Early Nutritional–Immune Biomarker Trajectories Following Gastrectomy for Gastric Cancer: A Prospective Longitudinal Cohort Study
TL;DR
Nutritional recovery following gastrectomy is a dynamic and prolonged process characterized by marked early nutritional–inflammatory biomarker changes and incomplete biochemical restoration at three months, and these findings apply primarily to patients who survived and completed the three-month follow-up.
Abstract
Background: Nutritional deterioration is a common consequence of gastrectomy for gastric cancer and may persist despite standardized perioperative care. However, prospective longitudinal evidence describing the early course of postoperative nutritional recovery remains limited. This study aimed to characterize nutritional recovery trajectories following curative gastrectomy and to evaluate the influence of the extent of gastric resection on postoperative recovery. Methods: A prospective cohort of 239 consecutive patients undergoing curative-intent subtotal or total gastrectomy for gastric adenocarcinoma was followed between January 2022 and December 2025. The longitudinal complete-case analysis included 217 patients with available assessments at all three predefined time points: preoperatively (T0), at hospital discharge (T1), and three months after surgery (T3). Nutritional–immune biomarker trajectories were assessed preoperatively (T0), at hospital discharge (T1), and three months after surgery (T3) using serum albumin, total cholesterol, absolute lymphocyte count, and the Controlling Nutritional Status (CONUT) score. Longitudinal changes were evaluated using linear mixed-effects models with patient-specific random intercepts. Results: All evaluated nutritional–immune biomarkers changed significantly in an adverse direction after surgery, reaching their most unfavorable values at hospital discharge (all p < 0.001), followed by partial biochemical recovery at three months. Because albumin, lymphocyte count, and CONUT are influenced by the acute inflammatory and metabolic response to surgery, the discharge changes should not be interpreted as direct evidence of acute malnutrition. Nevertheless, none of the evaluated biomarkers returned to its preoperative value. Recovery between discharge and three months represented 65.6% of the initial decline for serum albumin, 50.5% for absolute lymphocyte count, 51.7% for total cholesterol, and 60.9% for the CONUT score. After adjustment for age, sex, neoadjuvant chemotherapy, baseline body mass index, ASA status, pathological T3–T4 stage, and major postoperative morbidity, total gastrectomy was associated with a greater early decline in absolute lymphocyte count at hospital discharge (β = −165.7 cells/mm3; 95% CI, −204.9 to −126.6; p < 0.001). This difference was no longer present at three months (p = 0.955). No significant time-by-gastrectomy interactions were observed for albumin, cholesterol, or corrected CONUT. Conclusions: Nutritional recovery following gastrectomy is a dynamic and prolonged process characterized by marked early nutritional–inflammatory biomarker changes and incomplete biochemical restoration at three months. Resection extent was not independently associated with persistently less favorable albumin, cholesterol, or corrected CONUT trajectories. The findings describe early biochemical changes and should not be extrapolated to body composition, functional recovery, micronutrient status, quality of life, or long-term survivorship. These findings apply primarily to patients who survived and completed the three-month follow-up.