Short-term nutritional implications of total gastrectomy for malignancy, and the impact of parenteral nutritional support

Aims: To report on peri-operative nutritional status in gastric cancer patients undergoing total gastrectomy, and to examine the rote of post-operative parenteral nutrition. Methods: Retrospective study of prospectively collected data on 90 consecutive patients who underwent total gastrectomy for malignancy. Results: At diagnosis 46% of patients reported clinically severe weight loss, and dietary intake was inadequate in 72% of patients. Post-operatively 42% were given total parenteral nutrition (TPN) and 53% were given intravenous fluids (IVF) atone. TPN patients spent a mean of 13.6 days on nutrition support versus IVF patients who spent a mean of 9.2 days without any form of nutrition. IVF patients lost significantly more weight in hospital than TPN patients (5.2 kg versus 3.1 kg, p = 0.008). 69% of IVF patients lost severe amount of weight versus 34% in the TPN group (p = 0.01). Post-discharge, IVF patients continued to lose significantly more weight than those given TPN post-operatively (7.5 kg versus 2.9 kg, p = 0.01) corresponding to 10.5% of their body weight from discharge to follow up versus 4.9% for TPN group (p = 0.014). From pre-illness to follow up, patients lost an average of 15.5 kg-IVF patients lost 17.8 kg versus 9.6 kg in TPN (p<0.01). There was no difference in post-operative complications between the groups; however, patients with > 10% weight loss had a significantly higher rate of complications and a significantly higher mortality rate than patients who lost < 10% body weight (26.2% versus 51.9%, p = 0.036 and 11.1% versus 0%, p = 0.027, respectivety). On multivariate logistic regression analysis > 10% weight loss at diagnosis was the only predictive factor of post-operative complications OR 3.1 (95% CI 1.0-9.6), p = 0.04). Conclusions: There is a high prevalence of malnutrition in gastric cancer patients undergoing surgery. Total gastrectomy is associated with dramatic weight toss, which continues beyond the surgeon's view post-discharge, with patients losing an average of 15.5kg by 3-month follow up. Provision of nutrition support in the form of TPN post-operatively significantly reduces in-hospital weight toss and also helps to attenuate further weight toss post-discharge. (C) 2007 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. ALL rights reserved.