Multi-institutional Prospective Feasibility Study to Explore Tolerability and Efficacy of Oral Nutritional Supplements for Patients with Gastric Cancer Undergoing Gastrectomy (CCOG1301)

Background: Postoperative malnutrition after gastrectomy is deemed inevitable, which could have prejudicial influence on survival for gastric cancer patients. A prospective feasibility study was conducted to evaluate the efficacy of postoperative oral nutritional supplements.

Methods: Stage I-III gastric cancer patients who underwent distal or total gastrectomy received oral administration of Racol NF (Otsuka Pharmaceutical Factory, Japan), a liquid enteral nutritional formula, as a supplement to regular meals. Racol NF administration at a recommended dosage of 400 kcal/400 ml per day was started within 7 days postoperatively and was continued for 3 months postoperatively. The primary end point was ratio of the weight loss at 3 months postoperatively to the preoperative body weight (body weight loss ratio). Secondary end points were the adherence to Racol NF therapy and changes in body composition.

Results: One hundred eighteen patients were registered before surgery, 82 of whom were eligible for efficacy analyses. The average rate of body weight loss after 3 months postoperatively was 8.3%. The mean daily intake of Racol NF was 211 ml. There was a significant correlation between adherence to Racol NF therapy and body weight loss ratio (P < 0.001). Adherence to Racol NF therapy was the only factor that correlated with the body weight loss ratio among all clinical characteristics by the multiple linear regression analysis (P = 0.007).

Conclusions: Oral nutritional supplementation with Racol NF led to a significant reduction in body weight loss for gastrectomized patients who tolerated more than 200 ml of the nutrient per day compared with those who could not tolerate this amount.