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Observational Study
. 2019 Dec:31:75-82.
doi: 10.1016/j.suronc.2019.09.008. Epub 2019 Sep 13.

Impact of remnant stomach volume and anastomosis on nutrition and body composition in gastric cancer patients

Koeun Lee  1 , Kyung Won Kim  2 , Jung-Bok Lee  3 , Yongbin Shin  2 , Jin Kyoo Jang  2 , Jeong-Hwan Yook  4 , Byung-Sik Kim  4 , In-Seob Lee  5
Affiliations
Observational Study

Impact of remnant stomach volume and anastomosis on nutrition and body composition in gastric cancer patients

Koeun Lee et al. Surg Oncol. 2019 Dec.

Abstract

Background: In gastrectomy for gastric cancer, oncologic safety including secure resection margin is considered important while less attention is given to maximizing remnant stomach volume (RSV). Nutrition and body composition are important postoperative factors for patient well-being. In this prospective observational study, we investigated the effects of RSV and anastomosing method on nutrition, anemia, and body composition change.

Methods: We enrolled 247 patients who underwent curative laparoscopic gastrectomy (Billroth-1: 111, Billroth-2: 31, Roux-en-Y: 38, total gastrectomy: 67) for stage 1 gastric cancer between 2015 and 2016. Their clinicodemographic characteristics and laboratory data were collected. RSV, area of abdominal muscle, and subcutaneous/visceral fat were measured using CT data.

Results: Patients with larger RSV and those who underwent Billroth-1 exhibited smaller reduction in hemoglobin and nutritional parameters during the first three postoperative months, and showed better recovery in the aforementioned variables as well in the first postoperative year. Visceral fat was the most affected factor by gastrectomy, and abdominal muscle and subcutaneous/visceral fat were better preserved in patients with larger RSV. The proportion of sarcopenic patients was also the smallest in the Billroth-1 group and larger RSV group. Patients who underwent total gastrectomy showed the highest degree of deterioration in all parameters.

Conclusions: Estimating RSV and body composition by using CT offers valuable clinical information. The Billroth-1 procedure and larger RSV were associated with better postoperative nutritional variables and reduced prevalence of sarcopenia among gastric cancer patients after gastrectomy. When performing gastrectomy in stage 1 gastric cancer patients, RSV should be considered.

Keywords: Anastomosis; Body composition; Gastric cancer; Nutrition; Remnant stomach; Sarcopenia.

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