Changes in Physical Components after Gastrectomy for Adenocarcinoma of Stomach and Esophagogastric Junction

Thikhamporn Tawantanakorn; Wanalee Phibalyart; Thammawat  Parakonthun; Chawisa Nampoolsuksan; Tharathorn Suwatthanarak; Nicha Srisuworanan; Voraboot Taweerutchana; Atthaphorn Trakarnsanga; Chainarong Phalanusitthepha; Jirawat  Swangsri; Asada Methasate; Thawatchai Akaraviputh; Vitoon  Chinswangwatanakul

doi:10.33192/smj.v75i4.260962

Authors

Thikhamporn Tawantanakorn Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Wanalee Phibalyart Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Thammawat Parakonthun Siriraj Upper Gastrointestinal Cancer Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Chawisa Nampoolsuksan Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Tharathorn Suwatthanarak Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Nicha Srisuworanan Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Voraboot Taweerutchana Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Atthaphorn Trakarnsanga Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Chainarong Phalanusitthepha Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Jirawat Swangsri Siriraj Upper Gastrointestinal Cancer Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Asada Methasate Siriraj Upper Gastrointestinal Cancer Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Thawatchai Akaraviputh Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Vitoon Chinswangwatanakul Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok

DOI:

https://doi.org/10.33192/smj.v75i4.260962

Keywords:

Enhanced Recovery after Surgery (ERAS), gastrectomy, physical change

Abstract

Objective: Enhanced Recovery After Surgery (ERAS) is a multidisciplinary approach that aims to optimize perioperative management, promote postoperative recovery, reduce postoperative complications, and improve long-term survival. The current study aimed to evaluate and compare the postoperative physical activity after gastrectomy between patients who underwent upper gastrointestinal surgery according to ERAS and those who underwent surgery based on the conventional care (CC) protocol.

Materials and Methods: This prospective and retrospective review enrolled 60 patients (n = 31, ERAS group; n = 29, CC protocol group) diagnosed with adenocarcinoma of the stomach and esophagogastric junction who underwent curative surgical resection. Physical outcomes, including body weight, body mass index, body fat percentage, basal metabolic rate, muscle mass, gait speed, and handgrip strength at the preoperative and immediate postoperative periods and at 1, 3, and 6 months postoperatively, were comparedbetween the ERAS and CC protocol groups.

Results: One month after surgery, the ERAS group had a lower percentage of body weight loss than the CC protocol group. There was no significant difference in terms of muscle mass loss between the two groups. The hand grip strength of the ERAS group increased after surgery. Further, at 1 month postoperatively, the gait speed of patients who underwent total gastrectomy in the ERAS group was significantly higher than that of patients in the CC protocol group.

Conclusion: ERAS for gastrectomy was associated with a lower percentage of weight loss and a trend toward physical activity enhancement in the early postoperative period.

References

Erratum: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2020;70:313.

Imsamran W, Pattatang A, Supattagorn P, Chiawiriyabunya I, Namthaisong K. Cancer in Thailand 2013-2015. Rama VI Road, Ratchathewi District Bangkok 10400, Thailand: Cancer Registry Unit, National Cancer Institute Thailand; 2018.

Papenfuss WA, Kukar M, Oxenberg J, Attwood K, Nurkin S, Malhotra U, et al. Morbidity and mortality associated with gastrectomy for gastric cancer. Ann Surg Oncol 2014;21:3008-14.

Parakonthun T, Sirisut B, Nampoolsuksan C, Gonggetyai G, Swangsri J, Methasate A. Factors associated with complication after gastrectomy for gastric or esophagogastric cancer compared among surgical purpose, surgical extent, and patient age: Retrospective study from a high volume center in Thailand. Ann Med Surg (Lond). 2022;78:103902.

Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg 2014;101:1209-29.

Tanaka R, Lee SW, Kawai M, Tashiro K, Kawashima S, Kagota S, et al. Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial. Gastric Cancer 2017;20:861-71.

Tweed T, van Eijden Y, Tegels J, Brenkman H, Ruurda J, van Hillegersberg R, et al. Safety and efficacy of early oral feeding for enhanced recovery following gastrectomy for gastric cancer: A systematic review. Surg Oncol 2019;28:88-95.

Nampoolsuksan C, Parakonthun T, Tawantanakorn T, Mora A, Swangsri J, Akaraviputh T, et al. Short-term Postoperative Outcomes Before and After the Establishment of the Siriraj Upper Gastrointestinal Cancer Center: A Propensity Score Matched Analysis. Siriraj Med J 2020;72:321-29.

Wee IJY, Syn NL, Shabbir A, Kim G, So JBY. Enhanced recovery versus conventional care in gastric cancer surgery: A meta-analysis of randomized and non-randomized controlled trials. Gastric Cancer 2019;22:423-34.

Tian YL, Cao SG, Liu XD, Li ZQ, Liu G, Zhang XQ, et al. Short- and long-term outcomes associated with enhanced recovery after surgery protocol vs conventional management in patients undergoing laparoscopic gastrectomy. World J Gastroenterol 2020;26:5646-60.

Yamada T, Hayashi T, Cho H, Yoshikawa T, Taniguchi H, Fukushima R, et al. Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer 2012;15:34-41.

Parakonthun T, Tawantanakorn T, Swangsri J, Suwatthanarak T, Srisuworanan N, Taweerutchana V, et al. Results of an enhanced recovery after surgery protocol for upper gastrointestinal surgery at a super-tertiary referral hospital in Thailand. Surg Gastroenterol Oncol 2020;25:248-59.

Park YS, Park DJ, Lee Y, Park KB, Min SH, Ahn SH, et al. Prognostic roles of perioperative body mass index and weight loss in the long-term survival of gastric cancer patients. Cancer Epidemiol Biomarkers Prev 2018;27:955-62.

Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol (1985) 2003;95:1851-60.

Naewla S, Arrayawichanon P, Siritaratiwat W, Amatachay S. Correlation between the 6-minute walk test and variables derived from the 10-meter walk test in independent ambulatory patients with spinal cord injury. J Med Tech Phy Ther 2012 24:299-307.

Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021;24:1-21.

Gianotti L, Fumagalli Romario U, De Pascale S, Weindelmayer J, Mengardo V, Sandini M, et al. Association between compliance to an enhanced recovery protocol and outcome after elective surgery for gastric cancer. Results from a western population-based prospective multicenter study. World J Surg 2019;43:2490-8.

Mingjie X, Luyao Z, Ze T, YinQuan Z, Quan W. Laparoscopic radical gastrectomy for resectable advanced gastric cancer within enhanced recovery programs: A prospective randomized controlled trial. J Laparoendosc Adv Surg Tech A 2017;27:959-64.

Kim EY, Jun KH, Kim SY, Chin HM. Body mass index and skeletal muscle index are useful prognostic factors for overall survival after gastrectomy for gastric cancer: Retrospective cohort study. Med (Baltim) 2020;99:e23363.

Aoyama T, Yoshikawa T, Shirai J, Hayashi T, Yamada T, Tsuchida K, et al. Body weight loss after surgery is an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol 2013;20:2000-6.

Al Snih S, Markides KS, Ottenbacher KJ, Raji MA. Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period. Aging Clin Exp Res 2004;16:481-6.

Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412-23.

Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007;357:1810-20.

Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (Classic): A phase 3 open-label, randomised controlled trial. Lancet 2012;379:315-21.

Lee J, Lim DH, Kim S, Park SH, Park JO, Park YS, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: The ARTIST trial. J Clin Oncol 2012;30:268-73.