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Sawada A, Takagi R, Takegaki J, Fukao N, Okumura K, Fujita S. Effect of Oral Skim Milk Administration on Skeletal Muscle Protein Synthesis after Total Gastrectomy in Rat. Nutrients 2024; 16:2390. [PMID: 39125271 PMCID: PMC11313795 DOI: 10.3390/nu16152390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/30/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
Leucine is a branched-chain amino acid that is present in protein, and it is an essential factor in activating the mechanistic target of the rapamycin complex 1 signaling pathway and increasing muscle protein synthesis. However, the loss of digestive function after total gastrectomy leads to impaired protein absorption, potentially failing to stimulate muscle protein synthesis. Therefore, this study aimed to investigate whether muscle protein synthesis is enhanced by oral skim milk administration after total gastrectomy. Male Sprague Dawley rats were divided into total gastrectomy (TG) and sham surgery (S) groups. After five weeks postoperatively, we orally administered skim milk to achieve 3.1 g protein/kg body weight and collected blood and gastrocnemius muscle. The gastrocnemius muscle weight was significantly lower in the TG group than in the S group (p < 0.05). The increase in plasma leucine concentration was significantly lower in the TG group than in the S group (p < 0.05). The skeletal muscle protein synthesis and the phosphorylation of p70S6K and 4E-BP1 showed a similar increase in both groups. Even after TG, muscle protein synthesis was stimulated by consuming skim milk, accompanied by a sufficient rise in plasma leucine concentration.
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Affiliation(s)
- Atsushi Sawada
- Department of Physical Therapy, School of Rehabilitation Sciences, Health Sciences University of Hokkaido, Tobetsu 061-0293, Japan;
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu 525-8577, Japan
| | - Ryo Takagi
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama 226-8555, Japan;
| | - Junya Takegaki
- Graduate School of Agricultural Science, Kobe University, Kobe 657-8501, Japan;
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu 525-8577, Japan
| | - Naoki Fukao
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu 525-8577, Japan
| | - Koki Okumura
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu 525-8577, Japan
| | - Satoshi Fujita
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu 525-8577, Japan
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2
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Risk score for predicting death from other causes after curative gastrectomy for gastric cancer. Gastric Cancer 2023; 26:317-323. [PMID: 36449204 DOI: 10.1007/s10120-022-01354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The number of patients who die from causes other than gastric cancer after R0 resection is increasing in Japan, due in part to the aging population. However, few studies have comprehensively investigated the clinicopathological risks associated with deaths from other causes after gastrectomy. This study aimed to build a risk score for predicting such deaths. METHODS We retrospectively reviewed clinical data for 3575 patients who underwent gastrectomy for gastric cancer at nine institutions in Japan between January 2010 and December 2014. RESULTS The final study population of 1758 patients were assigned to Group A (n = 187): patients who died from other causes within 5 years of surgery, and Group B (n = 1571): patients who survived ≥ 5 years after surgery. Multivariate analysis identified nine characteristics as risk factors for poor survival: age ≥ 75 years, male sex, body mass index < 22 kg/m2, Eastern Cooperative Oncology Group Performance Status (≥ 1), diabetes mellitus, cardiovascular/cerebrovascular disease, other malignant diseases, preoperative albumin level < 3.5 g/dL, and total gastrectomy. Patients with risk scores of 0-2, 3-4, or 5-9 (based on 1 point per characteristics) were classified into Low-risk, Intermediate-risk, and High-risk groups, respectively. The 5-year survival rates were 96.5%, 85.3%, and 56.5%, for the Low-, Intermediate-, and High-risk groups, respectively, and the hazard ratio (95% confidence intervals) was 16.33 (10.85-24.58, p < 0.001) for the High-risk group. CONCLUSIONS The risk score defined here may be useful for predicting deaths from other causes after curative gastrectomy.
