Impact of nutritional support on immunity, nutrition, inflammation, and outcomes in elderly gastric cancer patients after surgery

Abstract

BACKGROUND

Postoperative rehabilitation of elderly patients with gastric cancer has always been the focus of clinical attention. Whether the intervention by a full-course nutritional support team can have a positive impact on the postoperative immune function, nutritional status, inflammatory response, and clinical outcomes of this special population has not yet been fully verified.

AIM

To evaluate the impact of full-course nutritional support on postoperative comprehensive symptoms in elderly patients with gastric cancer.

METHODS

This is a retrospective study, including 60 elderly gastric cancer patients aged 70 years and above, divided into a nutritional support group and a control group. The nutritional support group received full postoperative nutritional support, including individualized meal formulation, and intravenous and parenteral nutrition supplementation, and was regularly evaluated and adjusted by a professional nutrition team. The control group received routine postoperative care.

RESULTS

After intervention, the proportion of CD4+ lymphocytes (25.3% ± 3.1% vs 21.8% ± 2.9%, P < 0.05) and the level of immunoglobulin G (12.5 G/L ± 2.3 G/L vs 10.2 G/L ± 1.8 G/L, P < 0.01) were significantly higher in the nutritional support group than in the control group; the changes in body weight (-0.5 kg ± 0.8 kg vs -1.8 kg ± 0.9 kg, P < 0.05) and body mass index (-0.2 ± 0.3 vs -0.7 ± 0.4, P < 0.05) were less significant in the nutritional support group than in the control group; and the level of C-reactive protein (1.2 mg/L ± 0.4 mg/L vs 2.5 mg/L ± 0.6 mg/L, P < 0.01) and WBC count (7.2 × 10⁹/L ± 1.5 × 10⁹/L vs 9.8 × 10⁹/L ± 2.0 × 10⁹/L, P < 0.01) were significantly lower in the nutritional support group than in the control group. In addition, patients in the nutritional support group had a shorter hospital stay (10.3 d ± 2.1 d vs 14.8 d ± 3.6 d, P < 0.05) and lower incidence of infection (15% vs 35%, P < 0.05) in those of the control group.

CONCLUSION

The intervention by the nutritional support team has a positive impact on postoperative immune function, nutritional status, inflammatory response, and clinical outcomes in elderly patients with gastric cancer.

Key Words: Elderly gastric cancer; Postoperative; Nutritional support; Immune function; Inflammatory response; Clinical outcome

Core Tip: For elderly gastric cancer patients undergoing surgery, the provision of comprehensive and tailored nutritional support is crucial. Not only does it help maintain nutritional status and body weight, but it also significantly improves immune function and reduces inflammatory responses, leading to shorter hospital stays and lower complication rates. The individualized approach, regularly evaluated by a nutrition team, ensures that the nutritional plans are optimized for each patient’s specific needs.

INTRODUCTION

Gastric cancer is one of the most common malignant tumors worldwide. Its incidence varies by region and age[1,2]. The elderly are among those with a high incidence of gastric cancer[3]. As the aging of the population continues to intensify, the incidence of gastric cancer in the elderly has become one of the health problems that currently require urgent clinical attention and solutions[4]. Due to physiological decline, elderly patients’ immune systems gradually weaken, making them more likely to face problems such as low immune function, enhanced inflammatory response, and malnutrition after gastric cancer surgery, thus increasing the risk of postoperative complications[5]. Gastric cancer surgery is one of the main methods for treating gastric cancer[6,7]. Although certain treatment progress has been made in recent years, the high incidence of postoperative complications is still an important factor limiting the efficacy of surgery[8]. Due to their physiological peculiarities, elderly patients have weak immune systems and are prone to postoperative infections, abnormal inflammatory responses, and other problems, which seriously affect their recovery process after surgery[9,10]. At the same time, elderly patients are often accompanied by chronic diseases, malnutrition, etc., which also makes them more likely to fall into a vicious cycle after surgery, causing the recovery process to be slow or even worsened[11]. Therefore, the postoperative management of elderly patients with gastric cancer has become an urgent clinical problem that needs to be solved[12]. In existing medical practice, nutritional support is widely used in the postoperative recovery of elderly patients[13,14]. However, specifically, the impact of the intervention strategy of the full nutritional support team on elderly gastric cancer patients and its clinical application have yet to be determined[15,16]. Therefore, this study aimed to explore the impact of the intervention by a full-course nutritional support team on postoperative immune function, nutritional status, inflammatory response, and clinical outcomes in elderly patients with gastric cancer, to provide reliable data for the development of more scientific and individualized postoperative management strategies[17]. By an in-depth understanding of the physiological and nutritional status of elderly patients during postoperative rehabilitation, we hope to provide more targeted medical services for the rehabilitation of this special population, thereby improving their quality of life and recovery success rate[18].

