Introduction Patients with gastric carcinoma often suffer from malnutrition after curative gastrectomy. It is difficult to identify patients who require further nutritional support as part of their long-term post-operative care because factors influencing weight loss are unknown, and it is also inefficient to directly evaluate the nutritional status of every patient using available screening tools. This study aims to identify factors influencing weight loss after curative gastrectomy, which can be used to efficiently identify at-risk patients to improve outcomes.
Methods 163 patients (71.8% of those eligible) who underwent curative gastrectomy from 2000 to 2010 at the National University Hospital were identified from a prospectively maintained database. Factors predicting severe malnutrition at 6 months post-gastrectomy (defined as ≥10% loss of pre-operative weight), and factors influencing gain/plateau vs further weight loss over the following 6 months in the patients who were malnourished at 6 months post-gastrectomy were identified with multiple logistic regression.
Results Severe malnutrition was present in 52.8% (n=86) at 6 months post-gastrectomy. For these patients, those who had anaemia (OR 3.662, p=0.006), gastrointestinal bleeding (OR 2.532; p=0.038) or weight loss (OR 1.052; p=0.010) at presentation, histopathologies of poorly and moderately differentiated tumours (OR 3.632 and 1.757 respectively; p=0.029), adjuvant therapy (OR 8.464; p=0.000), and those requiring step-down care upon discharge (OR 5.739; p=0.021) were at increased risk of weight loss. However, male gender (OR 0.288; p=0.012), vomiting at presentation (OR 0.219; p=0.014), and neo-adjuvant therapy (OR 0.225; p=0.027) were associated with decreased risk. Age, race and operation length were not significant factors at 6 months. Of the patients who were malnourished at 6 months, 54.9% (n=39) developed further weight loss over the subsequent 6 months. Pre-operative total lymphocyte count (OR 2.141; p=0.033) and tumour size (OR 1.235; p=0.054) were associated with increased risk. Age, gender and race were not significant factors at 12 months.
Conclusion Malnutrition is a significant problem post-gastrectomy. More nutritional care should be provided to patients presenting with acute presentation, poor tumour biology and those requiring adjuvant therapy and step-down care as these are risk factors at 6 months. At 1 year, patients who initially had larger tumour sizes and higher pre-operative total lymphocyte counts are at greater risk of continued weight loss, and should receive further nutritional support as part of their long-term post-operative care.
Competing interests None declared.
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