Multimodal prehabolitation and nutritional optimization in a malnourished gastric cancer patient undergoing total gastrectomy: A Case Report

Abstract

Background: Patients with gastric cancer often develop severe malnutrition and impaired oral intake, which are associated with increased postoperative complications and reduced tolerance to oncologic treatments. Enhanced Recovery After Surgery (ERAS) pathways emphasize early multimodal prehabilitation and targeted nutritional optimization to improve surgical outcomes.

Case presentation:A 54-year-old male with subcardial gastric adenocarcinoma and absolute dysphagia was referred to a multimodal prehabilitation program prior to neoadjuvant chemotherapy. Multidisciplinary management included nutritional, physiotherapeutic, and psychological interventions. Due to complete dysphagia, exclusive home enteral nutrition via jejunostomy was initiated and individualized to meet caloric and protein requirements, with progressive adjustment based on serial assessments. As chemotherapy proceeded, oral intake gradually resumed, supported by oral nutritional supplements, while enteral support was tapered. Preoperatively, immunonutrient-enriched supplements and preoperative carbohydrate loading were implemented according to ERAS recommendations. The patient underwent total gastrectomy with Roux-en-Y reconstruction and experienced an uncomplicated postoperative course. Early postoperative feeding was introduced on postoperative day 3 with a stepwise progression from clear liquids to fortified soft diet, supported by high-calorie, high-protein oral supplements and frequent dietetic counseling. Despite transient nutrition-impact symptoms, the patient achieved near-complete nutritional intake at discharge and continued outpatient multimodal follow-up.

Conclusion: This case illustrates that early, individualized nutritional intervention integrated within a multidisciplinary prehabilitation and ERAS framework can effectively mitigate malnutrition and support recovery in patients undergoing major gastric surgery.