Annals of Clinical Nutrition and Metabolism

Original Articles

Current Status of Calorie Support during the Immediate Post-Operative Period Following a Gastrectomy: Eung Kyu Kim, Jae-Moon Bae, You Na Kim, Ji Yeong An, Min-Gew Choi, Jun Ho Lee, Tae Sung Sohn, Sung Kim; Surg Metab Nutr 2019;10(2):66-74. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.66

Abstract PDF ePub: Purpose:
The aim of this study was to elucidate the patterns of calorie support during the immediate postoperative period following a gastrectomy in gastric cancer patients.
Materials and Methods:
The clinicopathologic characteristics and nutritional parameters, including the actual infused amount of calories during the immediate postoperative period, were retrospectively collected and analyzed, This was data from a total 1,390 cases out of 1,404 patients who underwent curative gastrectomy at Samsung Medical Center, from Jan. 1 2016 through Dec. 31, 2016.
Results:
The actual infused amount of calories during the immediate postoperative period (the first three days following surgery) was only 41.6% of the recommended average intake of calories, which was significantly lower (759.8±139.4 kcal/day vs 1,825.7±251.6 kcal/day, respectively). The target calories supply per unit body weight was 30 kcal/kg. According to the operative method, the average infused amount of calories was lower in open gastrectomy compared to when utilizing the minimal invasive methods (laparoscopic assisted or robot assisted gastrectomy) (742.11 kcal/day:11.7 kcal/kg vs 792.95 kacl/day:12.8 kcal/kg or 791.43 kcal/day:12.8 kcal/kg, respectively). In regards to the operative type, the average infused amount of calories was higher in subtotal gastrectomy compared to that in total gastrectomy (732.1 kcal/day:12.23 kcal/kg vs 689.5 kcal/day:11.7 kcal/kg, respectively). The female group had a higher calorie supply per unit body weight compared to that of the male group (766.0 kcal/day:13.7 kcal/kg vs 758.9 kcal/day:11.3 kcal/kg, respectively). According to body mass index (BMI), the low BMI group had a lower calorie intake compared to that of the normal or high BMI group (700.2 kcal/day:15.3 kcal/kg vs 761.8 kcal/day:13.6 kcal/kg vs 766.5 kcal/day:11.1 kcal/kg, respectively). The actual infused amount of calorie significantly varied day by day in all the groups (range: 31.52 kcal/day to 1,559.31 kcal/day).
Conclusion:
The actual calorie intake significantly varied from day-to-day. Moreover, the intake was significantly lower than the average daily recommended amount of calories following a gastrectomy in gastric cancer patients during the immediate postoperative period.

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Clinical Implications of the Cut-off Value of the Preoperative Prognostic Nutritional Index in Patients with Early Stage Gastric Cancer: Ji Hye Jung, Ji Yeong An, You Na Kim, Min Gew Choi, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim; Surg Metab Nutr 2019;10(2):59-65. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.59

Abstract PDF ePub: Purpose:
The perioperative nutritional status is a potential prognostic factor in gastric cancer patients. This study assessed the optimal cut-off value of the prognostic nutritional index (PNI) for predicting the survival of patients with early stage gastric cancer and evaluated its power for predicting the survival after gastric cancer surgery.
Materials and Methods:
This study reviewed the data of 8,014 patients with stage T1N0~1M0 and T2~3N0M0 gastric cancer who underwent a curative gastrectomy without adjuvant chemotherapy between January 2006 and December 2015. The log-rank test on SAS was conducted to determine the preoperative PNI cut-off value that indicated the most significant difference in survival, and the clinical features and oncological outcomes were analyzed according to the cut-off value of the preoperative PNI.
Results:
The preoperative PNI cut-off value that indicated the most significant difference in survival was 43.7. Using this cut-off value, patients were classified into high PNI and low PNI groups. The five-year overall survival rate was 96.9% and 81.5% for the high and low PNI group, respectively (P<0.001). Considering each stage (Ia, Ib, and IIa), the overall survival rates were significantly higher for the high PNI group than the low PNI group. Multivariable analysis revealed the cut-off value of the preoperative PNI to be among the independent risk factors for survival.
Conclusions:
The cut-off value of the preoperative PNI that could be used to determine the significant differences in the survival of patients with early stage gastric cancer was identified and proven to have a significant impact on predicting survival.

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Risk Factor of Anemia after a Gastrectomy in Patients with Gastric Cancer: In Jun Yang, Dong-Wook Kim, Ye Seob Jee; Surg Metab Nutr 2019;10(1):15-19. Published online June 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.1.15

Abstract PDF ePub: Purpose:

In this study, we evaluate hematologic change of iron and vitamin B₁₂ on post-operative anemia after gastrectomy for gastric cancer.

