Perioperative body composition assessment and nutritional intervention for gastric cancer patients

Body composition assessment is useful in predicting postoperative complications in patients with gastric cancer. Both low muscle mass and low muscle quality have been reported as risk factors for severe complications, and the 2018 revision of the European sarcopenia diagnostic criteria added muscle quality as a diagnostic tool in addition to muscle mass. However, there is no consensus on cut-off values for these measures and further research is needed. Muscle mass is one of the diagnostic criteria in the GLIM criteria, which is the global consensus for malnutrition. Low muscle mass reflects malnutrition. We should consider muscle mass as part of the nutritional assessment, and perioperative management should aim to improve the nutritional status of patients with low muscle mass. A systematic review has shown that a high visceral fat mass in patients with gastric cancer increases postoperative complications, especially infectious complications, while the long-term prognosis is rather favorable. This is due to postoperative weight loss after gastrectomy, which may be due to the nutritional protective effect of visceral fat mass. However, the beneficial effect of visceral fat mass disappears after severe complications. Further studies should clarify the optimal visceral fat mass based not only on postoperative complications but also on long-term prognosis. These body compositions should be considered as points of perioperative intervention for patients with gastric cancer. For gastric cancer patients with sarcopenia, a 2-week multifaceted intervention combining nutrition and exercise is effective in reducing postoperative complications. For patients with high visceral fat mass, a preoperative weight loss program with exercise for 4 weeks may reduce postoperative complications. For severe preoperative malnutrition, nutritional intervention for 10-14 days has been reported to reduce postoperative complications. However, the impact of these interventions on long-term prognosis remains unknown. In conclusion, perioperative management based on preoperative body composition is a useful indicator and future studies should include its effect on long-term prognosis.