Assessment of postoperative quality of life following pylorus-preserving gastrectomy and Billroth-I distal gastrectomy in gastric cancer patients: results of the nationwide postgastrectomy syndrome assessment study

Abstract

It has been suggested that PPG is superior to DGBI for ameliorating PGS. Preservation of the celiac branch of the vagus nerve is recommended to reduce postoperative disorders regardless of the reconstruction method used.

Factors affecting the quality of life of patients after gastrectomy as assessed using the newly developed PGSAS-45 scale: A nationwide multi-institutional study

“…Our study also showed a significantly higher “necessity for additional meals”, greater “weight loss”, lower “ability for working” and worse “dissatisfaction for daily life SS”, “PCS” and “MCS” of SF-8 in the TG group than in the DG group. Furthermore, it has been reported that function-preserving gastrectomy, such as PPG and proximal gastrectomy, is associated with a better postoperative QOL as compared to gastrectomy[9,11,16,17,20,23]. Thus, the type of gastrectomy is a well-known factor affecting the postoperative QOL of patients who underwent gastrectomy, and improvement in the gastrectomy procedures may be expected to improve the postoperative QOL of gastrectomy patients.…”

“…Multiple studies have reported a greater deterioration of the QOL after total gastrectomy (TG) than distal gastrectomy (DG)[8,10,13,18,19], and it is thought that the more extensive the resection of the stomach, the greater the severity of PGS[11]. On the other hand, function-preserving gastrectomy, in which the extent of gastrectomy is reduced, such as pylorus-preserving gastrectomy (PPG)[9,11,16,17,23] and proximal gastrectomy[20], is often used for treating early gastric cancer and has been reported to be useful to improve the QOL of patients after surgery. Thus, improvement in the gastrectomy procedures is recognized as one of the reliable means to reduce the risk of development of PGS.…”

The current state of stomach cancer surgery in the world

“…In addition, better nutritional status in terms of serum protein and albumin and lower incidence of gallstone were observed for the PPG group (80). A comparison of health-related quality of life between patients who received PPG and those treated with distal gastrectomy using data from the aforementioned validation study of the PGSAS-45 revealed significant difference in favor of PPG in diarrhea subscale, dumping subscale and frequency of additional meals (81). In addition, patients with larger proximal gastric remnant benefitted from superior quality of life in terms of several subscales of the PGSAS-45 questionnaires (82).…”

A Randomized Controlled Trial of Vagus Nerve-preserving Distal Gastrectomy Versus Conventional Distal Gastrectomy for Postoperative Quality of Life in Early Stage Gastric Cancer Patients

“…A review of function-preserving laparoscopic gastrectomy concluded that this procedure may provide better QoL after surgery compared with conventional gastrectomy. 26 In the retrospective nationwide assessment study in Japan, Fujita et al 27 found that pylorus-preserving gastrectomy (PPG) was associated with better results compared with Billroth I distal gastrectomy in terms of postoperative dumping symptoms, diarrhea, and appetite loss, although delayed gastric emptying was a common adverse effect after PPG. Indeed, patients with PPG reported these complications more frequently than those undergoing Billroth I distal gastrectomy in the early postoperative period, 28 and food residue could be observed in the remnant stomach in PPG patients even several years after surgery, although most cases improved gradually over time.…”