J Gastric Cancer.  2018 Jun;18(2):189-199. 10.5230/jgc.2018.18.e21.

Long-Term Nutritional Outcomes of Near-Total Gastrectomy in Gastric Cancer Treatment: a Comparison with Total Gastrectomy Using Propensity Score Matching Analysis

• Seo HS
• Jung YJ
• Kim JH
• Park CH
• Kim IH
• Lee HH

• KMID: 2414539
• DOI: http://doi.org/10.5230/jgc.2018.18.e21

Abstract

PURPOSE
This study sought to examine whether near total gastrectomy (nTG) confers a long-term nutritional benefit when compared with total gastrectomy (TG) for the treatment of gastric cancer.
MATERIALS AND METHODS
Patients who underwent nTG or TG for gastric cancer were included (n=570). Using the 1:2 matched propensity score, 25 patients from the nTG group and 50 patients from the TG group were compared retrospectively for oncologic outcomes, including long-term survival and nutritional status.
RESULTS
The length of the proximal resection margin, number of retrieved lymph nodes and tumor nodes, metastasis stage, short-term postoperative outcomes, and long-term survival were not significantly different between the groups. The body mass index values, and serum total protein and hemoglobin levels of the patients decreased significantly until postoperative 6 months, and then recovered slightly over time (P < 0.05); however, there was no difference in the levels between the groups. The prognostic nutritional index values and serum albumin levels decreased significantly until postoperative 6 months and then recovered (P < 0.05); the levels decreased more in the nTG group than in the TG group (P < 0.05). The mean corpuscular volumes and serum transferrin levels increased significantly until postoperative 1 year and then recovered slightly over time (P < 0.05); however, there was no difference between the groups. Serum vitamin B12, iron, and ferritin levels of the patients did not change significantly over time, and no difference existed between the groups.
CONCLUSIONS
A small remnant stomach after nTG conferred no significant nutritional benefits over TG.

Keyword

Stomach neoplasms; Nutritional status; Gastrectomy; Gastric stump

MeSH Terms

Body Mass Index
Erythrocyte Indices
Ferritins
Gastrectomy*
Gastric Stump
Humans
Iron
Lymph Nodes
Neoplasm Metastasis
Nutrition Assessment
Nutritional Status
Propensity Score*
Retrospective Studies
Serum Albumin
Stomach Neoplasms*
Transferrin
Vitamin B 12
Ferritins
Iron
Serum Albumin
Transferrin
Vitamin B 12

Figure

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  Fig. 1 Survival rate according to the extent of gastrectomy. (A) OS and (B) disease-free survival. OS = overall survival; DFS = disease-free survival; TG = total gastrectomy; nTG = near total gastrectomy.

• 

  Fig. 2 Changes of nutritional status according to the extent of gastrectomy. (A) BMI and (B) PNI. BMI = body mass index; PNI = prognostic nutritional index; TG = total gastrectomy; nTG = near total gastrectomy.

• 

  Fig. 3 Changes of nutritional indices according to the extent of gastrectomy. (A) Serum total protein level and (B) serum albumin level. TG = total gastrectomy; nTG = near total gastrectomy.

• 

  Fig. 4 Changes of anemia indices according to the extent of gastrectomy. (A) Serum hemoglobin level and (B) MCV. MCV = mean corpuscular volume; TG = total gastrectomy; nTG = near total gastrectomy.

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  Fig. 5 Changes of vitamin B12 and iron profiles after gastrectomy. (A) Serum vitamin B12 level; (B) serum iron level; (C) serum ferritin level; and (D) serum transferrin level. TG = total gastrectomy; nTG = near total gastrectomy.

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