Nutritional and Immune Recovery Trajectories Following Gastrectomy for Gastric Cancer: A Prospective Longitudinal Cohort Study

Background: Nutritional deterioration is a common consequence of gastrectomy for gastric cancer and may persist despite standardized perioperative care. However, prospective longitudinal evidence describing the early course of postoperative nutritional recovery remains limited. This study aimed to characterize nutritional recovery trajectories follo-wing curative gastrectomy and to evaluate the influence of the extent of gastric resection on postoperative recovery. Methods: We conducted a prospective longitudinal cohort stu-dy including 217 consecutive patients who underwent curative-intent subtotal or total gastrectomy for gastric adenocarcinoma between January 2022 and December 2025. Nutri-tional status was assessed preoperatively (T0), at hospital discharge (T1), and three mon-ths after surgery (T3) using serum albumin, total cholesterol, absolute lymphocyte count, and the Controlling Nutritional Status (CONUT) score. Longitudinal changes were evalu-ated using linear mixed-effects models with patient-specific random intercepts. Results: All nutritional parameters deteriorated significantly after surgery, reaching their lowest values at hospital discharge (all p < 0.001), followed by partial recovery at three months. Nevertheless, none returned to preoperative baseline values. Recovery between discharge and three months represented 65.6% of the initial decline for serum albumin, 50.5% for absolute lymphocyte count, 51.7% for total cholesterol, and 70.1% for the CONUT score. Longitudinal mixed-effects analyses demonstrated significantly less favorable recovery trajectories after total compared with subtotal gastrectomy for serum albumin (p = 0.025), lymphocyte count (p < 0.001), and CONUT score (p < 0.001), whereas cholesterol recovery did not differ significantly between procedures (p = 0.267). Conclusions: Nutritional reco-very following gastrectomy is a dynamic and prolonged process characterized by marked early deterioration and incomplete restoration during the first three postoperative months. Patients undergoing total gastrectomy experience slower recovery trajectories, supporting the implementation of risk-adapted postoperative nutritional surveillance and individua-lized nutritional interventions extending beyond hospital discharge