Nutrition update in gastric cancer surgery

Abstract

Patients with gastric cancer are often malnourished during tumor progression. Malnutrition is a risk factor for postoperative complications and a poor prognosis. Early evaluation and management of nutrition can improve these outcomes. Various combined indices in which albumin is the primary component are used to evaluate the nutritional status, including the Prognostic Nutritional Index, Glasgow Prognostic Score, and Controlling Nutritional Status score. Both the American Society for Parenteral and Enteral Nutrition and the European Society for Clinical Nutrition and Metabolism guidelines recommend immediate and early oral/enteral nutrition. However, few reports have described the additional effects of preoperative immunonutrition on clinical outcomes of gastric cancer surgery. Gastrectomy types and reconstruction methods that consider the postoperative nutritional status have been used when oncologically acceptable. Total gastrectomy has recently tended to be avoided because of its negative impact on nutritional status. New findings obtained from the emergence of continuous glucose measurement, such as glucose fluctuation and nocturnal hypoglycemia, may affect nutritional management after gastrectomy. Some prospective clinical studies on perioperative nutritional intervention have set postoperative body weight loss as a primary endpoint. It seems important to continue oral nutritional supplement, even in small doses, to reduce body weight loss after gastrectomy. Evidence generated by prospective, well‐developed randomized controlled studies must be disseminated so that nutritional therapy is widely recognized as an important multimodal therapy in patients undergoing gastric cancer surgery.

The prognostic significance of combined geriatric nutritional risk index and psoas muscle volume in older patients with pancreatic cancer

“…Malnutrition is closely associated with poor survival in patients with cancer of the digestive system [10][11][12]. Cancer-related malnutrition is indicative of hypercatabolism promoted by aggressive biological behaviors from cancer [5].…”

Role of Nutritional Care and General Guidance for Patients with Advanced or Metastatic Gastric Cancer

“…Despite the recent development of improved treatments for gastric cancer, including antiangiogenic therapies and immunotherapy, nutritional care for gastric cancer lags substantially behind other cancer types. Furthermore, while many studies have investigated perioperative nutritional care for patients with gastric cancer who have undergone gastrectomy [15,16], there is limited literature regarding nutritional care for patients with advanced or metastatic gastric cancer. Therefore, the purpose of this narrative review is to describe the relevance of nutritional status in patients with advanced or metastatic gastric cancer and provide general guidance regarding management of their nutritional care.…”

The Effect of Omega-3 Enriched Oral Nutrition Supplement on Nutritional Indices and Quality of Life in Gastrointestinal Cancer Patients: A Randomized Clinical Trial

“…However, blood albumin concentration has been known to be associated with other physiological factors including age, circulating estrogen concentration, chronic blood loss and iron deficiency (Banh, 2006) suggesting albumin alone might not be an accurate marker for nutritional intervention in cancer patients (Friedman and Fadem, 2010) receiving different treatments. One of the most recent reviews states that serum albumin levels for nutritional monitoring of critically ill patients are influenced by the acute phase response such as inflammation and may not accurately reflect nutritional status (Kubota et al, 2020). Other recent studies combined albumin concentration with other nutritional and inflammatory biomarkers to assess the efficacy of ONS intervention (Hao et al, 2020;Jeon et al, 2020) with better predictions for cancer prognosis.…”