Schiano di Visconte M, Sarnari S, Brillantino A, Marano L, Talento P, Guttadauro A. Nutritional status and adjuvant chemotherapy in gastric cancer: An underestimated determinant of treatment success. World J Gastrointest Surg 2026; 18(5): 118610 [DOI: 10.4240/wjgs.v18.i5.118610]
Corresponding Author of This Article
Michele Schiano di Visconte, MD, PhD, Chief Physician, Department of General Surgery, Colorectal and Pelvic Floor Diseases Center, Azienda ULSS 2 “Marca Trevigiana”, Via Sant’Ambrogio in Fiera 37, Treviso 31100, Veneto, Italy. mschianodivisconte@gmail.com
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Surgery
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editorial
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Schiano di Visconte M, Sarnari S, Brillantino A, Marano L, Talento P, Guttadauro A. Nutritional status and adjuvant chemotherapy in gastric cancer: An underestimated determinant of treatment success. World J Gastrointest Surg 2026; 18(5): 118610 [DOI: 10.4240/wjgs.v18.i5.118610]
World J Gastrointest Surg. May 27, 2026; 18(5): 118610 Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.118610
Nutritional status and adjuvant chemotherapy in gastric cancer: An underestimated determinant of treatment success
Michele Schiano di Visconte, Sonia Sarnari, Antonio Brillantino, Luigi Marano, Pasquale Talento, Angelo Guttadauro
Michele Schiano di Visconte, Sonia Sarnari, Department of General Surgery, Colorectal and Pelvic Floor Diseases Center, Azienda ULSS 2 “Marca Trevigiana”, Treviso 31100, Veneto, Italy
Antonio Brillantino, Department of General Surgery, Antonio Cardarelli Hospital, Napoli 80131, Naples, Italy
Luigi Marano, Department of Medicine, Academy of Applied Medical and Social Sciences, Akademia Medycznych I Społecznych Nauk Stosowanych, Elblag 52-300, Poland
Pasquale Talento, Department of Surgery, AUSL-IRCCS Reggio Emilia, Reggio Emilia 42122, Emilia-Romagna, Italy
Angelo Guttadauro, Department of Surgery, University of Milan-Bicocca, Monza 20900, Italy
Author contributions: Schiano di Visconte M and Sarnari S conceived and designed the study, performed the literature search, and drafted the manuscript; Brillantino A and Marano L contributed to the interpretation of the literature and critically revised the manuscript for important intellectual content; Talento P contributed to the methodological framework and synthesis of the evidence; Guttadauro A provided senior supervision, critically reviewed the manuscript, and approved the final version. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.
AI contribution statement: The manuscript was entirely conceived, written, and critically revised by the authors. No part of the manuscript was generated by AI. No AI tools were used for content generation or rewriting. No AI tools were used for data analysis. The manuscript is an editorial and does not involve original data analysis. All figures included in the manuscript are original conceptual illustrations created by the authors. All references were independently selected by the authors and are indexed in recognized scientific databases (e.g., PubMed). No AI tools were used to generate or fabricate references.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Michele Schiano di Visconte, MD, PhD, Chief Physician, Department of General Surgery, Colorectal and Pelvic Floor Diseases Center, Azienda ULSS 2 “Marca Trevigiana”, Via Sant’Ambrogio in Fiera 37, Treviso 31100, Veneto, Italy. mschianodivisconte@gmail.com
Received: January 7, 2026 Revised: January 16, 2026 Accepted: February 3, 2026 Published online: May 27, 2026 Processing time: 141 Days and 3.7 Hours
Abstract
Adjuvant chemotherapy is the cornerstone of curative treatment for resected gastric cancer (GC). However, its real-world effectiveness is frequently compromised by incomplete treatment delivery and reduced dose intensity. Although tumor-related factors have traditionally guided therapeutic decision-making, host-related determinants of treatment feasibility remain underappreciated in the literature. Nutritional status is a prevalent and clinically measurable determinant that directly influences treatment tolerance and outcomes. Nutritional risk, as assessed by validated screening tools such as the Nutritional Risk Screening 2002, has consistently been associated with chemotherapy completion, the incidence of severe treatment-related toxicity, and survival outcomes. Malnutrition predisposes patients to treatment-related toxicity, dose reductions, and early treatment discontinuation, thereby attenuating the survival benefits observed in randomized clinical trials. The dynamic nature of nutritional deterioration during adjuvant therapy further underscores the limitations of single time-point assessments. Nutritional decline often progresses during systemic treatment, even in patients without a baseline nutritional risk, with important implications for adherence to chemotherapy and maintenance of relative dose intensity. Recognizing nutrition as a modifiable determinant of therapeutic success has relevant implications for contemporary GC management. In this editorial, we comment on the article by Zhou et al published in the recent issue of the World Journal of Gastrointestinal Surgery, which critically examines emerging evidence linking nutritional status to adjuvant chemotherapy feasibility in GC, with particular emphasis on dose intensity as a mechanistic mediator and on the clinical implications for routine practice.
Core Tip: Nutritional status substantially influences the feasibility and effectiveness of adjuvant chemotherapy in patients with resected gastric cancer. Nutritional impairment is common and closely associated with chemotherapy tolerance, maintenance of relative dose intensity, and treatment completion, all of which are critical determinants of oncologic outcomes. Simple and validated screening tools, such as Nutritional Risk Screening 2002, enable early identification of patients at increased risk of treatment-related toxicity and non-completion. Incorporating routine nutritional assessment and timely nutritional support into adjuvant treatment pathways may represent a practical strategy for optimizing chemotherapy delivery in everyday clinical practice.
