title: Short-term nutritional implications of total gastrectomy for malignancy, and the impact of parenteral nutritional support.
abstract: OBJECTIVE
  To report on peri-operative nutritional status in gastric cancer patients undergoing total gastrectomy, and to examine the role of post-operative parenteral nutrition.
  
  
  METHODS
  Retrospective study of prospectively collected data on 90 consecutive patients who underwent total gastrectomy for malignancy.
  
  
  RESULTS
  At diagnosis 46% of patients reported clinically severe weight loss, and dietary intake was inadequate in 72% of patients. Post-operatively 42% were given total parenteral nutrition (TPN) and 53% were given intravenous fluids (IVF) alone. TPN patients spent a mean of 13.6 days on nutrition support versus IVF patients who spent a mean of 9.2 days without any form of nutrition. IVF patients lost significantly more weight in hospital than TPN patients (5.2 kg versus 3.1 kg, p=0.008). 69% of IVF patients lost severe amount of weight versus 34% in the TPN group (p=0.01). Post-discharge, IVF patients continued to lose significantly more weight than those given TPN post-operatively (7.5 kg versus 2.9 kg, p=0.01) corresponding to 10.5% of their body weight from discharge to follow up versus 4.9% for TPN group (p=0.014). From pre-illness to follow up, patients lost an average of 15.5 kg--IVF patients lost 17.8 kg versus 9.6 kg in TPN (p<0.01). There was no difference in post-operative complications between the groups; however, patients with >10% weight loss had a significantly higher rate of complications and a significantly higher mortality rate than patients who lost <10% body weight (26.2% versus 51.9%, p=0.036 and 11.1% versus 0%, p=0.027, respectively). On multivariate logistic regression analysis >10% weight loss at diagnosis was the only predictive factor of post-operative complications OR 3.1 (95% CI 1.0-9.6), p=0.04).
  
  
  CONCLUSIONS
  There is a high prevalence of malnutrition in gastric cancer patients undergoing surgery. Total gastrectomy is associated with dramatic weight loss, which continues beyond the surgeon's view post-discharge, with patients losing an average of 15.5 kg by 3-month follow up. Provision of nutrition support in the form of TPN post-operatively significantly reduces in-hospital weight loss and also helps to attenuate further weight loss post-discharge.
authors.affiliation: University Department of Clinical Surgery, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland. ryanal@tcd.ie
authors.forename: Aoife M
authors.initials: AM
authors.lastname: Ryan
authors.forename: Laura A
authors.initials: LA
authors.lastname: Healy
authors.forename: Derek G
authors.initials: DG
authors.lastname: Power
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Rowley
authors.forename: John V
authors.initials: JV
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005440:Fluid Therapy; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D016017:Odds Ratio; D010289:Parenteral Nutrition, Total / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D013997:Time Factors; D015431:Weight Loss