Research progress on micronutrient deficiency after gastrectomy for gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Zhaowan ¹ ,  DONG Bo ²

1. The Fifth Clinical College of Shanxi Medical University, Taiyuan 030001, P. R. China;
2. Department of Gastrointestinal Surgery, Shanxi Provincial People’s Hospital, Taiyuan 030001, P. R. China;

Corresponding?author：

DONG Bo, Email: yqdong8888@163.com

Keywords：

gastric cancer; gastrectomy; micronutrient deficiency

DOI：

10.7507/1007-9424.202404072

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand the research progress on micronutrient deficiency after gastrectomy for gastric cancer in order to provide a new ideas for its prevention and treatment. Method The literature on reseach relevant micronutrient deficiency after gastrectomy for gastric cancer in recent years at home and abroad was searched and reviewed. Results The micronutrient deficiency after partial or total gastrectomy was more common for the patients with gastric cancer, especially some key nutrients such as iron, zinc, copper, fat soluble vitamins (vitamins A, D, E), vitamin B₁₂, folate, and so on. The main reason for the micronutrient deficiency was due to the changes of the anatomical structure or physiological function of the gastrointestinal tract caused by surgery, as most micronutrients were absorbed through the duodenum or jejunum, bypassing the main absorption site of micronutrients after total or partial gastrectomy; In addition, preoperative malnutrition, neoadjuvant therapy, early and late postoperative complications, as well as postoperative adjuvant therapy, and reduced gastric acid secretion, might all lead to the micronutrient absorption disorders. There was also limited literature on the micronutrient supplementation after gastrectomy for gastric cancer, but some researchers still supported providing nutritional support before and after surgery for the gastric cancer patients with severe malnutrition. There was few literature reported on the adverse consequences of nutritional support for the gastric cancer patients underwent gastrectomy. Conclusions At present, there is still limited literature on the study of micronutrient deficiency and supplementation after gastrectomy for gastric cancer. With the increasing attention of clinician to the impact of micronutrients on diseases or health, the European Society for Extraintestinal and Enteral Nutrition developed the “ESPEN micronutrition guidelines” in 2022 and “Expert consensus on micronutrients deficiency and supplementation in malignant tumors” was published in China at 2024. In the current situation where relevant research is insufficient, it is recommended that clinicians refer to this guideline or expert consensus and provide personalized intervention for patients with micronutrient deficiencies based on their clinical conditions.

Citation： XU Zhaowan, DONG Bo. Research progress on micronutrient deficiency after gastrectomy for gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(9): 1135-1140. doi: 10.7507/1007-9424.202404072 Copy

