Effect of perioperative parenteral nutritional support for gastric cancer patients undergoing gastrectomy

Malnutrition is frequently seen in gastric cancer patients. Perioperative nutritional support may reduce postoperative complications, especially in severely depleted gastric cancer patients with GI obstruction. However, the beneficial effects of perioperative total parenteral nutrition for gastric cancer surgery patients still have not been clearly demonstrated in Taiwan. This study evaluated the effects of perioperative nutritional support for severely malnourished patients with gastric cancer undergoing gastrectomy.

The study analyzed malnourished patients with gastric cancer who underwent gastrectomy from Oct 2000 to Oct 2002. Total nutritional support was examined for severely depleted patients with body weight loss > 10% over 6 months or a low serum albumin level (< 3.0g/dL). These patients were classified into two groups, those without TPN (total parenteral nutrition) use and those with TPN use. The patients who received TPN were further divided into 2 groups, those who received TPN postoperatively and those who received it perioperatively. Correlation with the postoperative outcome was then made.

Forty patients who underwent total gastrectomy and 78 patients who underwent subtotal gastrectomy had severe malnutrition preoperatively. We found gastric cancer patients with malnutrition had high morbidity and mortality rates (29.7% and 8.6%, respectively) when undergoing gastrectomy, especially total gastrectomy. There was a higher morbidity rate in the group without TPN (66.7% vs. 16% and 43.75% vs. 21.74%) in both the subtotal and total gastrectomy groups, and a longer postoperative stay for patients without TPN (35.21 +/- 25.05 vs. 21.32 +/- 12.32) in the total gastrectomy group than for patients with TPN in these groups. The mortality rate, morbidity rate and postoperative stay were higher in patients who received postoperative TPN only than in patients with peri-operative TPN.

TPN use, perioperatively or postoperatively, can help reduce the morbidity and mortality of these patients. Total nutritional support is effective for patients with malnutrition undergoing gastric cancer surgery.