Materials and Methods:

The patients with gastric cancer who underwent gastrectomy between January 2013 and December 2013 in Dankook university hospital were retrospectively reviewed. The 62 patients were followed up for 36 month postoperatively.

Results:

The incidences of anemia in female patients were turned out to be higher than those in male patients but there were no statistical difference; (44.4% vs 40.9%, P=0.399) at 6 month, (33.3% vs 25.0%, P=0.252) at 12 month, (22.2% vs 15.9%, P=0.277) at 18 month, (27.8% vs 15.9%, P=0.142) at 36 month after surgery. Patients with distal gastrectomy after the surgery showed decreasing incidence of anemia while patients with total gastrectomy showed decreasing incidence of anemia until 12 months but increasing incidence after that time.

Conclusion:

Anemia, Vitamin B₁₂ and iron deficiency must be evaluated after surgery for gastric cancer and active treatment is necessary as needed.

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Risk of Malnutrition after Gastrointestinal Cancer Surgery: A Propensity Score Matched Retrospective Cohort Study: Sung-Hoon Yoon, Bong-Hyeon Kye, Hyung-Jin Kim, Kyong-Hwa Jun, Hyeon-Min Cho, Hyung-Min Chin; Surg Metab Nutr 2018;9(1):16-25. Published online June 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.1.16

Abstract PDF ePub: Purpose:

Patients with cancers arising from the gastrointestinal tract can suffer from nutritional inadequacies caused by various factors. This study investigated the risk of malnutrition after curative surgery in patients with gastric cancer (GC) or colorectal cancer (CRC) using various preoperative and postoperative nutritional screening tools.

Materials and Methods:

In the authors’ hospital, 407 patients (206 patients with GC and 201 patients with CRC) underwent surgery between July 2011 and June 2012. The patients from the two groups were matched using the propensity score and then analyzed the nutritional data from 170 patients (85 patients in each group), retrospectively.

Results:

In both groups, the postoperative nutritional status was impaired significantly compared to the preoperative status. The postoperative risk of undernutrition in CRC patients was significantly lower than that of the GC patients according to the Malnutrition Universal Screening Tool (P=0.007). At the time of hospital discharge after surgery, the incidence of a lower serum albumin level (P=0.002) and more than 5% weight loss (P=0.013) were higher in the GC group than in the CRC group. A comparison of the postoperative nutritional status among the types of surgery in each group, total gastrectomy in the GC group (P=0.015) and proctectomy with diverting stoma in the CRC group (P=0.06), were related to more than 5% weight loss.

Conclusion:

Gastrointestinal cancer surgery might increase the patients’ postoperative risk of malnutrition, particularly in GC surgery. Therefore, consecutive assessments of the nutritional status and appropriate nutritional support are necessary after surgery for GC and CRC.

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Association of Nutrition Status-Related Indices and XELOX Chemotherapy Compliance in Gastric Cancer Patients: Sang Hyun Park, Geum Jong Song, Myoung Won Son, Sun Wook Han, Sang Ho Bae, Sung Yong Kim, Moo Jun Baek, Moon Soo Lee; Surg Metab Nutr 2017;8(2):36-40. Published online December 30, 2017; DOI: https://doi.org/10.18858/smn.2017.8.2.36

Abstract PDF ePub: Purpose:
Cancer-associated malnutrition is common in gastric cancer patients and affects their response to treatment. This study evaluated pre-operative and pre-chemotherapy nutritional status-related indices associated with compliance in post-operation state gastric cancer patients receiving chemotherapy.
Materials and Methods:
We retrospectively reviewed medical records of patients with gastric cancer undergoing curative D2 resection between August 2014 and July 2016. A total of 51 patients who underwent adjuvant chemotherapy with a regimen of capecitabine and oxaliplatin (XELOX) were screened. Nutritional status assessment included body weight (BW), body mass index (BMI), serum albumin, serum total protein, hemoglobin, and total lymphocyte count (TLC).
Results:
Twenty-six patients had stage II gastric cancer, and 25 patients had stage Ⅲ gastric cancer according to the guidelines of the American Joint Committee on Cancer. Eighty-two percent of patients completed their chemotherapy according to the therapy protocol. However, 49% of patients were subjected to drug dose reduction, and 18% of patients needed to cease therapy. We found that pre-chemotherapy serum albumin level was significantly associated with completion of chemotherapy (P=0.043), and there was no significant relationship of BW, BMI, serum total protein, hemoglobin, and TLC with compliance of chemotherapy.
Conclusion:
Our study results suggest that patients with a low serum albumin level are highly susceptible to discontinuation of chemotherapy. Thus, serum albumin concentration could be used as a predictor of successful completion of chemotherapy before starting treatment.