Gastro-Intestinal Disorders and Micronutrient Deficiencies following Oncologic Esophagectomy and Gastrectomy

Abstract

Primary surgical indications for the esophagus and stomach mainly involve cancer surgeries. In recent years, significant progress has been made in the field of esogastric surgery, driven by advancements in surgical techniques and improvements in perioperative care. The rate of resectability has increased, and surgical strategies have evolved to encompass a broader patient population. However, despite a reduction in postoperative mortality and morbidity, malnutrition remains a significant challenge after surgery, leading to weight loss, muscle mass reduction, and deficiencies in essential nutrients due to digestive complications. Malnutrition worsens quality of life and increases the risk of tumor recurrence, significantly affecting prognosis. Nevertheless, the nutritional consequences following surgery are frequently overlooked, mainly due to a lack of awareness regarding their long-term effects on patients who have undergone digestive surgery, extending beyond six months. Micronutrient deficiencies are frequently observed following both partial and total gastrectomy, as anticipated. Surprisingly, these deficiencies appear to be similarly prevalent in patients who have undergone esophagectomy with iron, vitamins A, B1, B12, D, and E deficiencies commonly observed in up to 78.3% of the patients. Recognizing the distinct consequences associated with each type of intervention underscores the importance of implementing preventive measures, early detection, and prompt management.

Understanding and Managing Metabolic Deficiencies Post Bariatric and Esophagectomy Surgeries: A Narrative Review of the Literature

“…Timely detection and treatment of deficiencies like iron and vitamin supplements are essential for enhancing long-term outcomes and minimizing health risks. Additionally, closely monitoring patients' well-being and eating patterns is crucial for preventing and addressing complications related to malnutrition [ 45 , 46 ].…”

“…Thus, ongoing monitoring through lab tests is crucial. Generally, possible explanations for the deficiency involve reduced intake of vitamin B12 in the diet due to changes affecting satiety, digestion of vitamin B12 from food due to decreased acid secretion, shortened exposure time to this acid in the conduit, and diminished production of intrinsic factors [ 45 , 47 ].…”

“…Studies suggest that most copper absorption occurs in the duodenum, with some uptake in the stomach and ileum. The acidity levels in the stomach are crucial for releasing copper from food sources, underlining the importance of maintaining gastric health for optimal copper absorption [ 45 ].…”

“…Insufficient levels of this micronutrient can cause problems such as low white blood cell count, red blood cell issues, and coordination difficulties. Taking iron supplements alone without copper supplementation may worsen these problems related to copper deficiency [ 45 ].…”

“…Although the actual magnesium circulating concentrations are usually difficult to define, magnesium deficiencies have been reported after bariatric and digestive tract surgery [ 50 ]. Important to mention is that the magnesium levels are usually not notable nor severe [ 45 ].…”