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3
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Youn SY, Kim BE, Kim EM. Nutrition Intervention in a Gastric Cancer Patient With Gastrectomy for 12 Months: A Case Report. Clin Nutr Res 2023; 12:1-6. [PMID: 36793777 PMCID: PMC9900073 DOI: 10.7762/cnr.2023.12.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/25/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Gastrectomy is the most effective method of treating gastric cancer, but it is commonly associated with weight loss, nutritional deficiencies, and the increased risk of malnutrition due to post-surgery complications, including gastric stasis, dumping syndrome, malabsorption, and maldigestion. Malnutrition is a risk factor for postoperative complications and poor prognosis. To prevent it and guarantee a quick recovery after surgery, continuous and individualized nutrition intervention should be performed both before surgery and postoperatively. The Department of Dietetics at Samsung Medical Center (SMC) performed nutritional status assessment before gastrectomy, initial nutritional assessment within 24 hours of admission, description of therapeutic diet after surgery, nutrition counselling before discharge, and nutritional status assessment and individual nutrition counselling after 1, 3, 6, and 12 months from surgery. This is a case report of a patient who underwent gastrectomy as well as intensive nutrition intervention in SMC.
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Affiliation(s)
- So Young Youn
- Department of Dietetics, Samsung Medical Center, Seoul 06351, Korea
| | - Bo Eun Kim
- Department of Dietetics, Samsung Medical Center, Seoul 06351, Korea
| | - Eun Mee Kim
- Department of Dietetics, Samsung Medical Center, Seoul 06351, Korea
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Lee HJ, Alzahrani KM, Kim SR, Park JH, Suh YS, Park DJ, Lee HJ, Yang HK, Kong SH. Comparison between laparoscopic pylorus-preserving gastrectomy and laparoscopic distal gastrectomy for overweight patients with early gastric cancer. Ann Surg Treat Res 2023; 104:18-26. [PMID: 36685775 PMCID: PMC9830043 DOI: 10.4174/astr.2023.104.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose Laparoscopic pylorus-preserving gastrectomy (LPPG) has a nutritional advantage over laparoscopic distal gastrectomy (LDG), however, may be less beneficial in overweight patients in terms of weight loss. The purpose of this study was to compare LPPG and LDG in overweight patients with early gastric cancer. Methods Clinicopathologic data of overweight patients (body mass index [BMI], ≥25 kg/m2) who underwent LPPG (n = 63) or LDG (n = 183) in 2016-2018 were retrospectively reviewed. In the LDG group, patients with Billroth-II anastomosis were separately grouped (LDG B-II, n = 66). Changes in BMI, hemoglobin, albumin, and total protein were compared among groups. Results Changes in BMI were not significant different among groups. The LPPG group had significantly higher albumin than the LDG group at postoperative 6 months and 1 year. The LPPG group had higher total protein than the LDG group at postoperative 2 years. The LPPG group had a higher complication rate of Clavien-Dindo classification III or higher (20.6%) than the LDG group (8.2%, P = 0.007). However, after excluding pyloric stenosis, there was no significant difference among groups (LPPG vs. LDG, P = 0.290; LPPG vs. LDG B-II, P = 0.921). Conclusion LPPG and LDG groups showed similar weight loss. However, the LPPG group had higher albumin and protein levels than the LDG group of overweight patients. Thus, it is not necessary to select LDG only for weight loss. LPPG may be selected as one option due to its potential nutritional benefit when pyloric stenosis is properly managed.
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Affiliation(s)
- Hwa-Jeong Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Khalid Mohammed Alzahrani
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Sa-Ra Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Ji-Hyun Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea
| | - Do-Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,VITCAL, Co., Ltd., Seoul, Korea
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Yan Y, Wang D, Liu Y, Lu L, Wang X, Zhao Z, Li C, Liu J, Li W, Fu W. Optimal Reconstruction After Laparoscopic Distal Gastrectomy: A Single-Center Retrospective Study. Cancer Control 2022; 29:10732748221087059. [PMID: 35412845 PMCID: PMC9121732 DOI: 10.1177/10732748221087059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives Although laparoscopic distal gastrectomy has been widely used for distal
gastric cancer, the best functional reconstruction type has not yet been
established. Based on previous experience, we propose a modified uncut
Roux-en-Y anastomosis. This study aimed to compare the outcomes of different
intracorporeal anastomoses after laparoscopic distal gastrectomy. Methods From April 2015 to August 2020, the data of 215 patients who underwent
laparoscopic distal gastrectomy was collected. The patients were divided
into 4 groups according to the digestive tract reconstruction method,
Billroth-I, Billroth-II, Roux-en-Y, and the modified uncut Roux-en-Y.
Clinicopathologic characteristics, surgery details, short-term outcomes, and
postoperative nutritional status were analyzed. Results The operation time of Billroth-I anastomosis was significantly shorter (216.2
± 25.8 min, P < .001) than that of other methods. There was no difference
in postoperative complications and OS among the 4 reconstruction methods.