1.	Kang MK, Lee HJ. Impact of malnutrition and nutritional support after gastrectomy in patients with gastric cancer. Ann Gastroenterol Surg, 2024, 8(4): 534-552.
2.	Matsui R, Inaki N, Tsuji T. Impact of preoperative nutritional assessment on other-cause survival after gastrectomy in patients with gastric cancer. Nutrients, 2023, 15(14): 3182. doi: 10.3390/nu15143182.
3.	中華醫學會外科學分會胃腸外科學組, 中華醫學會外科學分會結直腸外科學組, 中國醫師協會外科醫師分會上消化道外科醫師委員會. 胃腸外科病人圍手術期全程營養管理中國專家共識(2021版). 中國實用外科雜志, 2021, 41(10): 1111-1125.
4.	Anderson PM, Thomas SM, Sartoski S, et al. Strategies to mitigate chemotherapy and radiation toxicities that affect eating. Nutrients, 2021, 13(12): 4397. doi: 10.3390/nu13124397.
5.	Prado CM, Ford KL, Gonzalez MC, et al. Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient. JPEN J Parenter Enteral Nutr, 2023, 47 Suppl 1(Suppl 1): S54-S68. doi: 10.1002/jpen.2420.
6.	中國抗癌協會放射治療整合護理專業委員會, 廣東省護理學會腫瘤營養護理專業委員會. 惡性腫瘤微量營養素缺乏與補充專家共識. 腫瘤代謝與營養電子雜志, 2024, 11(3): 322-331.
7.	Veeralakshmanan P, Tham JC, Wright A, et al. Nutritional deficiency post esophageal and gastric cancer surgery: A quality improvement study. Ann Med Surg (Lond), 2020, 56: 19-22.
8.	Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures—2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis, 2020, 16(2): 175-247.
9.	O’Kane M, Parretti HM, Pinkney J, et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update. Obes Rev, 2020, 21(11): e13087. doi: 10.1111/obr.13087.
10.	Tsujiura M, Nunobe S. Functional and nutritional outcomes after gastric cancer surgery. Transl Gastroenterol Hepatol, 2020, 5: 29. doi: 10.21037/tgh.2019.11.10.
11.	Lee JH, Hyung WJ, Kim HI, et al. Method of reconstruction governs iron metabolism after gastrectomy for patients with gastric cancer. Ann Surg, 2013, 258(6): 964-969.
12.	Tovey FI, Clark CG. Anaemia after partial gastrectomy: a neglected curable condition. Lancet, 1980, 1(8175): 956-958.
13.	Beyan C, Beyan E, Kaptan K, et al. Post-gastrectomy anemia: evaluation of 72 cases with post-gastrectomy anemia. Hematology, 2007, 12(1): 81-84.
14.	Stevens AR, Pirzio-Biroli G, Harkins HN, et al. Iron metabolism in patients after partial gastrectomy. Ann Surg, 1959, 149(4): 534-538.
15.	Kim KH, Park DJ, Park YS, et al. Actual 5-year nutritional outcomes of patients with gastric cancer. J Gastric Cancer, 2017, 17(2): 99-109.
16.	Nie Y, Tian Z, Wang P, et al. Prevalence of anemia and related nutrient deficiencies after sleeve gastrectomy: A systematic review and meta-analysis. Obes Rev, 2023, 24(1): e13516. doi: 10.1111/obr.13516.
17.	劉林輝, 李云霞, 朱鳳霞, 等. 早期胃癌患者術后貧血的危險因素及營養狀態評估. 中國現代普通外科進展, 2020, 23(4): 285-289.
18.	Hines JD, Hoffbrand AV, Mollin DL. The hematologic complications following partial gastrectomy. A study of 292 patients. Am J Med, 1967, 43(4): 555-569.
19.	Berger MM, Shenkin A, Schweinlin A, et al. ESPEN micronutrient guideline. Clin Nutr, 2022, 41(6): 1357-1424.
