Nutritional Implications in Preparing Patients for Total Gastrectomy
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NUTRITION, METABOLISM, AND SURGERY (K MILLER, SECTION EDITOR)
Nutritional Implications in Preparing Patients for Total Gastrectomy Sonika Malik1 • Carol E. Semrad1
Published online: 1 September 2020 Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Prophylactic total gastrectomy is recommended to prolong life in individuals who carry the CDH1 variants associated with early diffuse gastric cancer. Loss of the stomach requires life-long changes in diet and poses a risk for select vitamin and mineral deficiencies that require supplementation and monitoring. This review covers the physiology of the stomach and the pathobiology and management of individuals post-gastrectomy with altered small bowel anatomy. Recent Findings Enhanced recovery after surgery guidelines (ERAS) for total gastrectomy reduces complication rates, enhances healing, and lessens hospital stay. Oral vitamin B12 in pharmacologic doses is equally effective to parenteral B12 supplementation post-gastrectomy. Glucagon-like peptide 1 (GLP-1) is an important hormone involved in the vasomotor symptoms of dumping syndrome that holds promise as a target for therapy. Summary Although the stomach is not a vital organ, its motor and physiologic functions are important for nutrition and quality of life. Prevention of malnutrition and improving quality of life are accomplished by diet education, supplementation of vitamin B12 and other at risk vitamins and minerals, and monitoring throughout life.
This article is part of the Topical collection on Nutrition, Metabolism, and Surgery. & Carol E. Semrad [email protected] 1
Keywords Gastrectomy Nutrition Vitamin B12 Malabsorption
Introduction Prophylactic total gastrectomy is recommended in individuals who carry pathogenic CDH1 (E-cadherin) variants given high lifetime risk of diffuse gastric cancer [1••, 2]. These patients are often asymptomatic until there is advanced disease with a poor prognosis. Endoscopic surveillance has inadequate sensitivity and specificity due to absence of obvious endoscopic findings [3]. The optimal age to perform total gastrectomy is between 20 and 30 years as the risk for diffuse gastric cancer increases with age with lifetime estimates of up to 70% and 56% for men and women, respectively [4]. Total gastrectomy can be performed by laparotomy, laparoscopy, or robotic approach. The most common technique is removal of the entire gastric mucosa and creation of a Roux-en-Yesophagojejunal anastomosis with or without creation of a jejunal pouch [2, 5] (Fig. 1). Total gastrectomy is also performed in a subset of those with complications of sleeve gastrectomy and Roux-en-Y gastric bypass for obesity. The stomach is not a vital organ. However, loss of the stomach and alteration of small bowel anatomy poses a risk for nutritional and metabolic derangements that may result in malnutrition and a poor quality of life, particularly early after surgery. The purpose of this article is to review normal gastric physiology, the nutrit
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