Dietary counseling in rehabilitation following gastric cancer surgery

Gastric cancer patients undergoing surgical procedures, such as total or subtotal gastrectomy, often encounter a range of challenging symptoms during postoperative rehabilitation. Indeed, surgery alters patients' gastrointestinal anatomy and physiological functions, affecting nutrient absorption and giving rise to gastrointestinal symptoms. Common symptoms include dumping syndrome, diarrhea, gastroesophageal reflux as well as nausea and early satiety. Moreover, the severity of these symptoms can lead to additional psychological distress and negatively impact oral food intake. Disturbances in symptoms and systemic inflammation, related to cancer and surgery along with emotional distress, can progressively contribute to wasting, ultimately resulting in weight loss. Following gastrectomy, most patients experience insufficient protein and calorie intake, leading to continued weight loss over an extended period. Malnutrition stands as a risk factor for postoperative complications and a poor prognosis. Therefore, to prevent this and ensure a swift recovery after surgery, individualized nutritional interventions led by dietary counseling should be consistently carried out. This should be done both during the postoperative hospitalization period (aimed at gradually increasing oral feeding intake) and in the subsequent phase at home (by providing nutritional advice to fully meet nutritional requirements and regain an adequate diet). Understanding the issues that affect patients' nutritional status after gastric cancer surgery is a critical aspect of rehabilitation programs, which are designed to enhance clinical outcomes and optimize quality of life.