Effect of Prehabilitation-Based Individualized Dietary Guidance on Nutrition and Short-Term Quality of Life in Locally Advanced Gastric Cancer Patients Undergoing Surgery: A Single-Center Randomized Controlled Trial

Objective: To evaluate the effect of individualized dietary guidance based on the prehabilitation concept on nutritional outcomes and quality of life (QoL) in patients with locally advanced gastric cancer (LAGC) undergoing surgery. Methods: This is a single-center randomized controlled trial (RCT). Patients who underwent radical gastrectomy following neoadjuvant therapy were included at the First Affiliated Hospital of Soochow University between January 2023 and October 2025 and randomly assigned to either the control group or the intervention group. Both groups received standard perioperative care. The control group received nutritional support, while the intervention group received individualized dietary guidance based on the Patient-Generated Subjective Global Assessment (PG-SGA) in combination with the prehabilitation concept. Nutritional parameters albumin (Alb), prealbumin (PA), and hemoglobin (Hb) and Prognostic Nutritional Index (PNI) were assessed at preoperative baseline and postoperative day 5– 7 (before discharge). Quality of life (QoL) was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) at baseline and 3 months post-intervention. Postoperative safety and short-term outcomes, including length of stay (LOS), complications (classified by Clavien-Dindo grade), mortality, and readmission within 3 months, were also recorded. Results: A total of 120 patients were eligible for the study between January 2023 and October 2025, of whom 72 were approached and enrolled (response rate: 60%), with 36 in each group. Compared with the control group, the intervention group showed significantly better nutritional indices after the intervention. In contrast, the control group showed significant decreases in PNI (52.64± 4.98 vs 43.28± 4.73), Alb (42.87± 4.73 vs 36.67± 6.28 g/L), PA (229.12± 39.43 vs 179.32± 32.72 mg/L), and Hb (134.92± 21.63 vs 113.54± 18.21 g/L), whereas no significant within-group changes were observed in the intervention group. EORTC QLQ-C30 scores for all functional domains (except cognitive functioning and financial difficulties) significantly increased, while scores for all symptom domains and single items (except financial difficulties) significantly decreased in both groups. Following the intervention, the intervention group demonstrated significantly higher PNI (51.21± 5.27 vs 43.28± 4.73, P < 0.001) and peripheral blood levels of Alb (40.78± 6.91 vs 36.67± 6.28 g/L, P =0.01), PA (223.83± 37.32 vs 179.32± 32.72 mg/L, P < 0.001), and Hb (129.93± 20.74 vs 113.54± 18.21 g/L, P =0.001) compared with the control group. Additionally, the intervention group had significantly higher scores in four of the five functional domains (physical function: 56.84± 4.37 vs 51.73± 4.02, P < 0.001; emotional function: 57.63± 4.82 vs 53.82± 4.77, P =0.001; role function: 64.93± 3.76 vs 59.86± 4.39, P < 0.001; social function: 63.91± 4.63 vs 59.64± 5.21, P < 0.001) and significantly lower scores in all symptom domains and in five of the six single items (fatigue: 26.12± 3.65 vs 30.49± 3.87, P < 0.001; appetite loss: 14.28± 3.02 vs 18.02± 3.29, P < 0.001) than the control group. Regarding postoperative safety, no severe complications (Clavien-Dindo grade ≥III) or deaths occurred in either group during hospitalization or the 3-month follow-up. The incidence of minor complications (Clavien-Dindo grade I–II) was similar between groups (3 vs 2). The intervention group had a numerically shorter postoperative LOS (7.6± 1.8 vs 8.2± 2.1 days), but the difference was not statistically significant. No readmissions within 3 months were recorded in either group. Conclusion: Prehabilitation-based individualized dietary guidance effectively improves short-term nutritional outcomes and enhances QoL in patients with LAGC undergoing surgery following neoadjuvant therapy. The intervention demonstrated a favorable safety profile, with no increase in complications, mortality, or readmissions. This single-center study provides preliminary evidence, and long-term outcomes (e.g. survival, readmission) were not evaluated. Keywords: locally advanced gastric cancer, dietary guidance, prehabilitation, quality of life, nutrition, neoadjuvant therapy, postoperative complications