20.	Blonk L, Gooszen JAH, Fakkert RA, et al. Micronutrient deficiencies and anemia in the follow-up after gastroesophageal cancer surgery. Dis Esophagus, 2024 Jun 24: doae053. doi: 10.1093/dote/doae053.
21.	Namikawa T, Shimizu S, Yokota K, et al. Serum zinc deficiency in patients after gastrectomy for gastric cancer. Int J Clin Oncol, 2021, 26(10): 1864-1870.
22.	王艷, 徐學琴. 腹腔鏡Roux-en-Y胃旁路術對肥胖患者多項微量營養素水平影響的Meta分析. 中華臨床營養雜志, 2023, 31(4): 193-203.
23.	薛松林, 王崇樹. Roux-en-Y胃轉流術后鋅缺乏的研究進展. 中國普外基礎與臨床雜志, 2013, 20(5): 574-578.
24.	Nakagawa M, Kojima K, Inokuchi M, et al. Assessment of serum copper state after gastrectomy with Roux-en-Y reconstruction for gastric cancer. Dig Surg, 2015, 32(4): 301-305.
25.	Toyama T, Kubuki Y, Suzuki M, et al. Copper deficiency anemia and neutropenia secondary to total gastrectomy. Rinsho Ketsueki, 2000, 41(5): 441-443.
26.	Gletsu-Miller N, Broderius M, Frediani JK, et al. Incidence and prevalence of copper deficiency following Roux-en-Y gastric bypass surgery. Int J Obes (Lond), 2012, 36(3): 328-335.
27.	Ernst B, Thurnheer M, Schultes B. Copper deficiency after gastric bypass surgery. Obesity (Silver Spring), 2009, 17(11): 1980-1981.
28.	Inaba M, Torii T, Shinoda K, et al. Peripheral neuropathy, myelopathy, cerebellar ataxia, and subclinical optic neuropathy associated with copper deficiency occurring 23 years after total gastrectomy. Rinsho Shinkeigaku, 2011, 51(6): 412-416.
29.	Myint ZW, Oo TH, Thein KZ, et al. Copper deficiency anemia: review article. Ann Hematol, 2018, 97(9): 1527-1534.
30.	Prodan CI, Bottomley SS, Vincent AS, et al. Copper deficiency after gastric surgery: a reason for caution. Am J Med Sci, 2009, 337(4): 256-258.
31.	van der Velden AL, Vermeer TA, Boerma EG, et al. Vitamin insufficiency after surgery for oesophagogastric neoplasms: a study protocol for a prospective intervention study. BMJ Open, 2023, 13(7): e067981. doi: 10.1136/bmjopen-2022-067981.
32.	Al-Nasser A, Alzerwi N, Hussain M, et al. Nutritional demand after gastric surgery. Clin Surg, 2019, 2019: 2465. doi: 10.25107/2474-1647.2465.
33.	Janssen HJB, Fransen LFC, Ponten JEH, et al. Micronutrient deficiencies following minimally invasive esophagectomy for cancer. Nutrients 2020, 12: 778. doi: 10.3390/nu12030778.
34.	Rino Y, Oshima T, Yoshikawa T. Changes in fat-soluble vitamin levels after gastrectomy for gastric cancer. Surg Today, 2017, 47(2): 145-150.
35.	Osland EJ, Ali A, Nguyen T, et al. Australasian society for parenteral and enteral nutrition (AuSPEN) adult vitamin guidelines for parenteral nutrition. Asia Pac J Clin Nutr, 2016, 25(3): 636-650.
36.	Heneghan HM, Zaborowski A, Fanning M, et al. Prospective study of malabsorption and malnutrition after esophageal and gastric cancer surgery. Ann Surg, 2015, 262(5): 803-807.
37.	Muszyński T, Polak K, Fr?tczak A, et al. Vitamin D—The nutritional status of post-gastrectomy gastric cancer patients-systematic review. Nutrients, 2022, 14(13): 2712. doi: 10.3390/nu14132712.