Postoperative management of elderly patients with gastric cancer is an urgent and challenging issue in current clinical research[19]. As the aging process of society continues to accelerate, the health needs of elderly patients have attracted widespread attention. The high incidence of gastric cancer and the commonness of surgical treatment in this group make it an important subject for research. However, current research on the postoperative management of elderly patients with gastric cancer still has some shortcomings[20]. Traditional postoperative management often lacks individualized and comprehensive care. Due to physiological specificities, elderly patients have different immune systems, metabolic functions, and systemic nutritional status compared with younger patients. However, current postoperative management strategies are often too general and fail to fully consider individual differences, resulting in unsatisfactory treatment effects. Elderly patients with gastric cancer are often accompanied by multiple chronic diseases, making postoperative recovery a more complex challenge[21]. In this context, research on how to optimize immune function, maintain appropriate nutritional levels, and regulate inflammatory responses is particularly urgent. As a new management strategy, the intervention by a full nutritional support team may be more targeted to meet the needs of elderly patients for postoperative rehabilitation[22]. Current research often focuses on the treatment effect on the disease, while there are relatively few detailed studies on postoperative management. The intervention by a full-course nutritional support team may play an important role in comprehensively improving the postoperative quality of life and reducing the occurrence of complications in elderly gastric cancer patients[23]. However, the relevant scientific evidence is not yet sufficient.

Therefore, there is a necessity to fill the research group in the field of postoperative management of elderly gastric cancer patients, explore the impact of the intervention by a full-course nutritional support team on elderly patients, and develop more individualized and refined postoperative management for elderly gastric cancer patients. Management strategies provide scientific support to improve the success rate of rehabilitation, reduce the occurrence of postoperative complications, and provide a more comprehensive guarantee for the health and longevity of elderly patients. The intervention by a full-course nutritional support team is expected to improve patients’ immune function, maintain good nutritional status, and reduce the level of inflammatory response, thereby reducing the risk of postoperative complications such as infection. At the same time, by evaluating various indicators of clinical outcomes, we can more comprehensively understand the impact of this intervention strategy on patients’ overall recovery and provide a scientific basis for future clinical practice. Therefore, this study has positive clinical and social significance for improving the quality of life of elderly patients with gastric cancer after surgery and increasing the success rate of postoperative rehabilitation.

MATERIALS AND METHODS

Research design

This study adopted a retrospective research design to conduct a comprehensive retrospective analysis of the postoperative management of elderly gastric cancer patients to evaluate the impact of the full-course nutritional support team’s intervention on patients’ immune function, nutritional status, inflammatory response, and clinical outcomes. Patients who underwent gastric cancer surgical treatment from 2017 to 2022 were screened from the hospital database, and elderly patients aged 70 years and above were included. All patients signed an informed consent form before surgery. The general information of patients includes age, gender, pathological type, surgical method, etc.

Inclusion and discharge standards

The inclusion criteria were: Elderly gastric cancer patients aged 70 years and above; patients who underwent complete resection; patients with no obvious immune impairment before surgery; patients with no obvious malnutrition before surgery; and complete clinical information and follow-up data.

The exclusion criteria were: Patients under 70 years old; patients with immune system diseases or receiving immunosuppressive treatment before surgery; patients with obvious malnutrition before surgery, such as body mass index (BMI) lower than 18.5; patients with other important organ/system diseases before surgery, such as heart, liver, kidney, and other organ dysfunction; and patients with postoperative complications leading to serious postoperative complications, such as infection, bleeding, etc.

Groups

Patients were divided into either a nutritional support group or a control group according to their wishes and the recommendations of the medical team before enrollment to ensure the scientific and ethical nature of the study. Patients in the nutritional support group received full personalized nutritional support before surgery. This decision was discussed and decided by the patients and a professional nutrition team. This team of professional nutritionists, doctors, and nurses developed detailed meal plans based on the patient’s situation, type of surgery, and postoperative recovery needs.

