Annals of Clinical Nutrition and Metabolism

Original Article

Current status and short-term results regarding frailty in patients undergoing gastrointestinal cancer resection in Japan: a retrospective cohort study: Asuka Yasueda, Junichi Nishimura, Seiji Ikeda, Naotsugu Haraguchi, Hirofumi Akita, Hiroshi Wada, Chu Matsuda, Takeshi Omori, Masayoshi Yasui, Hironari Tamiya, Hideaki Tahara, Hiroshi Miyata; Ann Clin Nutr Metab 2026;18(1):54-62. Published online March 30, 2026; DOI: https://doi.org/10.15747/ACNM.25.0013

Graphical Abstract Abstract PDF: Purpose
Frailty is a state of physical and cognitive decline that exists between robust health and the need for nursing care. Frailty is reported to occur at a high rate among patients with cancer and is associated with postoperative complications, such as delirium, infection, reduced survival, and rehospitalization. In this study, we investigated the incidence of frailty and surgical outcomes in patients who underwent surgery for gastrointestinal cancer.
Methods
A total of 201 patients who underwent preoperative physical assessment at Osaka International Cancer Institute between July and September 2021 were included. The Japanese version of the Cardiovascular Health Study (J-CHS) index was used to assess the frequency of frailty and related postoperative outcomes.
Results
Among the 201 patients, 27 (13%) were classified as frail and 126 (63%) as pre-frail. Of the 27 frail patients, 22 (81%) were older adults—a significantly higher proportion compared to the pre-frail/robust group (P=0.004). The median hospital stay for frail patients was 17 days (range, 5–98 days), which was significantly longer than that for robust patients (P<0.001). Postoperative complications occurred in 13 frail patients (48%), which was higher than in pre-frail (n=36, 29%) and robust (n=6, 13%) patients. Furthermore, multivariate analysis showed that frailty was an independent risk factor for postoperative complications.
Conclusion
These findings indicate that frailty is common among older adults with gastrointestinal cancer and has a significant impact on both the length of hospital stay and the risk of postoperative complications.

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Review

Postoperative gut dysbiosis and its clinical implications, with an emphasis on probiotic strategies in gastric cancer patients undergoing gastrectomy: a narrative review: Cheong Ah Oh; Ann Clin Nutr Metab 2025;17(2):114-124. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0023

Abstract PDF

Purpose
This review explores alterations in gut microbiota following gastrointestinal surgery, with a focus on gastrectomy for gastric cancer, and evaluates the therapeutic potential of probiotics in restoring microbial balance and reducing postoperative complications, including infections, inflammation, immune dysfunction, and cancer recurrence.
Current concept
Gastrointestinal surgery disrupts gut microbial homeostasis via surgical stress, oxygen exposure, altered bile flow, and perioperative antibiotic use. Gastrectomy, in particular, induces marked changes in the microbiota, including increased oral-origin and aerotolerant bacteria, decreased short-chain fatty acid–producing species, and elevated bile acid-transforming organisms. These alterations contribute to complications such as small intestinal bacterial overgrowth, surgical site infections, postoperative ileus, nutrient malabsorption, and potentially a higher risk of colorectal cancer. Probiotics—especially strains of Lactobacillus, Bifidobacterium, and Clostridium—have demonstrated beneficial effects by modulating the gut ecosystem, enhancing epithelial barrier integrity, and regulating immune and metabolic pathways. Randomized clinical trials support using probiotics in improving gastrointestinal recovery, reducing systemic inflammation, restoring microbial diversity, and shortening hospital stays after gastrectomy. Multi-strain probiotic formulations, particularly when administered perioperatively, show the greatest promise. However, safety concerns remain, especially for immunocompromised or critically ill patients, underscoring the need for rigorous clinical oversight and adherence to regulatory standards such as the European Food Safety Authority’s Qualified Presumption of Safety guidelines.
Conclusion
Postoperative dysbiosis is a modifiable factor in adverse surgical outcomes. Probiotic supplementation offers promising therapeutic potential in patients undergoing gastrectomy, though optimal strains, dosing, and timing remain to be determined. Tailored, evidence-based strategies may ultimately enhance both recovery and long-term outcomes after gastric cancer surgery.

Citations

Citations to this article as recorded by

Interactions Between the Human Microbiome and Surgical Practice
Julia Kalinowski, Nada Nasr, Angelina Colamarino, Michelle Marie Esposito
Hygiene.2026; 6(1): 10. CrossRef
How gut microbiota modulate anesthetic drug response and perioperative outcomes
Dawei Wang
Drug Metabolism Reviews.2026; : 1. CrossRef

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