Cancer-related fatigue and functional gastrointestinal disorders after total gastrectomy: A case report

doi:10.4240/wjgs.v18.i5.118473

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Report

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. May 27, 2026; 18(5): 118473
Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.118473

Cancer-related fatigue and functional gastrointestinal disorders after total gastrectomy: A case report

Bing Lu, Kai Wen

Bing Lu, Department of Gastroenterology, Xiangya Changde Hospital, Changde 415000, Hunan Province, China

Kai Wen, Department of Rehabilitation Medicine, Xiangya Changde Hospital, Changde 415000, Hunan Province, China

Author contributions: Lu B is responsible for research design, data organization, and paper writing and revision; Wen K coordinated the research and revised the final draft. All authors acknowledge the final manuscript and confirm its ethical compliance.

AI contribution statement: No main text was AI-generated; AI not used for language polishing, translation, data analysis or writing; AI not involved in study design/result interpretation; and no AI-generated images.

Informed consent statement: Informed consent was obtained from the patient before the publication of this case report.

Conflict-of-interest statement: The authors declare no competing financial interests.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Kai Wen, Associate Chief Physician, Research Fellow, Department of Rehabilitation Medicine, Xiangya Changde Hospital, No. 1688 Moon Avenue, Wuling District, Changde 415000, Hunan Province, China. 17607361799@163.com

Received: February 6, 2026
Revised: March 5, 2026
Accepted: March 17, 2026
Published online: May 27, 2026
Processing time: 110 Days and 4.8 Hours

Abstract

BACKGROUND

Improved survival after gastric cancer (GC) surgery has shifted clinical attention toward persistent non-organic symptoms, including cancer-related fatigue (CRF) and functional gastrointestinal disorders (FGIDs). These conditions frequently emerge during routine follow-up yet remain underrecognized and undertreated. This study reports a case of concurrent CRF and FGID after total gastrectomy and reviews relevant literature to clarify diagnostic considerations, underlying pathophysiological mechanisms, and multidisciplinary management strategies.

CASE SUMMARY

Clinical records, laboratory data, imaging findings, endoscopic results, and follow-up information were retrospectively analyzed. Fatigue severity was assessed using a numeric rating scale, and differential diagnoses excluded organic etiologies, including tumor recurrence and mechanical obstruction. A 55-year-old woman developed persistent postprandial abdominal pain and fatigue after total gastrectomy and perioperative chemotherapy. Her highest fatigue score reached 6/10, significantly impairing daily activities. Although multidimensional fatigue instruments were not used, clinical manifestations met the diagnostic criteria for CRF after exclusion of secondary causes. Gastrointestinal symptoms were consistent with FGID associated with post-gastrectomy syndrome. Literature review supported overlapping mechanisms involving nutritional deficiencies, altered motility, microbiota imbalance, and brain-gut axis dysregulation. Multidisciplinary management, including prokinetics, probiotics, nutritional supplementation, and traditional Chinese medicine, resulted in symptom improvement.

CONCLUSION

Recognizing CRF and postoperative FGID after GC surgery requires systematic assessment and integrated multidisciplinary strategies to improve long-term postoperative outcomes.

Keywords: Gastric cancer; Cancer-related fatigue; Functional gastrointestinal disorders; Post-gastrectomy syndrome; Case report

Core Tip: Cancer-related fatigue and functional gastrointestinal disorders (FGID) frequently coexist in patients after gastric cancer (GC) surgery, particularly following total gastrectomy. Their clinical manifestations are insidious, heterogeneous, and often overlooked once tumor recurrence has been excluded. This case underscores the importance of comprehensive differential diagnosis, multidisciplinary management, and holistic symptom assessment that extends beyond oncological surveillance. Early recognition and individualized intervention for cancer-related fatigue and FGIDs are crucial for improving long-term outcomes and enhancing the quality of life in post- GC surgery patients.