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

Abstract

BackgroundIn 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. MethodsWe 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. ResultsPatients 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. ConclusionsEstimating 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.