{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:41:24Z","timestamp":1790167284306,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Gastric cancer remains a significant global health burden, with curative treatment relying on surgical resection, typically total or subtotal gastrectomy. However, the procedure frequently triggers acute metabolic and nutritional disturbances that may impact recovery. Objective: This prospective study aimed to investigate whether the type of gastrectomy (total vs. subtotal) influences early postoperative biochemical and hematological alterations, with particular attention to nutritional impact. Methods: A cohort of 295 patients (123 female, 172 male) who underwent gastrectomy for gastric cancer at the Institute of Oncology Ia\u0219i (2023\u20132024) was evaluated. Laboratory parameters, including hemoglobin, hematocrit, lymphocyte and platelet counts, serum albumin, total protein, sodium, potassium, creatinine, and urea, were analyzed preoperatively and on postoperative day 14 using standard clinical methods. Results: Anemia was observed in over 90% of patients, irrespective of sex or procedure type. Electrolyte imbalances (notably hyponatremia and hypokalemia) and indicators of nutritional deficit (hypoalbuminemia, low creatinine) were highly prevalent, with a greater frequency among female patients. Total gastrectomy was associated with more severe biochemical and nutritional alterations compared to subtotal procedures. Conclusions: Total gastrectomy significantly exacerbates early postoperative metabolic and nutritional derangements. These findings reinforce the need for proactive, personalized postoperative nutritional and electrolyte management strategies to support recovery and reduce complication risks.<\/jats:p>","DOI":"10.3390\/nu17132146","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T06:18:36Z","timestamp":1751264316000},"page":"2146","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Nutritional and Biochemical Outcomes After Total Versus Subtotal Gastrectomy: Insights into Early Postoperative Prognosis"],"prefix":"10.3390","volume":"17","author":[{"given":"Fawzy","family":"Akad","sequence":"first","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Center for Obesity BioBehavioral Experimental Research, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristinel Ionel","family":"Stan","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florin","family":"Zugun-Eloae","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Transcend Research Center, Regional Oncology Institute, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin Nicolae","family":"Peiu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Akad","sequence":"additional","affiliation":[{"name":"Center for Obesity BioBehavioral Experimental Research, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Medical Sciences II, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragos-Valentin","family":"Crauciuc","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius Constantin","family":"Moraru","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cosmin Gabriel","family":"Popa","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liviu-Ciprian","family":"Gavril","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana-Florentina","family":"Sufaru","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Preda","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences II, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9330-1691","authenticated-orcid":false,"given":"Veronica","family":"Mocanu","sequence":"additional","affiliation":[{"name":"Center for Obesity BioBehavioral Experimental Research, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Morpho-Functional Sciences II, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Machlowska, J., Baj, J., Sitarz, M., Maciejewski, R., and Sitarz, R. (2020). GC: Epidemiology, Risk Factors, Classification, Genomic Characteristics and Treatment Strategies. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21114012"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000488240","article-title":"Carbohydrate Antigen 19-9, Carcinoembryonic Antigen, and Carbohydrate Antigen 72-4 in GC: Is the Old Band Still Playing?","volume":"5","author":"Kotzev","year":"2018","journal-title":"Gastrointest Tumors"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s10120-013-0259-5","article-title":"Clinical significance of serum tumor markers for GC: A systematic review of literature by the Task Force of the Japanese GC Association","volume":"17","author":"Shimada","year":"2014","journal-title":"Gastric Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1007\/s00595-021-02248-y","article-title":"Prognostic impact of CEA\/CA19-9 at the time of recurrence in patients with GC","volume":"51","author":"Moriyama","year":"2021","journal-title":"Surg Today"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1055\/s-2008-1069337","article-title":"Klinische Bedeutung des zirkulierenden tumorassoziierten Antigens CA 19-9 bei Karzinomen des Verdauungstraktes [Clinical significance of the circulating tumor-associated antigen CA 19-9 in cancers of the digestive tract]","volume":"109","author":"Staab","year":"1984","journal-title":"Dtsch Med. Wochenschr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"66","DOI":"10.7326\/0003-4819-104-1-66","article-title":"Carcinoembryonic antigen","volume":"104","author":"Fletcher","year":"1986","journal-title":"Ann. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1084\/jem.121.3.439","article-title":"Demonstration of Tumor-Specific Antigens in Human Colonic Carcinomata by Immunological Tolerance and Absorption Techniques","volume":"121","author":"Gold","year":"1965","journal-title":"J. Exp. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1007\/BF01542654","article-title":"Colorectal carcinoma antigens detected by hybridoma antibodies","volume":"5","author":"Koprowski","year":"1979","journal-title":"Somat. Cell Genet."