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. 2025 Jun 27;17(13):2146.
doi: 10.3390/nu17132146.

Nutritional and Biochemical Outcomes After Total Versus Subtotal Gastrectomy: Insights into Early Postoperative Prognosis

Fawzy Akad  1   2 , Cristinel Ionel Stan  1 , Florin Zugun-Eloae  1   3 , Sorin Nicolae Peiu  4 , Nada Akad  2   5 , Dragos-Valentin Crauciuc  1 , Marius Constantin Moraru  1 , Cosmin Gabriel Popa  1 , Liviu-Ciprian Gavril  1 , Roxana-Florentina Sufaru  1 , Cristina Preda  5 , Veronica Mocanu  2   6
Affiliations

Nutritional and Biochemical Outcomes After Total Versus Subtotal Gastrectomy: Insights into Early Postoperative Prognosis

Fawzy Akad et al. Nutrients. .

Abstract

Gastric cancer remains a significant global health burden, with curative treatment relying on surgical resection, typically total or subtotal gastrectomy. However, the procedure frequently triggers acute metabolic and nutritional disturbances that may impact recovery. Objective: This prospective study aimed to investigate whether the type of gastrectomy (total vs. subtotal) influences early postoperative biochemical and hematological alterations, with particular attention to nutritional impact. Methods: A cohort of 295 patients (123 female, 172 male) who underwent gastrectomy for gastric cancer at the Institute of Oncology Iași (2023-2024) was evaluated. Laboratory parameters, including hemoglobin, hematocrit, lymphocyte and platelet counts, serum albumin, total protein, sodium, potassium, creatinine, and urea, were analyzed preoperatively and on postoperative day 14 using standard clinical methods. Results: Anemia was observed in over 90% of patients, irrespective of sex or procedure type. Electrolyte imbalances (notably hyponatremia and hypokalemia) and indicators of nutritional deficit (hypoalbuminemia, low creatinine) were highly prevalent, with a greater frequency among female patients. Total gastrectomy was associated with more severe biochemical and nutritional alterations compared to subtotal procedures. Conclusions: Total gastrectomy significantly exacerbates early postoperative metabolic and nutritional derangements. These findings reinforce the need for proactive, personalized postoperative nutritional and electrolyte management strategies to support recovery and reduce complication risks.

Keywords: carbohydrate antigen 19-9 (CA19-9); carcinoembryonic antigen (CEA); gastrectomy; gastric cancer (GC); prognostic factors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Age distribution of the study population.
Figure 2
Figure 2
Comparative line chart. Subtotal Gastrectomy: ALB, serum albumin; Creat, creatinine; HB, hemoglobin; HT, hematocrit; K, potassium; Ly, lymphocytes; Na, sodium; PLT, platelets; PNI, prognostic nutritional index; PT, proteins; WBC, white blood count.
Figure 3
Figure 3
Comparative line chart. Total Gastrectomy: ALB, serum albumin; Creat, creatinine; HB, hemoglobin; HT, hematocrit; K, potassium; Ly, lymphocytes; Na, sodium; PLT, platelets; PNI, prognostic nutritional index; PT, proteins; TG, total gastrectomy; WBC, white blood count.
Figure 4
Figure 4
Postoperative comparison STG vs. TG: ALB, serum albumin; Creat, creatinine; HB, hemoglobin; HT, hematocrit; K, potassium; Ly, lymphocytes; Na, sodium; PLT, platelets; PNI, prognostic nutritional index; PT, proteins; STG, subtotal gastrectomy; TG, total gastrectomy; WBC, white blood count; X symbol indicates statistical significance.
See this image and copyright information in PMC

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