Prospective evaluation of nutritional status related to body mass indices and outcomes after modified D2 gastrectomy for carcinoma

Aims: The aim of this study was to examine the perioperative nutritional status, body mass indices (BMI) and nutritional intakes of patients undergoing a modified D2 gastrectomy (preserving pancreas and spleen) for carcinoma to determine whether a relationship exists between the above and outcomes. Methods: Fifty consecutive patients [median age 71 years, 38 male] with gastric adenocarcinoma were studied prospectively. Results: Seven patients (14%) were obese (BMI>30 kg/m2), 16 patients (32%) were overweight (BMI>25 kg/m2), 21 patients (42%) were of normal weight (BMI 20–25 kg/m2), and six patients (12%) were underweight (BMI<20 kg/m2). Operative morbidity was commoner in underweight patients (33%) when compared with overweight patients (17%, P=0.391) and patients of normal weight (14%, P=0.289). Fatal complications, however (two patients, 4%) were confined to overweight patients (P=0.118). Preoperative serum albumin levels were significantly higher in overweight patients (43 g/dl) compared to underweight patients (34.5 g/dl; P=0.003), though no correlation was found between patients’ serum albumin levels and postoperative morbidity (r=−0.023, P=0.877). Overweight patients were significantly less likely to achieve their protein requirements postoperatively than underweight patients (P=0.037). Early enteral feeding contributed to 56% of the median energy requirements and 45% of the median protein requirements on the seventh postoperative day. Conclusion: BMI alone is a poor indicator of outcomes after modified D2 gastrectomy for carcinoma. The role of early enteral nutrition in patients undergoing gastrectomy for cancer deserves further evaluation