The effect of supplementary parenteral nutrition with different energy intakes on clinical outcomes of patients after gastric cancer surgery.

BACKGROUND

To investigate the effect of postoperative supplementary parenteral nutrition (SPN) containing varying energy intake levels during the early postoperative period on the clinical outcomes of patients diagnosed with gastric cancer.

METHODS

Data from 237 patients, who were diagnosed with gastric cancer between January 2016 and June 2022, were retrospectively analyzed. Patients were divided into 2 groups based on mean daily SPN energy intake: low (L-SPN; < 20 kcal/kg/day); and high (H-SPN; ≥ 20 kcal/kg/day). Data regarding gender, age, body mass index, preoperative Nutrition Risk Screening 2002 (NRS 2002) score, American Society of Anesthesiologists Physical Status classification system, age-adjusted Charlson Comorbidity Index, diabetes, hypertension, chronic lung disease, and the Tumor-Node-Metastasis (TNM [Eighth edition]) classification were collected for propensity score matching (PSM). Postoperative indicators were monitored. A power analysis was performed during the design phase of this study to ensure that statistical power exceeded 80% to reliably detect differences between the 2 groups.

RESULTS

After PSM, data from 128 patients were analyzed (H-SPN, n = 64; L-SPN, n = 64). The H-SPN group experienced shorter postoperative hospital stay (8.11 ± 6.00 days vs. 10.38 ± 7.73 days; P = 0.045) and a lower number of infectious complications (36 [56.3%] vs. 60 [93.8%]; P < 0.001), particularly pulmonary infections, compared with the L-SPN group. Additionally, no increase in hospitalization costs or non-infectious complications occurred in the H-SPN group. Subgroup analysis revealed that H-SPN significantly reduced the incidence of infectious complications among those < 65 years of age (hazard ratio [HR] [95% confidence interval (CI) 0.240 0.069-0.829]; P = 0.024), NRS 2002 score ≥ 3 (HR 0.417 [95% CI 0.156-0.823]; P = 0.028), age-adjusted Charlson Complexity Index < 2 (HR 0.106 [95% CI 0.013-0.835]; P = 0.033), and TNM stage III (HR 0.504 [95% CI 0.224-0.921]; P = 0.046).

CONCLUSIONS

H-SPN effectively reduced postoperative infectious complications and the length of hospital stay, suggesting that early postoperative H-SPN may be an advantageous nutritional support strategy for patients diagnosed with gastric cancer.