Abstract:

Objective To explore the correlation between the nutritional status of patients and preoperative gastric morphology and functional characteristics in patients with gastric cancer after radical gastrectomy. Methods From September 2021 to September 2024， 134 patients with stage Ⅰ-Ⅱ gastric cancer who underwent radical gastrectomy （distal subtotal gastrectomy） at the First Affiliated Hospital of Xinjiang Medical University were selected as the research subjects. Clinical data of patients （including gastric morphology and functional characteristics） were collected and patients were divided into the outflow group （n=51） and the retention group （n=83） based on the preoperative gastric morphology. The related indicators of body composition analysis were collected one week before the surgery and one month after the surgery. Multiple linear regression analysis was used to analyze the related influencing factors of nutritional indicators. The occurrence of dumping syndrome， diarrhea and gastroesophageal reflux within 7 days after the surgery was statistically analyzed and compared between the two groups. The decline of nutritional indicators in patients with different complications was also compared. Results One week before surgery， the body mass index （BMI） values of patients in the outflow group and the retention group were （21.29±1.21） and （21.09±1.36） kg/m²， the fat-free BMI values were （15.29±1.07） and （15.31±1.08） kg/m² ， the fat indexes were （5.98±0.92） and （5.84±0.83） kg/m²， the skeletal muscle indexes were （10.13±1.02） and （10.23±1.98） kg/m²， and the inorganic salt indexes were （5.01±0.98） and （4.94±0.81） kg/m²， with no statistically significant differences （all P>0.05）. One month after surgery， the BMI values of patients in the two groups were （20.75±1.82） and （20.25±1.24） kg/m²， the fat-free BMI values were （14.68±0.94） and （14.36±0.88） kg/m² ，the fat indexes were （5.77±0.93） and （5.58±0.72） kg/m²， the skeletal muscle indexes were （9.51±1.12） and （9.46±1.57） kg/m²， and the inorganic salt indexes were （5.00±0.89） and （4.99±0.73） kg/m²， with no statistically significant differences （all P>0.05）. The fat-free BMI value and skeletal muscle index of the patients in the outflow group one week before the surgery were both higher than those one month after the surgery （both P<0.05）. The BMI value， fat-free BMI value， fat index and skeletal muscle index of the patients in the retention group one week before the surgery were all higher than those one month after the surgery （all P<0.05）. The BMI decrease rates of the two groups of patients one month after the surgery were （3.62±0.49）% and （3.94±0.48）%， respectively， with a statistically significant difference （t=3.67， P<0.001）. The decrease rates of fat-free BMI were （3.75±0.51）% and （4.06±0.47）%， respectively， with a statistically significant difference （t=3.52， P<0.001）. The rates of decrease in fat index were （3.54±0.43）% and （3.82±0.49）%， respectively， with a statistically significant difference （t=3.47， P<0.001）. The decrease rates of skeletal muscle index were （3.76±0.53）% and （4.01±0.48）%， respectively， with a statistically significant difference （t=2.75， P=0.007）. The decrease rates of inorganic salt index were （0.14±0.05）% and （0.13±0.04）%， respectively， with no statistically significant difference （t=1.21， P=0.229）. The analysis results of the related influencing factors of nutritional indicators showed that， gastric morphological classification was independently correlated with the decrease rate of fat index （t=-2.90， P=0.005） and the decrease rate of skeletal muscle index （t=-4.50， P<0.001）， and serum albumin （t=2.01， P=0.047） was independently correlated with the decrease rate of skeletal muscle index. Within 7 days after the surgery， the total incidence of complications in the retention group was 36.14% （30/83）， and that in the outflow group was 15.69% （8/51）， with a statistically significant difference （χ²=6.51， P=0.011）. The rates of decrease in fat index and skeletal muscle index in patients with dumping syndrome were （4.21±0.79）% and （4.48±0.94）%， respectively， while those in patients without dumping syndrome were （3.61±0.47）% and （3.84±0.43）%， respectively， with statistically significant differences （t=2.59， P=0.025； t=2.33， P=0.039）. The rates of decrease in fat index and skeletal muscle index in patients with diarrhea were （4.24±0.81）% and （4.41±0.85）%， respectively， while those in patients without diarrhea were （3.62±0.43）% and （3.85±0.41）%， respectively， with statistically significant differences （t=2.62， P=0.024； t=2.26， P=0.045）. The rates of decrease in fat index and skeletal muscle index in patients with gastroesophageal reflux were （4.19±0.72）% and （4.45±0.89）%， respectively， while those in patients without gastroesophageal reflux were （3.64±0.39）% and （3.82±0.43）% ， respectively， with statistically significant differences （t=2.61， P=0.024； t=2.42， P=0.037）. Conclusions The preoperative gastric morphology and functional characteristics have a significant influence on the nutritional status of patients with gastric cancer after distal subtotal gastrectomy， and are also closely related to the occurrence of complications such as dumping syndrome， diarrhea and gastroesophageal reflux within 7 days after surgery.

Key words: Stomach neoplasms, Nutritional status, Distal gastrectomy, Preoperative gastric shape