Post-operative early enteral nutrition intolerance in elderly patients undergoing laparoscopic gastric cancer surgery: current status and nursing strategies

Suqing Chen; Wenjuan Xu; Suqin Xu; Huimin Yao

doi:10.3389/fnut.2026.1777356

Post-operative early enteral nutrition intolerance in elderly patients undergoing laparoscopic gastric cancer surgery: current status and nursing strategies

Front Nutr. 2026 May 18:13:1777356. doi: 10.3389/fnut.2026.1777356. eCollection 2026.

Authors

Suqing Chen^#¹, Wenjuan Xu^#¹, Suqin Xu², Huimin Yao¹

Affiliations

¹ Department of Gastrointestinal Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
² Department of Respiratory Medicine, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.

^# Contributed equally.

Abstract

Background: Early enteral nutrition (EEN) is a core component of perioperative management for elderly patients undergoing laparoscopic gastric cancer surgery, but nutritional intolerance is a common clinical problem that impairs the effectiveness of nutritional support. This study aimed to evaluate the influencing factors of post-operative EEN intolerance and constructing a predictive model for clinical nursing management.

Methods: A retrospective case-control study was conducted, elderly patients undergoing laparoscopic gastric cancer surgery were included. Correlation analysis and Logistic regression analysis were performed to screen independent risk factors of EEN intolerance. A predictive model was constructed based on the independent risk factors, and the receiver operating characteristic (ROC) curve was used to evaluate its predictive efficacy.

Results: A total of 346 elderly patients undergoing laparoscopic gastric cancer surgery were included, of whom 194 (56.1%) developed post-operative EEN intolerance. Spearman correlation analysis identified significant positive correlations between EEN intolerance and age, TNM stage, diabetes mellitus, surgical scope, and intraoperative blood loss (all P < 0.001). Multivariate logistic regression analysis revealed that age ≥75 years, TNM stage III-IV comorbid diabetes mellitus, radical resection, and intraoperative blood loss ≥250 ml were independent risk factors for EEN intolerance (all P < 0.001). A predictive model incorporating these five factors demonstrated good discriminatory ability, with an area under the curve of 0.856. At the optimal cut-off value of 6.5 points, the model achieved a Youden index of 0.645, with a sensitivity of 0.756 and a specificity of 0.889.

Conclusion: Post-operative EEN intolerance occurs frequently in elderly patients undergoing laparoscopic gastric cancer surgery and is associated with multiple independent risk factors. The constructed predictive model demonstrated good predictive efficacy in this cohort. Clinical application of targeted perioperative management strategies based on these risk factors may help reduce the incidence of EEN intolerance and improve nutritional outcomes in this vulnerable population.

Keywords: elderly; enteral nutrition; gastric cancer; intolerance; nursing; surgery.