Assessment of preoperative short-term parenteral nutrition in gastric cancer surgery

The article, titled “Lack of clinical benefit from preoperative short-term parenteral nutrition on the clinical prognosis of patients treated with radical gastrectomy for gastric cancer: a two-center retrospective study based on propensity score matching analysis”, conducted by Jiang et al., examines the effectiveness of preoperative short-term parenteral nutrition (PN) in patients undergoing radical gastrectomy for gastric cancer (1). The study retrospectively analyzed data from 1,155 patients who underwent radical gastrectomy for gastric cancer, aiming to investigate the effects of preoperative short-term PN on clinical outcomes and overall survival (OS). Patients were compared based on whether they received preoperative PN or not. The research revealed that preoperative short-term PN did not significantly enhance clinical outcomes, including survival rates or survival time, for gastric cancer patients undergoing radical gastrectomy. Furthermore, it was observed that preoperative PN was linked to an elevated risk of pancreatic postoperative complications. The study indicates that preoperative short-term PN does not confer a substantial benefit to the prognosis of gastric cancer patients following radical gastrectomy. Although the study presents novel content, there are some shortcomings that need to be addressed.

Firstly, the study relies heavily on retrospective data, which may introduce inherent biases. Retrospective studies, while valuable, can be affected by incomplete or inaccurate record-keeping, potentially limiting the accuracy and reliability of the data analyzed.

Secondly, despite the use of propensity score matching (PSM) to balance baseline characteristics, there may still be unmeasured confounders that could affect the results. PSM cannot account for all possible variables, and thus the study may not have been fully controlled for all potential biases (2). Additionally, PSM reduces the sample size, which could have altered the characteristics of the population to some extent. The authors suggest that multicenter, prospective, randomized trials are needed to confirm the conclusions of the study. Overall, while the study provides valuable insights into the effect of preoperative short-term PN on clinical outcomes in patients with gastric cancer, its limitations should be taken into account when interpreting the results.

Thirdly, the study did not include a randomized controlled trial (RCT) design, which is considered the gold standard for clinical research (3,4). RCTs can provide stronger evidence of causality than observational studies, and the lack of RCT in the study may limit the strength of the conclusions drawn from the data.

Lastly, while the study has a large sample size, it may not be representative of a broader population of gastric cancer patients. The generalizability of the findings may be limited, as the samples were drawn from a specific region or hospital system.

In summary, the study provides valuable evidence regarding the lack of clinical benefit of preoperative short-term PN in patients undergoing radical gastrectomy for gastric cancer. However, the retrospective design and potential limitations of the study necessitate further prospective RCTs to confirm the findings.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-324/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Jiang Z, Lin H, Huang J, et al. Lack of clinical benefit from preoperative short-term parenteral nutrition on the clinical prognosis of patients treated with radical gastrectomy for gastric cancer: a two-center retrospective study based on propensity score matching analysis. J Gastrointest Oncol 2024;15:96-111. [Crossref] [PubMed]
2. Reiffel JA. Propensity Score Matching: The 'Devil is in the Details' Where More May Be Hidden than You Know. Am J Med 2020;133:178-81. [Crossref] [PubMed]
3. Lim CY, In J. Randomization in clinical studies. Korean J Anesthesiol 2019;72:221-232. Correction appears in Korean J Anesthesiol 2019;72:396.
4. Bothwell LE, Podolsky SH. The Emergence of the Randomized, Controlled Trial. N Engl J Med 2016;375:501-4. [Crossref] [PubMed]