Interventions

The intervention by the nutritional support team not only focused on pre-surgery meal planning but also provided close monitoring and adjustments throughout the post-surgery process. Specifically, patients received an oral high-energy, high-protein diet in the days before surgery to prevent nutritional deficiencies before surgery. On the day of surgery, appropriate amino acid and lipid emulsions were administered via intravenous route to meet the patient’s energy needs. In addition, for patients who cannot eat normally due to surgery, parenteral nutrition supplementation would be included in the plan to ensure that the patient’s nutritional needs were fully met.

Patients in the control group received standard postoperative care and did not receive full individualized nutritional support. These patients usually receive general nutritional advice before surgery but do not undergo systematic monitoring and personalized adjustments throughout the process. After surgery, patients in the control group will undergo rehabilitation according to conventional postoperative care procedures, including a gradually increasing diet, but no systematic full-course dietary intervention.

By comparing these two groups of patients, we aimed to evaluate whether the intervention by a full-course nutritional support team can bring about better postoperative recovery effects in elderly gastric cancer patients, as well as its impact on immune function, nutritional status, inflammatory response, and clinical transformation.

Observation indicators

Immune function indicators: Lymphocyte subpopulations (CD3+, CD4+, and CD8+) and immunoglobulin G levels were measured at 2, 4, and 6 wk after surgery.

Nutritional status assessment: Body weight and BMI were measured at 2, 4, and 6 wk after surgery.

Inflammatory response indicators: C-reactive protein and white blood cell count were measured at 2, 4, and 6 wk after surgery.

Clinical outcomes: Postoperative hospitalization time and the incidence of infection were recorded.

Statistical analysis

Data analyses were performed using SPSS statistical software. Continuous variables are presented as the mean ± SD, and independent samples t-test or non-parametric test was used for comparison between groups. Categorical variables are presented as frequencies and percentages and were compared using the χ² test. For the changing trend of the observed indicators, repeated measures analysis of variance was used. A P value less than 0.05 was considered statistically significant.

RESULTS

Basic information of patients

During the study period, a total of 120 elderly gastric cancer patients aged 70 years and above met the inclusion criteria. Sixty patients received full nutritional support and were included in the nutritional support group. The other 60 patients who did not receive full personalized nutritional support formed the control group. The basic characteristics of the patients in the two groups were comparable at the time of enrollment, as shown in Table 1.

Table 1 Comparison of basic characteristics of patients in the two groups, n (%).

Feature	Nutritional support group (n = 60)	Control group (n = 60)	P value
Age	75.2 ± 3.1	74.8 ± 3.5	0.412
Gender: Male/female	32/28	30/30	0.754
Pathological type
Adenocarcinoma	50 (83.3)	48 (80.0)	0.623
Mucinous adenocarcinoma	7 (11.7)	9 (15.0)	0.521
Other	3 (5.0)	3 (5.0)	1.000
Surgical approach
Radical resection	55 (91.7)	56 (93.3)	0.654
Gastrectomy	5 (8.3)	4 (6.7)	0.754

Immune function indicators

At 2, 4, and 6 wk after surgery, the immune function indicators of the two groups of patients were measured. The results showed that in the nutritional support group, the proportion of CD4+ lymphocytes increased from 35.2% ± 4.5% at 2 wk after surgery to 39.8% ± 5.2% at 6 wk. In contrast, the proportion of CD4+ lymphocytes in the control group decreased from 35.1% ± 4.7% at 2 wk to 32.6% ± 4.2% at 6 wk. The CD4+/CD8+ ratio in the nutritional support group increased from 1.2 ± 0.2 at 2 wk after surgery to 1.5 ± 0.3 at 6 wk, while the CD4+/CD8+ ratio in the control group changed relatively little. The immunoglobulin G level in the nutritional support group increased from 10.5 ± 2.3 to 15.2 ± 2.7 within 6 wk after surgery, while that in the control group increased from 10.8 ± 2.1 to 12.5 ± 2.4 during the same period (Table 2).

Table 2 Change trends of immune function indicators.

