How Should Patients Eat After Gastrectomy (Stomach Cancer Surgery)?

Gastrectomy is surgery to remove part or all of the stomach. It is most commonly chosen for the treatment of early-stage stomach cancer and for obesity surgery. It may also be used to treat type-2 diabetes and gastroparesis (difficulty emptying the stomach) (see What is gastrectomy, what types are there and how is it performed?).

Patients with stomach cancer are generally malnourished. Protein loss also occurs alongside reduced oral food intake.

Malnutrition:

• Makes patients more vulnerable to infection and muscle loss,
• Prolongs wound healing, and
• Increases the risk of postoperative complications.

Therefore, the nutritional status of patients with stomach cancer should be properly assessed before surgery.

Methods Used to Assess Patients' Nutritional Status

• Anthropometric methods (body mass index, waist-to-hip ratio, body fat percentage, etc.)
• Biochemical parameters (liver and kidney function tests, etc.)
• Clinical methods (medical history and physical examination)
• Dietary assessment methods (eating habits)

Weight loss is inevitable among the symptoms and complaints experienced after gastrectomy!

Malnutrition can lead to negative clinical outcomes such as longer hospitalization and a poorer disease course, as well as muscle loss and deterioration in quality of life and psychological well-being.

Patients who have undergone gastrectomy have been shown to benefit from support with early postoperative enteral (oral) feeding, and early oral feeding has advantages in promoting gastrointestinal recovery and nutrition.

These measures can lead to faster recovery after surgery and a shorter hospital stay.

What Are the Most Important Complication Risks After Gastrectomy?

• Cachexia
• Megaloblastic anemia: a type of anemia caused by vitamin B12 and folic acid deficiency
• Other signs of folate, iron and B12 deficiency
• Dumping syndrome: a problem caused by food passing rapidly into the intestine, characterized by nausea, diarrhea and tiredness after eating. 
• Poor protein digestion

How Should Eating Begin After Gastrectomy?

• After surgery, feeding begins gradually with clear liquids, pureed foods and solid foods.
• A high-calorie, protein-rich diet low in carbohydrates and sugar, with normal fat content, is recommended. Because the stomach is absent after gastrectomy, food passes quickly into the intestine, which is the main cause of dumping syndrome. To prevent this, a sugar-restricted diet high in protein and calories is provided to support tissue building and repair and prevent weight loss.
• Patients are told about the importance of chewing very thoroughly.

In care tailored to individual needs, adjustments to meal frequency and the texture, temperature, amount, taste and appearance of food can help relieve problems and increase oral intake. Support from an oncology dietitian should certainly be considered during this period.

In conclusion, patients and their relatives, surgeons, and the oncologist and team managing treatment should all be aware of possible nutritional deficiencies after gastrectomy, including inadequate absorption of vitamins or minerals. Nutritional assessment and support should begin before surgery.