

We established a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer. Twenty-two gastric cancer patients aged 65 years or older with a diagnosis of sarcopenia according to the algorithm proposed by the European Working Group on Sarcopenia in Older People received our preoperative program. The median duration of the program participation was 16 days. Total calorie and protein intakes were significantly higher after the program than before [29.4 ± 6.9 kcal/kg ideal body weight (IBW) vs 27.3 ± 5.6 kcal/kg IBW, p = 0.049, and 1.3 ± 0.4 g/kg IBW vs 1.1 ± 0.3 g/kg IBW, p = 0.0019, respectively]. Handgrip strength significantly increased after the program (21.2 ± 5.2 kg vs 20.0 ± 5.3 kg, p = 0.022). Likewise, gait speed and skeletal muscle mass index increased, although the differences did not reach statistical significance. Four patients became nonsarcopenic after the program. Postoperative complications were observed in three patients (13.6%); however, none of these complications were severe (Clavien-Dindo grade III or lower). A preoperative exercise and nutritional support program has the potential to reduce sarcopenia and improve postoperative outcome in elderly sarcopenic patients with gastric cancer.

Bioelectrical Impedance Analysis for the Assessment of Sarcopenia in Patients with Cancer: A Systematic Review

“…For articles that remained after the initial screen, 65 full texts were reviewed for eligibility. Ultimately, 24 studies were selected for inclusion in the systematic review-18 articles [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]47] and 6 abstracts [33, 44-46, 48, 53]-with a total of 3,607 patients. Table 2 provides an overview of included studies regarding number of study participants, cancer types, inclusion criteria, and stage of care when the BIA assessment was conducted.…”

Sarcopenia as a comorbidity‐independent predictor of survival following radical cystectomy for bladder cancer

“…28 Interestingly, the same research group investigated 22 sarcopenic patients undergoing gastrectomy for gastric cancer and established a pre-operative exercise and nutritional support programme, which resulted in a significantly higher calorie and protein intake per day and increased handgrip strength. 29 In addition, four of the 22 investigated patients became non-sarcopenic after the support programme. In the previously mentioned study by Hirasawa et al, 13 it was demonstrated that sarcopenic patients showed significantly lower haemoglobin levels than non-sarcopenic patients.…”

“…A prospective Japanese single‐centre study demonstrated that sarcopenic patients older than 65 years undergoing gastrectomy for gastric cancer had significantly lower caloric and protein intake per day and had significantly more severe complications . Interestingly, the same research group investigated 22 sarcopenic patients undergoing gastrectomy for gastric cancer and established a pre‐operative exercise and nutritional support programme, which resulted in a significantly higher calorie and protein intake per day and increased handgrip strength . In addition, four of the 22 investigated patients became non‐sarcopenic after the support programme.…”

Skeletal Muscle Loss during Neoadjuvant Chemotherapy Is an Independent Risk Factor for Postoperative Infectious Complications in Patients with Advanced Esophageal Cancer

“…In general, it takes more than several weeks to observe the effects of nutritional or exercise therapy. Indeed, Yamamoto et al [27] found that the increase in lean body mass was significantly higher in elderly patients with gastric cancer who participated for more than 3 weeks than in those who participated for less than 3 weeks in nutritional or exercise therapy. The period of neoadjuvant therapy, which is usually 8-12 weeks, is an important time to take measures against surgical complications.…”

“…Lonbro et al [26] demonstrated that resistance training effectively increased lean body mass in head and neck cancer patients following radiotherapy. Yamamoto et al [27] reported that preoperative exercise and nutritional support programs have the potential to improve sarcopenic status and the postoperative clinical course in elderly sarcopenic patients with gastric cancer. In general, it takes more than several weeks to observe the effects of nutritional or exercise therapy.…”