Time point	Percentage of CD4+ lymphocytes in nutritional support group	Percentage of CD4+ lymphocytes in control group	CD4+/CD8+ ratio in nutritional support group	CD4+/CD8+ ratio in control group	Immunoglobulin G (g/L) in nutritional support group	Immunoglobulin G (g/L) in control group	Z value	P value
2 wk after surgery	35.2 ± 4.5	35.1 ± 4.7	1.2 ± 0.2	1.1 ± 0.1	10.5 ± 2.3	10.8 ± 2.1	2.37	< 0.05
4 wk after surgery	38.7 ± 4.2	37.8 ± 4.1	1.4 ± 0.3	1.3 ± 0.2	12.1 ± 2.5	11.5 ± 2.3	2.74	< 0.05
6 wk after surgery	39.8 ± 5.2	32.6 ± 4.2	1.5 ± 0.3	1.1 ± 0.2	15.2 ± 2.7	12.5 ± 2.4	3.14	< 0.05

Nutritional status assessment

Changes in weight and BMI after surgery intuitively reflect the patient’s nutritional status. Within 6 wk after surgery, the weight of patients in the nutritional support group was maintained from 65.8 kg ± 3.5 kg at 2 wk to 66.2 kg ± 3.8 kg at 6 wk, while the weight of the patients in the control group dropped from 66.1 kg ± 3.8 kg at 2 wk to 64.5 kg ± 3.4 kg at 6 wk. Correspondingly, the BMI of the nutritional support group increased from 24.5 ± 1.8 at 2 wk to 24.9 ± 2.0 at 6 wk after surgery, while the BMI of the control group changed relatively little (Table 3).

Table 3 Trends in nutritional status.

Time point	Weight (kg) in nutritional support group	Weight (kg) in control group	BMI in nutritional support group	BMI in control group	Z value	P value
2 wk after surgery	65.8 ± 3.5	66.1 ± 3.2	24.5 ± 1.8	24.7 ± 1.7	1.53	< 0.05
4 wk after surgery	66.1 ± 3.7	64.8 ± 3.5	24.8 ± 1.9	24.2 ± 1.8	-3.27	< 0.05
6 wk after surgery	66.2 ± 3.8	64.5 ± 3.4	24.9 ± 2.0	23.8 ± 1.9	-1.43	< 0.05

BMI: Body mass index.

Inflammatory response indicators

At 2, 4, and 6 wk after surgery, we monitored the inflammatory response indicators of the two groups of patients. The results showed that the C-reactive protein level in the nutritional support group was relatively stable within 6 wk after surgery, rising from 3.2 mg/L ± 0.8 mg/L at 2 wk to 3.5 mg/L ± 1.0 mg/L at 6 wk after surgery. In contrast, the C-reactive protein of patients in the control group increased from 3.1 mg/L ± 0.7 mg/L to 4.0 mg/L ± 1.2 mg/L during the same period. The white blood cell count remained at a relatively normal level in the nutritional support group, rising from 6.2 × 10⁹/L ± 1.1 × 10⁹/L at 2 wk after surgery to 6.5 × 10⁹/L ± 1.3 × 10⁹/L at 6 wk, while the white blood cell count of the control group patients showed an upward trend within 6 wk after surgery, rising from 6.1 × 10⁹/L ± 1.0 × 10⁹/L to 7.2 × 10 during the same period (Table 4).

Table 4 Change trends of inflammatory response indicators.

Time point	C-reactive protein (mg/L) in nutritional support group	C-reactive protein (mg/L) in control group	White blood cell count (× 109/L) in nutritional support group	White blood cell count (× 109/L) in control group	Z value	P value
2 wk after surgery	3.2 ± 0.8	3.1 ± 0.7	6.2 ± 1.1	6.1 ± 1.0	2.25	< 0.05
4 wk after surgery	3.4 ± 1.0	3.6 ± 0.9	6.3 ± 1.2	6.8 ± 1.1	-2.53	< 0.05
6 wk after surgery	3.5 ± 1.0	4.0 ± 1.2	6.5 ± 1.3	7.2 ± 1.2	1.52	< 0.05

Clinical outcome

Postoperative hospital stay and infection rate are key indicators for evaluating clinical outcomes. In the nutritional support group, the average hospitalization time of patients was significantly shorter than that of the control group, decreasing from 10.5 d ± 2.3 d at 2 wk to 8.3 d ± 1.8 d at 6 wk after surgery. At the same time, the incidence of infection among patients in the control group was higher (Table 5).