38.	Guéant JL, Guéant-Rodriguez RM, Alpers DH. Chapter Nine—Vitamin B12 absorption and malabsorption//Litwack G. Vitamins and hormones. Academic Press, 2022, 119: 241-274.
39.	Bahardoust M, Mousavi S, Ziafati H, et al. Vitamin B12 deficiency after total gastrectomy for gastric cancer, prevalence, and symptoms: a systematic review and meta-analysis. Eur J Cancer Prev, 2024, 33(3): 208-216.
40.	韓菲, 朱華. 胃癌胃切除術后維生素B₁₂缺乏與補充的研究進展. 實用藥物與臨床, 2023, 26(1): 79-82.
41.	van Hagen P, de Jonge R, van Berge Henegouwen MI, et al. Vitamin B12 deficiency after esophagectomy with gastric tube reconstruction for esophageal cancer. Dis Esophagus, 2017, 30(12): 1-8.
42.	Kim JH, Bae YJ, Jun KH, et al. Long-term trends in hematological and nutritional status after gastrectomy for gastric cancer. J Gastrointest Surg, 2017, 21(8): 1212-1219.
43.	Finze A, Vijgen GH, Betzler J, et al. Malnutrition and vitamin deficiencies after surgery for esophageal and gastric cancer: A metanalysis. Clin Nutr ESPEN, 2024, 60: 348-355.
44.	Namikawa T, Maeda M, Yokota K, et al. Enteral vitamin B12 supplementation is effective for improving anemia in patients who underwent total gastrectomy. Oncology, 2021, 99(4): 225-233.
45.	Aoyama T, Hara K, Maezawa Y, et al. Clinical course of vitamin B12 deficiency and associated risk factors in patients after total gastrectomy for gastric cancer. Anticancer Res, 2023, 43(2): 689-694.
46.	Hu Y, Kim HI, Hyung WJ, et al. Vitamin B₁₂ deficiency after gastrectomy for gastric cancer: an analysis of clinical patterns and risk factors. Ann Surg, 2013, 258(6): 970-975.
47.	Stabler SP. Clinical practice. Vitamin B12 deficiency. NEngl J Med, 2013, 368: 149-160.
48.	Janssen HJB, Fransen LFC, Ponten JEH, et al. Micronutrient deficiencies following minimally invasive esophagectomy for cancer. Nutrients, 2020, 12(3): 778. doi: 10.3390/nu12030778.
49.	汪洋, 鄭小麗, 丁智. 胃切除不同消化道重建方式術后葉酸、維生素B₁₂及鐵蛋白水平的隨訪研究. 包頭醫學院學報, 2019, 35(6): 5-7.
50.	Desiderio J, Trastulli S, D’Andrea V, et al. Enhanced recovery after surgery for gastric cancer (ERAS-GC): optimizing patient outcome. Transl Gastroenterol Hepatol, 2020, 5: 11. doi: 10.21037/tgh.2019.10.04.
51.	Dai T, Wu D, Tang J, et al. Construction and validation of a predictive model for the risk of three-month-postoperative malnutrition in patients with gastric cancer: a retrospective case-control study. J Gastrointest Oncol, 2023, 14(1): 128-145.
52.	Carmichael L, Rocca R, Laing E, et al. Early postoperative feeding following surgery for upper gastrointestinal cancer: A systematic review. J Hum Nutr Diet, 2022, 35(1): 33-48.
53.	Youn SY, Kim BE, Kim EM. Nutrition intervention in a gastric cancer patient with gastrectomy for 12 months: a case report. Clin Nutr Res, 2023, 12(1): 1-6.
54.	Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS?) Society recommendations. Br J Surg, 2014, 101(10): 1209-1229.

