Nutritional status after total and partial gastrectomy with Roux-en-Y reconstruction

Area of Science:

• Gastroenterology
• Surgical Oncology
• Nutritional Science

Background:

• Gastric surgery, including total and partial gastrectomy, significantly alters digestive anatomy.
• Roux-en-Y reconstruction is a common method to restore gastrointestinal continuity after gastrectomy.
• Long-term nutritional consequences following these procedures require thorough investigation.

Purpose of the Study:

• To evaluate the long-term dietary intake and nutritional status of patients after total versus partial gastrectomy.
• To assess the prevalence of weight loss, subnormal body mass index, and fat malabsorption in these patient groups.
• To correlate surgical outcomes with nutritional parameters years after gastric cancer surgery.

Main Methods:

• Comparative study of two groups: 10 total gastrectomy and 10 partial gastrectomy patients.
• Clinical assessment including anthropometry, upper gastrointestinal endoscopy, and blood chemistry.
• Functional testing using the [14C]triolein breath test to assess fat malabsorption.
• Nutritional status evaluated 4-17 years post-operation.

Main Results:

• Total gastrectomy patients showed a significantly higher median weight loss (6.7 kg) compared to partial gastrectomy (2.1 kg).
• Fat malabsorption was observed in 50% of total gastrectomy patients and 30% of partial gastrectomy patients.
• Energy intake below recommendations was noted in 70% of partial gastrectomy patients versus 20% of total gastrectomy patients.

Conclusions:

• Total gastrectomy, despite reconstruction, is associated with more pronounced long-term weight loss and fat malabsorption.
• Nutritional status, particularly energy intake and fat absorption, remains a concern years after gastrectomy.
• Roux-en-Y reconstruction does not fully mitigate the long-term nutritional challenges posed by extensive gastric resection.