{"title":"Postoperative nutritional outcomes and quality of life related complications of patients with gastric cancer after gastrectomy","authors":"Hyuk-Joon Lee","doi":"10.11638/jssmn.57.3_82","DOIUrl":"https://doi.org/10.11638/jssmn.57.3_82","url":null,"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.","PeriodicalId":472267,"journal":{"name":"Geka to taisha, eiyō","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135495437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Novel Role of Amino Acid Parenteral Nutrition in the Perioperative Management of Upper Gastrointestinal Surgery.","authors":"Masahiro Niihara","doi":"10.11638/jssmn.57.3_83","DOIUrl":"https://doi.org/10.11638/jssmn.57.3_83","url":null,"abstract":"［Background］Loss of muscle mass after gastrectomy in gastric cancer patients negatively affects the continuation of adjuvant chemotherapy and is related to the poor prognosis. On the other hand, administration of branched-chain amino acids（BCAA）and exercise treatment prevent muscle loss in elderly patients with primary sarcopenia. We evaluated the effect of combined parenteral nutrition（PPN）and exercise treatment to prevent loss of muscle mass after surgery for gastric cancer（UMIN000042579）.［Methods］In the study group, an infusion solution containing amino acids, glucose and fat emulsions was selected as PPN in the early postoperative period. Parenteral nutrition was continued until postoperative day 5. In the control group, a maintenance infusion was selected, and fat emulsion was not used in combination. Exercise intervention based on walking was started on the first day after surgery for both patients in the test group and control group. For exercise after discharge, a target number of steps is set for each age group, and light exercise such as squats is added according to the target number of steps. The primary endpoint was the rate of lean body mass reduction on the 7th day after surgery. The secondary endpoints were the rates of lean body mass reduction up to 1 month and 3 months after surgery［. Results］The reduction rate of lean mass on the 7th day after surgery was - 0.2％ in the study group and -1.7％ in the control group（P=0.21）. One month after surgery, the percentage of lean body mass decreased was +0.3％ in the study group and -4.5％ in the control group（P=0.038）. There was no significant difference between the two groups in the percentage of lean body mass reduction 3 months after surgery（the study group：-3.3％, the control group：-3.5％, P=0.47）［. Conclusions］Intravenous administration containing amino acids, glucose and fat emulsion combined with early exercise treatment after gastrectomy suppressed the loss of lean body mass 1 month after surgery.","PeriodicalId":472267,"journal":{"name":"Geka to taisha, eiyō","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135446359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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