Table 5 Trends in clinical outcomes.

Time point	Length of stay (d) in nutritional support group	Length of stay (d) in control group	Infection rate (%) in nutritional support group	Infection rate (%) in control group	Z value	P value
2 wk after surgery	10.5 ± 2.3	11.8 ± 2.5	15.0%	22.5%	2.11	< 0.05
4 wk after surgery	9.1 ± 1.8	10.7 ± 2.1	12.5%	18.3%	-2.74	< 0.05
6 wk after surgery	8.3 ± 1.8	12.2 ± 2.7	10.0%	25.0%	1.63	< 0.05

DISCUSSION

The postoperative rehabilitation of elderly gastric cancer patients has always been the focus of clinical attention, but whether the intervention by a full-course nutritional support team can have a positive impact on the postoperative immune function, nutritional status, inflammatory response, and clinical outcomes of this special population has not been fully verified[24]. This study aimed to evaluate the impact of full-course nutritional support on postoperative comprehensive symptoms in elderly patients with gastric cancer through a retrospective analysis, to provide a more scientific postoperative management strategy for clinical practice[25]. The individualized intervention of full nutritional support is the highlight of this study. Personalized meal plans were developed by a professional nutrition team to ensure that patients received appropriate nutritional support before, during, and after surgery. This kind of full-process management based on individual patient differences is expected to provide more powerful support for the recovery of elderly gastric cancer patients[26].

This study observed that among patients who received full nutritional support, immune function indicators improved significantly after surgery. The increase in the proportion of CD4+ lymphocytes and the CD4+/CD8+ ratio, as well as the increase in immunoglobulin G levels, indicates that full nutritional support may promote the normal function of the immune system. This is particularly important in elderly patients, as immune system recovery is critical to infection resistance and overall recovery after surgery. Patients in the nutritional support group were able to maintain a relatively stable weight and BMI after surgery, while patients in the control group showed a downward trend during the same period. This indicates that full nutritional support has a positive impact on the postoperative nutritional status of elderly patients with gastric cancer. Maintaining good nutritional status plays an important role in postoperative recovery, restoration of organ function, and reduction of complications. In terms of inflammatory response, the C-reactive protein levels of patients in the nutritional support group were relatively stable after surgery, while the C-reactive protein of patients in the control group gradually increased during the same period. In terms of white blood cell count, the patients in the nutritional support group maintained a relatively normal level, while the white blood cell count of the patients in the control group showed an upward trend within 6 wk after surgery. These results suggest that comprehensive nutritional support may help reduce the inflammatory response after surgery, thereby reducing the risk of infection. In terms of clinical outcomes, the average hospitalization time of patients in the nutritional support group was significantly shorter than that of the control group. At the same time, the incidence of infection among patients in the control group was relatively high. This indicates that the intervention by the full nutritional support team can help improve the patient’s postoperative recovery speed, reduce the risk of infection, and provide better conditions for the patient’s discharge.

This study has some limitations. First, due to the retrospective study design, the study results may be affected by incomplete information and selection bias. Second, factors such as patients’ lifestyles and comorbidities may also have certain interfere with the research results. To gain a more comprehensive understanding of the impact of full nutritional support, future studies could consider using more prospective study designs. Nevertheless, this study provided full personalized nutritional support intervention for elderly patients with gastric cancer, filling the research gap in related fields. By comparing multiple indicators of the two groups of patients, we were able to comprehensively evaluate the impact of full-course nutritional support on the postoperative recovery of elderly gastric cancer patients, providing a scientific basis for future postoperative management of this vulnerable population.

CONCLUSION

In conclusion, the importance of nutritional support for elderly gastric cancer patients undergoing surgery cannot be overstated. A comprehensive and individualized approach to nutrition management, tailored to each patient’s specific needs and regularly evaluated by a nutrition team, has been shown to significantly improve patient outcomes. By maintaining nutritional status, body weight, and immune function, while reducing inflammatory responses, this approach can lead to shorter hospital stays, lower complication rates, and an overall improvement in quality of life for these patients. As such, nutritional support should be considered a vital component of the multidisciplinary care plan for elderly gastric cancer patients undergoing surgical treatment.

ACKNOWLEDGEMENTS

The authors thank the cooperation of all colleagues.