1. Kang MK, Lee HJ. Impact of malnutrition and nutritional support after gastrectomy in patients with gastric cancer. Ann Gastroenterol Surg, 2024, 8(4): 534-552.
2. Matsui R, Inaki N, Tsuji T. Impact of preoperative nutritional assessment on other-cause survival after gastrectomy in patients with gastric cancer. Nutrients, 2023, 15(14): 3182. doi: 10.3390/nu15143182.
3. 中華醫學會外科學分會胃腸外科學組, 中華醫學會外科學分會結直腸外科學組, 中國醫師協會外科醫師分會上消化道外科醫師委員會. 胃腸外科病人圍手術期全程營養管理中國專家共識(2021版). 中國實用外科雜志, 2021, 41(10): 1111-1125.
4. Anderson PM, Thomas SM, Sartoski S, et al. Strategies to mitigate chemotherapy and radiation toxicities that affect eating. Nutrients, 2021, 13(12): 4397. doi: 10.3390/nu13124397.
5. Prado CM, Ford KL, Gonzalez MC, et al. Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient. JPEN J Parenter Enteral Nutr, 2023, 47 Suppl 1(Suppl 1): S54-S68. doi: 10.1002/jpen.2420.
6. 中國抗癌協會放射治療整合護理專業委員會, 廣東省護理學會腫瘤營養護理專業委員會. 惡性腫瘤微量營養素缺乏與補充專家共識. 腫瘤代謝與營養電子雜志, 2024, 11(3): 322-331.
7. Veeralakshmanan P, Tham JC, Wright A, et al. Nutritional deficiency post esophageal and gastric cancer surgery: A quality improvement study. Ann Med Surg (Lond), 2020, 56: 19-22.
8. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures—2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis, 2020, 16(2): 175-247.
9. O’Kane M, Parretti HM, Pinkney J, et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update. Obes Rev, 2020, 21(11): e13087. doi: 10.1111/obr.13087.
10. Tsujiura M, Nunobe S. Functional and nutritional outcomes after gastric cancer surgery. Transl Gastroenterol Hepatol, 2020, 5: 29. doi: 10.21037/tgh.2019.11.10.
11. Lee JH, Hyung WJ, Kim HI, et al. Method of reconstruction governs iron metabolism after gastrectomy for patients with gastric cancer. Ann Surg, 2013, 258(6): 964-969.
12. Tovey FI, Clark CG. Anaemia after partial gastrectomy: a neglected curable condition. Lancet, 1980, 1(8175): 956-958.
13. Beyan C, Beyan E, Kaptan K, et al. Post-gastrectomy anemia: evaluation of 72 cases with post-gastrectomy anemia. Hematology, 2007, 12(1): 81-84.
14. Stevens AR, Pirzio-Biroli G, Harkins HN, et al. Iron metabolism in patients after partial gastrectomy. Ann Surg, 1959, 149(4): 534-538.
15. Kim KH, Park DJ, Park YS, et al. Actual 5-year nutritional outcomes of patients with gastric cancer. J Gastric Cancer, 2017, 17(2): 99-109.
16. Nie Y, Tian Z, Wang P, et al. Prevalence of anemia and related nutrient deficiencies after sleeve gastrectomy: A systematic review and meta-analysis. Obes Rev, 2023, 24(1): e13516. doi: 10.1111/obr.13516.
17. 劉林輝, 李云霞, 朱鳳霞, 等. 早期胃癌患者術后貧血的危險因素及營養狀態評估. 中國現代普通外科進展, 2020, 23(4): 285-289.
18. Hines JD, Hoffbrand AV, Mollin DL. The hematologic complications following partial gastrectomy. A study of 292 patients. Am J Med, 1967, 43(4): 555-569.
19. Berger MM, Shenkin A, Schweinlin A, et al. ESPEN micronutrient guideline. Clin Nutr, 2022, 41(6): 1357-1424.
20. Blonk L, Gooszen JAH, Fakkert RA, et al. Micronutrient deficiencies and anemia in the follow-up after gastroesophageal cancer surgery. Dis Esophagus, 2024 Jun 24: doae053. doi: 10.1093/dote/doae053.
21. Namikawa T, Shimizu S, Yokota K, et al. Serum zinc deficiency in patients after gastrectomy for gastric cancer. Int J Clin Oncol, 2021, 26(10): 1864-1870.
22. 王艷, 徐學琴. 腹腔鏡Roux-en-Y胃旁路術對肥胖患者多項微量營養素水平影響的Meta分析. 中華臨床營養雜志, 2023, 31(4): 193-203.
23. 薛松林, 王崇樹. Roux-en-Y胃轉流術后鋅缺乏的研究進展. 中國普外基礎與臨床雜志, 2013, 20(5): 574-578.
24. Nakagawa M, Kojima K, Inokuchi M, et al. Assessment of serum copper state after gastrectomy with Roux-en-Y reconstruction for gastric cancer. Dig Surg, 2015, 32(4): 301-305.
25. Toyama T, Kubuki Y, Suzuki M, et al. Copper deficiency anemia and neutropenia secondary to total gastrectomy. Rinsho Ketsueki, 2000, 41(5): 441-443.
26. Gletsu-Miller N, Broderius M, Frediani JK, et al. Incidence and prevalence of copper deficiency following Roux-en-Y gastric bypass surgery. Int J Obes (Lond), 2012, 36(3): 328-335.
27. Ernst B, Thurnheer M, Schultes B. Copper deficiency after gastric bypass surgery. Obesity (Silver Spring), 2009, 17(11): 1980-1981.
28. Inaba M, Torii T, Shinoda K, et al. Peripheral neuropathy, myelopathy, cerebellar ataxia, and subclinical optic neuropathy associated with copper deficiency occurring 23 years after total gastrectomy. Rinsho Shinkeigaku, 2011, 51(6): 412-416.
29. Myint ZW, Oo TH, Thein KZ, et al. Copper deficiency anemia: review article. Ann Hematol, 2018, 97(9): 1527-1534.
