Related Experiment Video
Updated: Aug 6, 2026
Laparoscopic Radical Gastrectomy for Remnant Gastric Cancer
Published on: October 31, 2025
Preoperative fluid imbalance predicts remote infection after gastrectomy for gastric cancer
Tomohiko Yasuda1, Daisuke Kakinuma2, Issei Inoue2
1Department of Gastroenterological Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari1715 Kamagari, Inzai-shi, 270-1694, Chiba, Japan. t-yasuda@nms.ac.jp.
Purpose:
Postoperative infectious complications (POI) after gastrectomy remain a major concern. While bioelectrical impedance analysis (BIA) is used for nutritional assessment, the clinical relevance of the preoperative extracellular water-to-total body water ratio (ECW/TBW) remains unclear. We investigated the association between preoperative ECW/TBW and POI.
Methods:
This single-center retrospective cohort study included 181 patients who underwent curative gastrectomy between November 2020 and October 2025. Preoperative ECW/TBW was measured using multifrequency BIA. The primary outcome was POI, defined as surgical site infection (SSI) and/or remote infection (RI) within 30 days. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed.
Results:
POI developed in 44 patients (24.3%), as SSI in 30 (16.6%) and as RI in 16 (8.8%). Multivariable analysis identified that a higher ECW/TBW was associated with POI (odds ratio [OR] per 0.01 increase, 1.68; 95% confidence interval [CI], 1.02-2.77; P = 0.040) and RI (OR 1.79; 95% CI, 1.00-3.21; P = 0.048), but not with SSI. ROC analysis showed a numerically higher AUC of ECW/TBW for predicting RI (area under the curve, 0.833) than phase angle (0.761).
Conclusions:
Elevated ECW/TBW may reflect systemic physiological vulnerability associated with RI, particularly postoperative respiratory infection.
