Multi-institutional prospective feasibility study to explore tolerability and efficacy of oral nutritional supplements for patients with gastric cancer undergoing gastrectomy (CCOG1301)

Abstract

Background Postoperative malnutrition after gastrectomy is deemed inevitable, which could have prejudicial influence on survival for gastric cancer patients. A prospective feasibility study was conducted to evaluate the efficacy of postoperative oral nutritional supplements. Methods Stage I-III gastric cancer patients who underwent distal or total gastrectomy received oral administration of Racol Ò NF (Otsuka Pharmaceutical Factory, Japan), a liquid enteral nutritional formula, as a supplement to regular meals. Racol Ò NF administration at a recommended dosage of 400 kcal/400 ml per day was started within 7 days postoperatively and was continued for 3 months postoperatively. The primary end point was ratio of the weight loss at 3 months postoperatively to the preoperative body weight (body weight loss ratio). Secondary end points were the adherence to Racol Ò NF therapy and changes in body composition. Results One hundred eighteen patients were registered before surgery, 82 of whom were eligible for efficacy analyses. The average rate of body weight loss after 3 months postoperatively was 8.3%. The mean daily intake of Racol Ò NF was 211 ml. There was a significant correlation between adherence to Racol Ò NF therapy and body weight loss ratio (P \ 0.001). Adherence to Racol Ò NF therapy was the only factor that correlated with the body weight loss ratio among all clinical characteristics by the multiple linear regression analysis (P = 0.007). Conclusions Oral nutritional supplementation with Racol Ò NF led to a significant reduction in body weight loss for gastrectomized patients who tolerated more than 200 ml of the nutrient per day compared with those who could not tolerate this amount.

Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis

“…As sarcopenia is associated with higher rates post-operative morbidity and mortality and poor long-term survival, perioperative interventions are important to reduce these risks. One study in this review reported benefits of oral nutrition supplement to reduce weight loss in the post-operative setting [28]. However, this study did not evaluate its impact on surgical outcomes and long-term survival.…”

Clinical Impact of Sarcopenia on Gastric Cancer

“…Of note, despite the very short period of intervention, this study showed that preoperative nutritional exercise interventions can be effective. Kobayashi et al have conducted a prospective study to evaluate the efficacy of postoperative oral nutrition supplements in Japan (54). Their results showed that postoperative nutritional supplementation can also lead to a significant reduction of body weight loss for gastrectomized patients.…”

Assessment of compliance with oral nutritional supplementation and exploration of barriers and facilitators for patients after gastrectomy: A mixed‐methods study

“…A randomized controlled study showed that taking ONS for 12 weeks after surgery could prevent patients with gastric cancer from losing 1.1 kg (2% of body weight; Hatao et al, 2017). The benefits of ONS are obvious, but the effects of ONS seem to be dose‐dependent (de van der Schueren et al, 2018; Dias Rodrigues et al, 2017; Kobayashi et al, 2017); therefore, the main factor in the effect of ONS is patient compliance. However, compliance with ONS is not satisfactory; for example, Grass et al reported that patient compliance with ONS was as low as 42% (Grass et al, 2015).…”