Hanyang Med Rev.  2011 Nov;31(4):254-260. 10.7599/hmr.2011.31.4.254.

Nutritional Consequences and Management After Gastrectomy

• Bae JM

• KMID: 1451838
• DOI: http://doi.org/10.7599/hmr.2011.31.4.254

Abstract

Gastric cancer is the most common cancer and the third most common cause of cancer deaths in Korea. Gastric resection, especially for the early stages of the disease, results in an excellent survival rate, and has been the mainstay of treatment for gastric cancer patients. Due to increasing use of surveillance endoscopy, the diagnosis of gastric cancer at early stages has increased. The 5-year survival rate for early gastric cancer has now improved to better than 90%, and consequently, the population of long-term survivors after gastrectomy has also increased. Therefore, the quality of life including nutritional support has become an important concern for gastrectomized patients during long-term follow-up. Nutritional capacities after gastrectomy should be evaluated by nutritional assessment and absorption tests. Nutritional deficits are more serious after total gastrectomy than after subtotal gastrectomy. Fat malabsorption has been shown to be a significant concern in patients that have undergone total gastrectomy. Other suggested causes of malnutrition include poor oral intake, relative pancreatic insufficiency, bacterial overgrowth, and shortened intestinal transit time. Food residue and bile reflux are frequently observed in the remnant stomach during surveillance endoscopy after a distal subtotal gastrectomy due to gastric cancer. The bile reflux is often associated with remnant gastritis or esophagitis and has an influence on the quality of life following a distal subtotal gastrectomy. Reconstruction methods have not influenced the food retention phenomenon after a distal gastrectomy over long-term periods. In addition, nutritional status after gastrectomy is significantly associated with postoperative complications. In conclusion, the provision of dietary education and nutritional support is highly recommended in postoperative patients for gastric cancer.

Keyword

Nutritional Status; Gastrectomy; Nutrition Assessment

MeSH Terms

Absorption
Bile Reflux
Endoscopy
Esophagitis
Exocrine Pancreatic Insufficiency
Follow-Up Studies
Gastrectomy
Gastric Stump
Gastritis
Humans
Korea
Malnutrition
Nutrition Assessment
Nutritional Status
Nutritional Support
Postoperative Complications
Quality of Life
Retention (Psychology)
Stomach Neoplasms
Survival Rate
Survivors

Figure

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  Fig. 1 Various reconstructive procedures after partial gastrectomy (Ref. 16 with permission from Yoo HJ.)

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  Fig. 2 Various reconstructive procedures after total gastrectomy. LEJ, loop esophagojejunostomy; EJ, esophagojejunostomy; Roux en Y, Roux en Y esophagojejunostomy; or R6, or reverse 6 anastomosis; JI, jejunal interposition; LEIA, loop esophagojejunostomy with afferent loop ligation. (Ref. 16 with permission from Yoo HJ.)

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  Fig. 3 Relation between time since total gastrectomy and magnitude of weight loss. Squares, patients with oral intake below 30 kcal/kg/day; triangles, patients with oral intake of 30 kcal/kg/day or above; circles: average of all patients (Ref. 2 with permission from Springer).

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