Abstract
BackgroundPostoperative early oral nutrition has increasingly been adopted for patients undergoing gastrectomy. However, intolerability to early oral nutrition remains a major concern, especially in older patients. This study aimed to investigate early oral nutrition intolerability in older patients who had undergone gastrectomy.MethodsWe retrospectively reviewed 825 patients who had undergone gastrectomy for gastric carcinoma between 2017 and 2019. All patients received an oral diet on postoperative day 1. Patients were divided into older (≥70 years) and younger (<70 years) adult groups, and short-term outcomes and intolerability to oral nutrition were compared. Intolerability to early oral nutrition was defined as oral diet cessation due to adverse gastrointestinal symptoms.ResultsAmong the 825 patients (≥70 years, n = 286; <70 years, n = 539), 151 (18.3%) developed intolerability to early oral nutrition, of whom 100 patients were < 70 years old and 51 were ≥70 years old. The most common symptom causing intolerability was abdominal distension. The mean duration of fasting after developing intolerability was 2.8 ± 2.4 days. The incidence of intolerability in the older and younger adult groups was 17.8% and 18.6%, respectively (p = 0.799). In terms of sex, operative approach, gastric resection, lymph node dissection, reconstruction, and tumor stage subgroups, the older adult group did not exhibit a significant increase in intolerability. Postoperatively, the older adult group showed a higher incidence of systemic complications; however, anastomotic complications did not significantly differ between the two groups.ConclusionsPostoperative early oral nutrition can safely be adopted for older patients undergoing gastrectomy, with acceptable intolerability and surgical outcomes.
Highlights
Despite a decrease in global incidence, gastric cancer is one of the most common malignant diseases and the leading cause of cancer-related mortality in East Asia [1]
Postoperative early oral nutrition can safely be adopted for older patients undergoing gastrectomy, with acceptable intolerability and surgical outcomes
We investigated the probability of intolerability according to age using the multivariable fractional polynomials (MFP) method to account for the nonlinear and asymmetric relationship between age and intolerability
Summary
Despite a decrease in global incidence, gastric cancer is one of the most common malignant diseases and the leading cause of cancer-related mortality in East Asia [1]. Older patients may require careful management because of increasing operative risk due to lower reserves in physiologic functions, poor nutritional status, and frequent comorbid conditions [3,4,5]. With improving survival rates for gastric cancer, there is increasing interest in the quality of patient care. ERAS has increasingly been adopted for patients with gastric cancer in recent years. Many studies have reported that ERAS can accelerate postoperative recovery and reduce the length of hospital stay without increasing patient risk after gastrectomy [7]. Postoperative early oral nutrition has increasingly been adopted for patients undergoing gastrectomy. Intolerability to early oral nutrition remains a major concern, especially in older patients. This study aimed to investigate early oral nutrition intolerability in older patients who had undergone gastrectomy
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