Nutritional Status of Gastric Cancer Patients after Total Gastrectomy

Abstract

A number of causes of malnutrition after total gastrectomy have been proposed. The purpose of this study was to assess nutritional status and to determine the cause of malnutrition after total gastrectomy. We studied 20 gastric cancer patients who had undergone total gastrectomy and immunochemotherapy and 6 normal controls. Nutritional status was assessed by dietary history, anthropometric methods, and serologic measurements. Malabsorption tests included the fecal fat excretion test, D-xylose absorption test, glucose tolerance test, vitamin B12 absorption test using dual isotopes, bacterial culture of jejunal aspirates, and jejunal biopsy. Weight loss was compared to the preoperative status in all patients (average 15%: 59.0 +/- 9.9 vs. 50.2 +/- 7.8 kg, preoperatively vs. postoperatively). Average daily calorie intake was 1586.2 kcal, which is lower than the normal intake of Korean adults (1838 kcal). Malnutrition of skeletal and visceral protein was not found. There was, however, severe fat malnutrition and a deficit of body fat. Postoperatively the body mass index was considerably lower than that preoperatively (22.2 +/- 0.4 vs. 18.9 +/- 0.4 kg/m2; preoperatively vs. postoperatively). With malabsorption tests, the daily excreted amount of fecal fat was 28.6 +/- 3.4 g (mean +/- SD) in patients and 6.9 +/- 0.2 g in controls. There was no significant malabsorption of carbohydrates. In 64.3% (9/14) of patients, vitamin B12 absorption was abnormal; and the serum concentration of vitamin B12, which was significantly related to malabsorption of this vitamin, was lower than normal in 73.7% (14/19). Bacterial overgrowth was not found, and there were no abnormal histologic findings in the jejunal mucosa. These results suggest that poor oral intake and fat malabsorption following total gastrectomy cause malnutrition and that fat malabsorption may be related to relative pancreatic insufficiency.

Prevalence of the Metabolic Syndrome and Associated Factors in Korean Cancer Survivors

“…Gastrectomy is the gold standard for curative treatment modality performed on gastric cancer patients (Brennan and Karpeh, 1996). Previous studies have shown that poor nutritional status was observed in patients who had undergone gastrectomy (Bae et al, 1998;Carey et al, 2011). After the operation, severe fat malnutrition and vitamin deficiency were found (Bae et al, 1998).…”

“…Previous studies have shown that poor nutritional status was observed in patients who had undergone gastrectomy (Bae et al, 1998;Carey et al, 2011). After the operation, severe fat malnutrition and vitamin deficiency were found (Bae et al, 1998). Major upper gastrointestinal surgery affects permanent alterations to the gastrointestinal tract, and therefore results in weight loss, body change, and malabsorption (Carey et al, 2011).…”

Weight loss and quality of life in patients surviving 2 years after gastric cancer resection

“…Our study identifies some baseline HRQL items related to long-term greater BWL. Two studies have previously described 7-15% of BWL after gastric cancer resection (14,15). Another study has even identified cachexia in half of the patients (9).…”

“…Previous studies have found that patients undergoing total gastrectomy will lose 7%-15% of their body weight, usually within the first year of surgery, and will not return to a preoperative weight (14)(15)(16). The reduction in calorie intake as well as malabsorption are considered the main factors responsible for BWL (14).…”

Clinical application of ghrelin administration for gastric cancer patients undergoing gastrectomy

“…It correlates well with a decline in postoperative quality of life and is the most reliable indicator of malnutrition, which impairs immune function, infection susceptibility, and survival [1][2][3]. Although various mechanisms have been considered, such as the perturbation of absorption due to reduced pancreatic excretion [4,5], a decrease in the gastric acid level [6], reflux esophagitis [7], intestinal floral alteration [8], and increased peristalsis and diarrhea [9], reduced food intake [10,11] is the most conceivable explanation for weight loss after gastrectomy. To combat loss of appetite, surgeons dealing with gastric cancers have tried to increase food intake by producing a gastric substitute, such as a jejunal pouch, with limited success [12].…”