Postoperative nutritional outcomes and quality of life related complications of patients with gastric cancer after gastrectomy

Abstract

Weight loss is a common problem after gastric cancer surgery. It is also related to decrease of patient’s quality of life and the compliance of postoperative chemotherapy. Some clinicians also insist weight loss itself can affect patient’s survival. We reviewed the weight change after gastrectomy in 1,421 gastric cancer patients. The BMI loss trajectory model showed significant BMI loss at 6 months after gastrectomy. Severe BMI loss（mean 21.5％；n=109）was significantly associated with the elderly, female sex, higher preoperative BMI, advanced cancer stage, open surgery, total gastrectomy, chemotherapy, and postoperative complications. Malnutrition（BMI＜18.5）6 months after gastrectomy was observed in 152（11.9％）of 1281 patients. We also developed the prediction model of malnutrition after gastrectomy using preoperative BMI, sex, and type of operation, and showed a quite excellent prediction accuracy of 0.91（95％ confidence interval 0.89-0.94）. We also performed the multicenter data collection of patient’s nutritional change after gastrectomy with the support of KSSMN. The data from 2,649 patients were divided into a derivation set. Postoperative duration, sex, age, preoperative body mass index, type of surgery, and cancer stage were included in the final prediction model. However, accurate prediction of postoperative body weight change is not easy, and this model showed approximately 20％ accuracy in predicting weight loss at each period. To improve the patients’ nutritional status after gastrectomy, we also developed smartphone based application（digital therapeutics, DTX）and applied it to 39 gastric cancer patients. Interestingly, underweighted patients are shown to be more adherent to the usage of DTX. I will introduce our effort to predict and prevent weight loss after gastric cancer surgery, including these data in my presentation.