Effectiveness of second-stage rehabilitation in patients after radical surgery for gastric cancer: a pilot study

BACKGROUND: Surgical intervention activates catabolic processes, which adversely affect treatment outcomes, increase the risk of complications, and prolong recovery. Implementation of a second-stage rehabilitation program promotes restoration of functional status; however, patients with concomitant nutritional disorders often tolerate such programs poorly.

AIM: The work aimed to evaluate the effect of a second-stage rehabilitation program—including moderate-intensity physical exercise combined with additional oral enteral nutrition enriched with protein and omega-3 fatty acids—on the functional and nutritional status of patients after radical surgery for gastric cancer (gastrectomy with D2 lymph node dissection).

METHODS: A prospective, observational, single-center study included 40 patients with gastric cancer (23 men and 17 women) aged 56–73 years. All patients had undergone radical surgery within 30 days before enrollment. The 14-day rehabilitation program consisted of supervised therapeutic exercise, independent training, correction of water–electrolyte imbalance, and supplemental enteral nutrition (Supportan Drink, 400 mL/day). Nutritional status, anthropometric parameters (weight loss over the previous 6 months and in the early postoperative period, body mass index, and mid-arm muscle circumference), physical endurance (6-minute walk test and handgrip strength), as well as anxiety and depression levels according to the Hospital Anxiety and Depression Scale (HADS), were assessed before and after completion of the rehabilitation program. Results are expressed as mean ± standard deviation. Differences were considered statistically significant at p ≤ 0.05.

RESULTS: Preoperative weight loss was 14.9% ± 9.03%, and postoperative weight loss before enrollment was 7.12% ± 2.28%. After completion of the rehabilitation program, mean mid-arm muscle circumference, handgrip strength, and 6-minute walk distance significantly increased: 24.38 ± 0.85 cm vs 26.77 ± 0.82 cm, 27.95 ± 2.1 kg vs 34.52 ± 2.2 kg, and 380.74 ± 15.26 m vs 437.18 ± 19.75 m, respectively (for all parameters, p < 0.05). Daily protein intake increased from 0.86 ± 0.19 g/kg to 1.39 ± 0.18 g/kg. Anxiety and depression scores significantly decreased from 11.35 ± 1.15 to 8.08 ± 1.12 points and from 12.5 ± 1.2 to 9.08 ± 1.1 points, respectively (p < 0.05).

CONCLUSION: Supplementation of the second-stage rehabilitation program (moderate-intensity physical exercise under the supervision of a therapeutic exercise instructor) with enteral nutrition enriched with protein and omega-3 fatty acids had a positive effect on the functional, psychological, and nutritional status of patients with gastric cancer after radical surgical treatment.