The incidences of esophagitis, gastritis, and bile reflux were significantly
lower in the Roux-en-Y and uncut Roux-en-Y group (P < .001) 1 year after
surgery. And the postoperative albumin and PNI levels in uncut Roux-en-Y
group were higher than those in other groups(P < .05). On multivariate
analysis, age and reconstruction type were independently related to
esophagitis, gastritis, and bile reflux. Serum albumin and the prognostic
nutritional index were significantly higher in the uncut Roux-en-Y group
than other groups (P < .05). Conclusions All 4 reconstruction techniques are feasible and safe. The Roux-en-Y and
uncut Roux-en-Y are superior to Billroth-Ⅰ and Billroth-Ⅱ+Braun in terms of
reflux esophagitis, gastritis, and bile reflux. Uncut Roux-en-Y may result
in better PNI than the others.
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Affiliation(s)
- Yongjia Yan
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Daohan Wang
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Yubiao Liu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Li Lu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Xi Wang
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Zhicheng Zhao
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Chuan Li
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Jian Liu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Weidong Li
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Weihua Fu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
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The type of gastrectomy affects skeletal muscle loss and the long-term outcomes of elderly patients with gastric cancer: a retrospective study using computed tomography images. Surg Today 2021; 52:812-821. [PMID: 34837102 DOI: 10.1007/s00595-021-02414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Sarcopenia is common in elderly gastrectomized patients and a known risk factor for postoperative complications and poor overall survival. However, the long-term outcomes of skeletal muscle loss after gastrectomy and the differences in outcomes of different gastrectomy procedures remain unclear. METHODS The subjects of this retrospective study were 136 patients who underwent various gastrectomy procedures for early gastric cancer, namely: total gastrectomy (TG; n = 20), proximal gastrectomy (PG; n = 16), distal gastrectomy (DG; n = 60), and pylorus-preserving gastrectomy (PPG; n = 40). Skeletal muscle volume (SMV), calculated as the skeletal muscle index (SMI), was measured using cross-sectional computed tomography (CT) scans preoperatively and then 1, 2, and 3 years after gastrectomy. RESULTS Sarcopenia developed from 2 years onwards in all the patients who underwent TG. The SMI and sarcopenia prevalence after gastrectomy deteriorated over time. Multivariate analysis revealed that TG and PG were significant risk factors for skeletal muscle loss in postoperative years 1 and 3. A decrease in the SMI after TG or PG was most remarkable in elderly patients. CONCLUSIONS The type of gastrectomy affects skeletal muscle loss in the long term. Elderly patients who undergo TG or PG are at high risk of severe skeletal muscle loss.
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Ieiri N, Hotta O. A case of autosomal dominant polycystic kidney disease with amelioration of refractory cyst infections following prolonged hemodialysis time. CEN Case Rep 2021; 10:598-602. [PMID: 34138451 PMCID: PMC8494846 DOI: 10.1007/s13730-021-00614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
Renal cyst infection is a frequent and serious problem in patients with autosomal dominant polycystic kidney disease (ADPKD). Cyst infection is often a refractory complication of treatment that leads to sepsis and death in patients with ADPKD. It was previously reported that a higher dose of dialysis demonstrated clearly better survival than shorten-time dialysis. The relationship between the frequency of cyst infection episodes in hemodialysis (HD) patients with ADPKD and the dialysis dose has not yet been fully elucidated. In this report, we describe a case of an HD patient with ADPKD that was provided elongation of HD time from 4-h twice weekly HD to 8-h thrice weekly nocturnal HD. As a result, the frequency of cyst infection episodes decreased from 10.0 to 1.5 days a month. Our findings suggest that prolonged HD time might contribute to amelioration of refractory cyst infections in patients with ADPKD.