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.clnu.2016.07.015","article-title":"ESPEN guidelines on nutrition in cancer patients","volume":"36","author":"Arends","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.clnesp.2021.09.005","article-title":"The clinical impact of malnutrition on the postoperative outcomes of patients undergoing gastrectomy for gastric cancer: Propensity score matched analysis of 2011\u20132017 hospital database","volume":"46","author":"Lee","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Bradley EL3rd Isaacs, J., Hersh, T., Davidson, E.D., and Millikan, W. (1975). Nutritional consequences of total gastrectomy. Ann. Surg., 182, 415\u2013429.","DOI":"10.1097\/00000658-197510000-00007"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Akad, F., Filip, B., Preda, C., Zugun-Eloae, F., Peiu, S.N., Akad, N., Crauciuc, D.V., Vatavu, R., Gavril, L.C., and Sufaru, R.F. (2024). Assessing Nutritional Status in Gastric Cancer Patients after Total versus Subtotal Gastrectomy: Cross-Sectional Study. Nutrients, 16.","DOI":"10.3390\/nu16101485"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1002\/ags3.12351","article-title":"Nutrition update in gastric cancer surgery","volume":"4","author":"Kubota","year":"2020","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.annonc.2022.07.004","article-title":"GC: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"33","author":"Lordick","year":"2022","journal-title":"Ann. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"13667","DOI":"10.3748\/wjg.v20.i38.13667","article-title":"STG for GC","volume":"20","author":"Santoro","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"167","DOI":"10.6004\/jnccn.2022.0008","article-title":"Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology","volume":"20","author":"Ajani","year":"2022","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s00292-021-01023-7","article-title":"The updated WHO classification of digestive system tumours-gastric adenocarcinoma and dysplasia","volume":"43","author":"Kushima","year":"2022","journal-title":"Pathologe"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1093\/annonc\/mdr437","article-title":"Attributable causes of cancer in Japan in 2005--systematic assessment to estimate current burden of cancer attributable to known preventable risk factors in Japan","volume":"23","author":"Inoue","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_20","first-page":"8497305","article-title":"Adenocarcinoma with Mixed Subtypes in the Early and Advanced Gastric Cancer","volume":"2021","author":"Zhao","year":"2021","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"19427","DOI":"10.18632\/oncotarget.24827","article-title":"Piotr Distinct molecular subtypes of gastric cancer: From Laur\u00e9n to molecular pathology","volume":"9","author":"Skierucha","year":"2018","journal-title":"Oncotarget"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ma, X., Zhou, X., Guo, J., Feng, X., Zhao, M., Zhang, P., Zhang, C., Gong, S., Wu, N., and Zhang, Y. (2024). CA19 9 is a significant prognostic factor in stage III GC patients undergoing radical gastrectomy. BMC Surg., 24.","DOI":"10.1186\/s12893-024-02324-3"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1097\/00000658-199711000-00006","article-title":"Total versus STG: Surgical morbidity and mortality rates in a multicenter Italian randomized trial. The Italian Gastrointestinal Tumor Study Group","volume":"226","author":"Bozzetti","year":"1997","journal-title":"Ann Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"621","DOI":"10.4149\/neo_2021_200923N1015","article-title":"The role of subtotal and TG in the treatment of GC","volume":"68","author":"Palaj","year":"2021","journal-title":"Neoplasma"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"35423","DOI":"10.18632\/oncotarget.8770","article-title":"Prognostic significance of preoperative serum CA125, CA19-9 and CEA in gastric carcinoma","volume":"7","author":"Wang","year":"2016","journal-title":"Oncotarget"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2685","DOI":"10.7314\/APJCP.2015.16.7.2685","article-title":"Preoperative serum CEA and CA19-9 in GC\u2014A single tertiary hospital study of 1075 cases","volume":"16","author":"Zhou","year":"2015","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1093\/annonc\/mdr561","article-title":"NSW Pancreatic Cancer Network. The prognostic and predictive value of serum CA19.9 in pancreatic cancer","volume":"23","author":"Humphris","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"8087","DOI":"10.2147\/IJGM.S335985","article-title":"Gastrin-17 Combined with CEA, CA12-5 and CA19-9 Improves the Sensitivity for the Diagnosis of GC","volume":"14","author":"Wang","year":"2021","journal-title":"Int. J. Gen Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/01.mpa.0000188305.90290.50","article-title":"Decreased total lymphocyte counts in pancreatic cancer: An index of adverse outcome","volume":"32","author":"Fogar","year":"2006","journal-title":"Pancreas"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.jss.2005.10.013","article-title":"Regulation of Fas-mediated apoptosis in neutrophils after surgery-induced acute inflammation","volume":"134","author":"Iwase","year":"2006","journal-title":"J. Surg. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/1025389031000111302","article-title":"Gender differences in cardiovascular and hypothalamic-pituitary-adrenal axis responses to psychological stress in healthy older adult men and women","volume":"6","author":"Bosch","year":"2003","journal-title":"Stress"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S104","DOI":"10.3346\/jkms.2007.22.S.S104","article-title":"Effects of gender on white blood cell populations and neutrophil-lymphocyte ratio following gastrectomy in patients with stomach cancer","volume":"22","author":"Gwak","year":"2007","journal-title":"J. Korean Med. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Powell, B., Szleifer, I., and Dhaher, Y.Y. (2018). In silico study of principal sex hormone effects on post-injury synovial inflammatory response. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0209582"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"De Felice, F., Malerba, S., Nardone, V., Salvestrini, V., Calomino, N., Testini, M., Boccardi, V., Desideri, I., Gentili, C., and De Luca, R. (2025). Progress and Challenges in Integrating Nutritional Care into Oncology Practice: Results from a National Survey on Behalf of the NutriOnc Research Group. Nutrients, 17.","DOI":"10.3390\/nu17010188"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Feng, F., Zheng, G., Wang, Q., Liu, S., Liu, Z., Xu, G., Wang, F., Guo, M., Lian, X., and Zhang, H. (2018). Low lymphocyte count and high monocyte count predicts poor prognosis of GC. BMC Gastroenterol., 18.","DOI":"10.1186\/s12876-018-0877-9"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/13\/2146\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:00:15Z","timestamp":1760032815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/13\/2146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":35,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["nu17132146"],"URL":"https:\/\/doi.org\/10.3390\/nu17132146","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,27]]}}}