Nutritional evaluation in the perioperative period of gastric cancer patients using bioelectrical impedance analysis (BIA)

Abstract

Gastric cancer is a ‘neglected cancer,’ with significant incidence (over 900 cases annually) and late-stage at the time of diagnosis in Croatia. Even in resectable cases, risk of malnutrition is high, and malnutrition-related to malignant disease presents a substantial problem in terms of compliance with treatment and complications during surgery. We retrospectively reviewed the patient records for patients operated for gastric cancer from January until December 2018. Data on sex, age, body mass index (BMI), complete preoperative blood count, postoperative recovery, and subsequent bioelectrical impedance analysis (BIA) measurements (preoperatively, on days 7, 14 and 30) were collected. All patients received nutritional support according to the Enhanced Recovery After Surgery (ERAS). Twenty-seven patients were operated for gastric cancer, eight were resected with curative intent (four total gastrectomies, one total gastrectomy with splenectomy, three distal gastrectomies and one local excision). Seven patients who had a resection were included in the perioperative nutritional protocol. All patients scored at risk according to Nutrition Score 2002 (NS2002). Two patients had tolerable initial BMIs and BIAs, only one patient with extremely low BMI and BIA had prolonged intensive care unit (ICU) stay and difficulties with peroral nutrition. Only the patients with tolerable initial values recovered those values postoperatively in the observed period but did not improve. Lean body mass is lost before surgery, and in the early postoperative period, it takes up to 3 months to compensate. However, in the late stage of the disease, routine ERAS nutritional protocol seems not to be enough. Perhaps, in gastric cancer, a more aggressive parenteral perioperative nutrition might be an option.