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Affiliation(s)
- Norio Ieiri
- Division of Internal Medicine, Hotta Osamu Clinic, Rokuchounomeminamimach 2-39, Wakabayashi-ku, Sendai, Miyagi, 984-0013, Japan.
| | - Osamu Hotta
- Division of Internal Medicine, Hotta Osamu Clinic, Rokuchounomeminamimach 2-39, Wakabayashi-ku, Sendai, Miyagi, 984-0013, Japan.,Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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8
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The evaluation of Ramadan fasting experience of patients with gastric cancer who underwent curative resection. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.896651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Kim YN, Choi YY, An JY, Choi MG, Lee JH, Sohn TS, Bae JM, Noh SH, Kim S. Comparison of Postoperative Nutritional Status after Distal Gastrectomy for Gastric Cancer Using Three Reconstructive Methods: a Multicenter Study of over 1300 Patients. J Gastrointest Surg 2020; 24:1482-1488. [PMID: 31309380 DOI: 10.1007/s11605-019-04301-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 05/02/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE Perioperative nutritional status has been reported to be associated with short- and long-term outcomes after surgery in gastric cancer patients. This study compared changes in nutritional status after distal gastrectomy using the Billroth I (BI), Billroth II (BII), and Roux-en-Y (RY) reconstruction techniques in gastric cancer patients. MATERIALS AND METHODS Data from 1305 gastric cancer patients who underwent distal gastrectomy at two tertiary hospitals from January 2011 to December 2016 were reviewed. The patients were divided into three groups according to reconstruction type: BI, BII, and RY. We evaluated changes in nutritional parameters including body mass index (BMI), biochemical data, the prognostic nutritional index (PNI), nutritional risk index (NRI), and geriatric nutritional risk index (GNRI) preoperatively, and 3, 6, and 12 months after surgery. RESULTS Total protein, albumin, PNI, and NRI were significantly lower in the BII group than in the BI and RY groups during follow-up (P < 0.001). In multivariate analysis, reconstruction types were independently related to decreases in BMI (> 10%), low serum protein, albumin, and cholesterol 12 months after surgery. Compared with BI, BII was associated with decreased BMI, low protein, and albumin and RY was associated with decreased BMI and low cholesterol. CONCLUSION During the first year after gastric cancer surgery, postoperative nutritional status differed according to the reconstruction type; BI resulted in the least weight and nutritional loss, RY yielded results comparable with BI in the nutritional indexes, and BII resulted in the greatest nutritional loss.
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Affiliation(s)
- You Na Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon Young Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Min-Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
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10
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The prevalence and clinical significance of postgastrectomy anemia in patients with early-stage gastric cancer: A retrospective cohort study. Int J Surg 2018; 52:61-66. [DOI: 10.1016/j.ijsu.2018.02.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 01/19/2023]
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11
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Introduzione. TUMORI JOURNAL 2017. [DOI: 10.5301/tj.2017.17298a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Kim JH, Bae YJ, Jun KH, Chin HM. Long-Term Trends in Hematological and Nutritional Status After Gastrectomy for Gastric Cancer. J Gastrointest Surg 2017; 21:1212-1219. [PMID: 28510794 DOI: 10.1007/s11605-017-3445-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 05/02/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study investigated long-term trends in hematological and nutritional parameters after gastrectomy for gastric cancer and evaluated the influence of the reconstruction type on these trends. METHODS The medical records of 558 patients who underwent curative gastrectomy with standard lymph node dissection for stage I gastric cancer between January 2006 and December 2013 were reviewed. The hematological and nutritional parameters evaluated included hemoglobin, ferritin, vitamin B12, total protein, albumin, total cholesterol, triglyceride, and calcium. The patients were followed up for 6 months postoperatively and then annually until death, cancer recurrence, or follow-up loss. RESULTS In the long term, ferritin and triglyceride gradually decreased after gastrectomy, while the other parameters decreased slightly or were stable. In the comparisons according to reconstruction type, the Roux-en-Y group had the lowest levels of hemoglobin, ferritin, vitamin B12, total protein, albumin, and total cholesterol beginning 6 months postoperatively compared with the Billroth I and II groups. However, only ferritin and vitamin B12 had significant differences in the 5-year cumulative incidences of deficiency/reduction according to the reconstruction type, whereas albumin, triglyceride, total cholesterol, and calcium did not. CONCLUSIONS Although malabsorption and malnutrition are common in patients after a gastrectomy, most nutritional parameters were stable or decreased slightly in the long-term and were not markedly influenced by the reconstruction type or extent of gastrectomy. Therefore, for more accurate nutritional assessment after gastrectomy, multidirectional monitoring should be considered rather than simply measuring biochemical parameters.
