case_images: PMC11074354_01
case_images: This illustrates the trajectory of patients' PG-SGA scores from the first cycle of the treatment through to one-month post-surgery, indicating a progressive shift in nutritional status from severe to mild malnutrition. Despite the patient being severely malnourished before surgery, the marked reduction in scores throughout the course of treatment lends credence to the efficacy of the nutrition therapy.
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case_images: The nutritional assessment results indicated that she suffered from severe malnutrition ( Figure 1 ). On the other hand, hemoglobin and albumin were significantly increased, and the PG-SGA scores decreased, indicating that nutritional therapy was effective ( Figures 1 ,  3 ). The change of PG-SGA scores and the nutritional markers also indicated its efficiency ( Figures 1 ,  3 ).
case_images: (A) CT reveals abnormal thickening of the antrum wall and incomplete obstruction prior to therapy. (E) Following three treatment cycles, CT scans showed significant improvement with disease regression, tumor retraction, and alleviated obstruction. (B, F) CT examination after admission showed suspicious biliary invasion. (C) Before therapy, gastroscopy revealed nearly complete stenosis of the pyloric ring cavity, accompanied by obstructive and edematous surrounding tissues. (G) Preoperative gastroscopy revealed obvious tumor retraction, along with significantly reduced obstruction and tissue edema compared to pretherapy gastroscopy. (D, H) Barium meal shows incomplete pyloric obstruction before the second cycle of treatment.
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case_images: During the first multidisciplinary team (MDT) discussion, we diagnosed the patient had advanced gastric cancer with incomplete pyloric obstruction based on the imaging, endoscopic, and pathological evidence, and determined a clinical stage of cT4bN2M0 ( Figure 2 ). Before the second cycle of treatment, the imaging showed that the patient still suffered the incomplete pyloric obstruction ( Figure 2C, F ). Figures 2 ,  3 ). Meanwhile considering the non-regressive state of the disease, we communicated with the patient and her family about the necessary of subsequent combination therapy for diminishing the TMB and the risk of DSF. Finally, we stop the use of oxaliplatin to alleviate adverse effects and gave the patient platelets transfusion and white blood cells raising drugs to treat the abnormalities of hemogram. Imaging and endoscopic examinations showed that the tumor had shrunk significantly and the obstruction had been relieved ( Figure 2D, E ).
case_images: This study presents the variations in the patient's nutritional examination indicators from admission to the preoperative period. With oral nutritional support, supplemented by parenteral nutrition and a tailored dietary plan, this patient's nutritional indicators were generally maintained within the normal range. However, there was a notable occurrence of severe bone marrow suppression following the initial cycle of Oxaliplatin treatment, which subsided after discontinuing the medication. Notably, the patient did not exhibit any evident surgical contraindications based on the preoperative indicators.
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case_images: Additionally, we continued to monitor various indicators of nutrition status, such as BMI, total protein, albumin, red blood cell, CRP levels, and hemoglobin ( Figure 3 ). And the blood tests showed a significant drop in her platelets and white blood cells ( Figure 3 ). Figures 2 ,  3 ). Meanwhile considering the non-regressive state of the disease, we communicated with the patient and her family about the necessary of subsequent combination therapy for diminishing the TMB and the risk of DSF. Finally, we stop the use of oxaliplatin to alleviate adverse effects and gave the patient platelets transfusion and white blood cells raising drugs to treat the abnormalities of hemogram. On the other hand, hemoglobin and albumin were significantly increased, and the PG-SGA scores decreased, indicating that nutritional therapy was effective ( Figures 1 ,  3 ). Moreover, the recovery from myelosuppression confirmed the correctness of stopping oxaliplatin ( Figure 3 ). Meanwhile, considering that the physical condition of the patient can tolerate the surgical injury, radical surgery was performed on the patient ( Figure 3 ). The change of PG-SGA scores and the nutritional markers also indicated its efficiency ( Figures 1 ,  3 ).
case_images: (A) The surgical photograph displayed the post-dissection of the sixth group of lymph nodes at the pylorus and revealed the absence of tissue edema. (B) Postoperative pathological results, the Becker tumor regression grading showed grade 1b (living tumor cells accounted for less than 10% of the original focus area). The postoperative pathological stage of this patient was ypT2N3aM0.
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case_images: The radical surgery was ensured, and the pathological examination revealed a significant regression of the tumor ( Figure 4 ).