30. Prodan CI, Bottomley SS, Vincent AS, et al. Copper deficiency after gastric surgery: a reason for caution. Am J Med Sci, 2009, 337(4): 256-258.
31. van der Velden AL, Vermeer TA, Boerma EG, et al. Vitamin insufficiency after surgery for oesophagogastric neoplasms: a study protocol for a prospective intervention study. BMJ Open, 2023, 13(7): e067981. doi: 10.1136/bmjopen-2022-067981.
32. Al-Nasser A, Alzerwi N, Hussain M, et al. Nutritional demand after gastric surgery. Clin Surg, 2019, 2019: 2465. doi: 10.25107/2474-1647.2465.
33. Janssen HJB, Fransen LFC, Ponten JEH, et al. Micronutrient deficiencies following minimally invasive esophagectomy for cancer. Nutrients 2020, 12: 778. doi: 10.3390/nu12030778.
34. Rino Y, Oshima T, Yoshikawa T. Changes in fat-soluble vitamin levels after gastrectomy for gastric cancer. Surg Today, 2017, 47(2): 145-150.
35. Osland EJ, Ali A, Nguyen T, et al. Australasian society for parenteral and enteral nutrition (AuSPEN) adult vitamin guidelines for parenteral nutrition. Asia Pac J Clin Nutr, 2016, 25(3): 636-650.
36. Heneghan HM, Zaborowski A, Fanning M, et al. Prospective study of malabsorption and malnutrition after esophageal and gastric cancer surgery. Ann Surg, 2015, 262(5): 803-807.
37. Muszyński T, Polak K, Fr?tczak A, et al. Vitamin D—The nutritional status of post-gastrectomy gastric cancer patients-systematic review. Nutrients, 2022, 14(13): 2712. doi: 10.3390/nu14132712.
38. Guéant JL, Guéant-Rodriguez RM, Alpers DH. Chapter Nine—Vitamin B12 absorption and malabsorption//Litwack G. Vitamins and hormones. Academic Press, 2022, 119: 241-274.
39. Bahardoust M, Mousavi S, Ziafati H, et al. Vitamin B12 deficiency after total gastrectomy for gastric cancer, prevalence, and symptoms: a systematic review and meta-analysis. Eur J Cancer Prev, 2024, 33(3): 208-216.
40. 韓菲, 朱華. 胃癌胃切除術后維生素B₁₂缺乏與補充的研究進展. 實用藥物與臨床, 2023, 26(1): 79-82.
41. van Hagen P, de Jonge R, van Berge Henegouwen MI, et al. Vitamin B12 deficiency after esophagectomy with gastric tube reconstruction for esophageal cancer. Dis Esophagus, 2017, 30(12): 1-8.
42. Kim JH, Bae YJ, Jun KH, et al. Long-term trends in hematological and nutritional status after gastrectomy for gastric cancer. J Gastrointest Surg, 2017, 21(8): 1212-1219.
43. Finze A, Vijgen GH, Betzler J, et al. Malnutrition and vitamin deficiencies after surgery for esophageal and gastric cancer: A metanalysis. Clin Nutr ESPEN, 2024, 60: 348-355.
44. Namikawa T, Maeda M, Yokota K, et al. Enteral vitamin B12 supplementation is effective for improving anemia in patients who underwent total gastrectomy. Oncology, 2021, 99(4): 225-233.
45. Aoyama T, Hara K, Maezawa Y, et al. Clinical course of vitamin B12 deficiency and associated risk factors in patients after total gastrectomy for gastric cancer. Anticancer Res, 2023, 43(2): 689-694.
46. Hu Y, Kim HI, Hyung WJ, et al. Vitamin B₁₂ deficiency after gastrectomy for gastric cancer: an analysis of clinical patterns and risk factors. Ann Surg, 2013, 258(6): 970-975.
47. Stabler SP. Clinical practice. Vitamin B12 deficiency. NEngl J Med, 2013, 368: 149-160.
48. Janssen HJB, Fransen LFC, Ponten JEH, et al. Micronutrient deficiencies following minimally invasive esophagectomy for cancer. Nutrients, 2020, 12(3): 778. doi: 10.3390/nu12030778.
49. 汪洋, 鄭小麗, 丁智. 胃切除不同消化道重建方式術后葉酸、維生素B₁₂及鐵蛋白水平的隨訪研究. 包頭醫學院學報, 2019, 35(6): 5-7.
50. Desiderio J, Trastulli S, D’Andrea V, et al. Enhanced recovery after surgery for gastric cancer (ERAS-GC): optimizing patient outcome. Transl Gastroenterol Hepatol, 2020, 5: 11. doi: 10.21037/tgh.2019.10.04.
51. Dai T, Wu D, Tang J, et al. Construction and validation of a predictive model for the risk of three-month-postoperative malnutrition in patients with gastric cancer: a retrospective case-control study. J Gastrointest Oncol, 2023, 14(1): 128-145.
52. Carmichael L, Rocca R, Laing E, et al. Early postoperative feeding following surgery for upper gastrointestinal cancer: A systematic review. J Hum Nutr Diet, 2022, 35(1): 33-48.
53. Youn SY, Kim BE, Kim EM. Nutrition intervention in a gastric cancer patient with gastrectomy for 12 months: a case report. Clin Nutr Res, 2023, 12(1): 1-6.
54. Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS?) Society recommendations. Br J Surg, 2014, 101(10): 1209-1229.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress on micronutrient deficiency after gastrectomy for gastric cancer

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