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Affiliation(s)
- Ji-Hyun Kim
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - You-Jin Bae
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyong-Hwa Jun
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,, 93-6, Jidong, Paldal-gu, Suwon, Gyeonggi-do, 442-723, Republic of Korea.
| | - Hyung-Min Chin
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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13
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Lahey MD, Kamel AY. Thiamin, Pyridoxine, Vitamin D, and Carotene Deficiency in a Malnourished Patient Following Billroth II Gastrectomy. Nutr Clin Pract 2016; 32:271-274. [PMID: 27810990 DOI: 10.1177/0884533616675594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe the case of a malnourished 48-year-old man who had previously undergone a Billroth II procedure for severe peptic ulcer disease. He was found to have a severely stenotic gastrojejunal anastomosis with inflamed mucosa that prevented him from tolerating solid food. Laboratory assessment revealed deficiencies in thiamin, pyridoxine, vitamin D, and carotene. This case demonstrates potential vital micronutrient complications following a partial gastrectomy.
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Affiliation(s)
- Mark D Lahey
- 1 Department of Pharmacy, UF Health Shands Hospital, Gainesville, Florida, USA
| | - Amir Y Kamel
- 1 Department of Pharmacy, UF Health Shands Hospital, Gainesville, Florida, USA
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14
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Imamura H, Nishikawa K, Kishi K, Inoue K, Matsuyama J, Akamaru Y, Kimura Y, Tamura S, Kawabata R, Kawada J, Fujiwara Y, Kawase T, Fukui J, Takagi M, Takeno A, Shimokawa T. Effects of an Oral Elemental Nutritional Supplement on Post-gastrectomy Body Weight Loss in Gastric Cancer Patients: A Randomized Controlled Clinical Trial. Ann Surg Oncol 2016; 23:2928-35. [PMID: 27084538 DOI: 10.1245/s10434-016-5221-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Post-gastrectomy weight loss is associated with deterioration in quality of life, and influences the long-term prognosis of gastric cancer patients. We conducted a prospective, randomized controlled, open-label study to examine whether an oral elemental diet (Elental(®), Ajinomoto Pharmaceuticals, Tokyo, Japan; hereafter referred to as ED) prevents postoperative weight loss in post-gastrectomy patients. METHODS Patients were randomly divided to receive the ED or control diet. The ED group received 300 kcal of ED plus their regular diet for 6-8 weeks after surgery, starting from the day the patient started a soft rice or equivalent diet after surgery, while the control group received the regular diet alone. The primary endpoint was the percentage of body weight loss (%BWL) from the presurgical body weight to that at 6-8 weeks after surgery. Secondary endpoints were dietary adherence, nutrition-related blood parameters, and adverse events. RESULTS This study included 112 patients in eight hospitals. The mean treatment compliance rate in the ED group was 68.7 ± 30.4 % (median 81.2 %). The %BWL was significantly different between the ED and control groups (4.86 ± 3.72 vs. 6.60 ± 4.90 %, respectively; p = 0.047). In patients who underwent total gastrectomy, the %BWL was significantly different between the two groups (5.03 ± 3.65 vs. 9.13 ± 5.43 %, respectively; p = 0.012). In multivariate analysis, ED treatment, surgery type, and preoperative performance status were independently associated with %BWL. No significant differences were observed in the other clinical variables. CONCLUSIONS ED supplementation reduced postoperative weight loss in gastric cancer patients undergoing gastrectomy.
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Affiliation(s)
- Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Japan.
| | | | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Kentaro Inoue
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Jin Matsuyama
- Department of Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Yusuke Akamaru
- Department of Surgery, Ikeda Municipal Hospital, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Sakai Municipal Hospital, Osaka, Japan
| | | | | | - Junji Kawada
- Department of Surgery, Kaizuka City Hospital, Osaka, Japan
| | | | - Tomono Kawase
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Japan
| | - Junichi Fukui
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Mari Takagi
- Department of Pharmacy, Osaka General Medical Center, Osaka, Japan
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
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15
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Bachmann J, Müller T, Schröder A, Riediger C, Feith M, Reim D, Friess H, Martignoni ME. Influence of an elevated nutrition risk score (NRS) on survival in patients following gastrectomy for gastric cancer. Med Oncol 2015; 32:204. [DOI: 10.1007/s12032-015-0631-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 05/05/2015] [Indexed: 12/19/2022]
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16
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Dietary alterations and restrictions following surgery for upper gastrointestinal cancers: Key components of a health-related quality of life intervention. Eur J Oncol Nurs 2015; 19:343-8. [PMID: 25697545 DOI: 10.1016/j.ejon.2015.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/14/2015] [Accepted: 01/22/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE The surgical treatment of upper gastrointestinal (GI) cancers, specifically esophageal and gastric cancers, often result in extensive health-related quality of life (HRQOL) concerns, particularly those associated with dietary adjustments. This paper provides a review of HRQOL changes following esophagectomy and gastrectomy, and describes key components of an intervention to improve dietary adjustments following surgery. METHODS Intervention development was informed by 1) current published evidence on HRQOL changes for patients following upper GI surgery, 2) examination of usual post-operative care related to dietary restrictions to identify areas for continued education and support and 3) the inclusion of a conceptual framework (the Chronic Care Model) to guide intervention design and inform the selection of appropriate outcome measures. RESULTS Three key components of an HRQOL intervention are identified, and should focus on HRQOL concerns associated with dietary alterations and restrictions following treatment, involve family caregivers, and be tailored and flexible to patient and family caregiver's needs and preferences. CONCLUSIONS Evidence-based interventions to support long-term dietary alterations and restrictions following upper GI surgery are lacking, despite evidence confirming its impact on morbidity and mortality. Interventions are needed to support dietary adjustments, prevent malnutrition and excessive weight loss, and enhance HRQOL following surgery for upper GI cancers.
