Introduction
Gastric cancer, phlebitis, sarcopenia, cancer deaths, gastric cancer
GASTRIC CANCER, SARCOPENIA, PHLEBITIS, GASTRIC CANCER
Gastric cancer is the second leading cause of cancer deaths worldwide and is increasing as the population ages [On the other hand, sarcopenia is also associated with poor prognosis in stage II/III gastric cancer who underwent standard therapy (surgery + postoperative adjuvant chemotherapy), either, putatively due to low adherence of postoperative adjuvant chemotherapy [Nutrition is one of the most promising interventions to sustain perioperative LBM. Nutritional elements, including BCAA, have long been candidates for improving muscle metabolism in surgical patients [For effective utility of BCAA to achieve maintenance and/or improvement of LBM, sufficient energy intake with amino acid (nitrogen) should be administered [In this current study, we therfore proposed that fat preparations including 500 kcal may be a promising way to achieve such sufficient energy to utilize BCAA efficiently to sustain LBM, as fat is more energy efficient (9 kcal/g) than glucose (4 kcal/g), and in addition, the concurrent administration of fat preparations is expected to reduce intravascular osmotic pressure, thereby reducing phlebitis. So, our original formula for PPN (amino acid + 7.5% glucose infusion + fat preparation including NPC of at least 1,100 kcal) is a promising regimen to improve short-term effects of LBM after gastrectomy.Moreover, exercise is also helpful for sustaining LBM, and recent rigorous research has proposed that nutrition in combination with proper exercise can only increase LBM, whereas neither nutrition nor exercise worked on its alone [