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17
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Kim B, Choi JY. Factors Associated with Early Nutritional Status after Radical Gastrectomy in Patients with Gastric Cancer. ASIAN ONCOLOGY NURSING 2015. [DOI: 10.5388/aon.2015.15.4.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bokyoung Kim
- Department of Nursing, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ja Yun Choi
- College of Nursing, Chonnam National University·CRINS, Gwangju, Korea
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18
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Lu Y, Carey S. Translating Evidence-Based Practice Guidelines Into a Summary of Recommendations for the Nutrition Management of Upper Gastrointestinal Cancers. Nutr Clin Pract 2014; 29:518-525. [DOI: 10.1177/0884533614532501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Sharon Carey
- University of Sydney, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
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Carey S, Laws R, Ferrie S, Young J, Allman-Farinelli M. Struggling with food and eating--life after major upper gastrointestinal surgery. Support Care Cancer 2013; 21:2749-57. [PMID: 23715818 DOI: 10.1007/s00520-013-1858-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Few qualitative studies have explored patients' experience of food and eating following major upper gastrointestinal cancer surgery. The aim of this article was to explore the longer-term impact of different types of major upper gastrointestinal surgeries on people's relationship with food. METHODS Twenty-six people having had major upper gastrointestinal cancer surgery greater than 6 months ago participated in semi-structured interviews. These interviews aimed to explore a person's physical, emotional and social relationship with food and eating following surgery. Interviews were tape-recorded, transcribed and analysed using an inductive thematic analysis approach. RESULTS Interview findings revealed a journey of adjustment, grieving and resignation. The physical symptoms and experiences of people differed between types of surgery, but the coping mechanisms remained the same. CONCLUSIONS The grieving and resignation people experienced suggest adjustment and coping similar to that of someone with a chronic illness. Remodeling of health services is needed to ensure this patient group receives ongoing management and support.
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Affiliation(s)
- Sharon Carey
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Missenden Road Camperdown, NSW, 2050, Sydney, Australia,
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20
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Berry AJ. Pancreatic surgery: indications, complications, and implications for nutrition intervention. Nutr Clin Pract 2013; 28:330-57. [PMID: 23609476 DOI: 10.1177/0884533612470845] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pancreatic surgery is a complicated procedure leaving postoperative patients with an altered gastrointestinal (GI) anatomy and a potential for further surgical complications such as leaks and fistulas. Beyond surgical complications, these patients are prone to delayed gastric emptying, fat malabsorption, and hyperglycemia, with early satiety and poor appetite further compromising nutrition status. Many of these patients are malnourished prior to this major surgical procedure, and significant weight loss is common postoperatively. Does this affect their outcome? There seems to be a lack of consensus in this patient population regarding how to optimize nutrition and limit potential deleterious effects of this surgery. It is important to first understand the underlying disease condition and the effects to the gland, different forms of surgery with subsequent GI alterations, and common surgical and digestive complications. Once this is reviewed, existing nutrition support literature will be explored in attempts to determine the best nutrition management in this patient population.
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Affiliation(s)
- Amy J Berry
- University of Virginia Health System, Surgical Nutrition Support/Nutrition Services, Charlottesville, VA 22908-0673, USA.
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