Evaluation of postoperative quality of life by PGSAS-45 following local gastrectomy based on the sentinel lymph node concept in early gastric cancer

Abstract

Background The usefulness of sentinel node navigation surgery (SNNS) for early gastric cancer has been demonstrated in a multicenter prospective study. However, quality of life (QOL) after local resection remains unclear. This present study investigated QOL after local resection and distal gastrectomy. Methods We examined 69 patients who underwent laparoscopic distal gastrectomy (LADG) (n = 44) and laparoscopic local resection (LLR) (n = 25) in our hospital between September 2011 and May 2018. We conducted a combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) with SNNS as LLR. All patients had pStage I or II and none had received adjuvant chemotherapy. We evaluated QOL using the postgastrectomy syndrome assessment scale questionnaire (PGSAS-45) 1, 6, and 12 months after surgery. Results In PGSAS-45, no significant differences were observed between LLR and LADG at 1 and 6 months after surgery. At 12 months, the LLR group scored better for some of the subscales (SS). In the endoscopic evaluation, the LLR group showed significant improvements in residual gastritis at 6 months (P = 0.006) and esophageal reflux and residual gastritis at 12 months (P = 0.021 and P = 0.017). A significant difference was observed in the prognostic nutritional index, which was assessed using serum samples, between the two groups at 6 months (P = 0.028). The body weight ratio was better in the LLR group than in the LADG group at 6 and 12 months (P = 0.041 and P = 0.007, respectively). Conclusions CLEAN-NET with SNNS preserved a better QOL and nutrition status than LADG in patients with early gastric cancer.

Function-Preserving Gastrectomy for Early Gastric Cancer

“…Few studies have assessed the QOL and nutritional status of patients following LR of the stomach with SNNS. According to an assessment using the PGSAS-45, patients who underwent CLEAN-NET with SNNS had better QOL than those who underwent laparoscopic distal gastrectomy (LDG) [ 79 ]. It was also reported that changes in body weight and the prognostic nutritional index were better in the LR group than in the LDG group [ 79 ].…”

“…According to an assessment using the PGSAS-45, patients who underwent CLEAN-NET with SNNS had better QOL than those who underwent laparoscopic distal gastrectomy (LDG) [ 79 ]. It was also reported that changes in body weight and the prognostic nutritional index were better in the LR group than in the LDG group [ 79 ]. As shown in Table 3 , the change in body weight after LR ranged from 96.2% to 97.4% [ 69 , 79 ].…”

“…It was also reported that changes in body weight and the prognostic nutritional index were better in the LR group than in the LDG group [ 79 ]. As shown in Table 3 , the change in body weight after LR ranged from 96.2% to 97.4% [ 69 , 79 ]. These results suggest that weight loss following LR may be less than that following other function-preserving gastrectomies such as PG (86.4–90.4%) and PPG (93.1–97.0%).…”

Current status and challenges in sentinel node navigation surgery for early gastric cancer

“…CLEAN-NET was beneficial since the stomach wall was not perforated with resection and achieved local resection. Combining local resection with SN biopsy, the post-gastrectomy symptoms were reported to be improved ( 44 ). Combining local resection using laparoscopy and endoscopic submucosal dissection, non-exposed endoscopic wall-inversion surgery (NEWS) was developed by Goto et al ( 45 ).…”

Sentinel node navigation to treat early gastric cancer after non‐curative endoscopic submucosal dissection: A case series

“… 8 , 9 Previous studies demonstrated the effectiveness of the sentinel node concept in the treatment of EGC. 6 , 10 , 11 The prognosis of EGC is mainly associated with lymph node metastases (LNM) and remnant cancer. The presence of positive resected margins, specifically positive vertical margins, during histology is significantly correlated with remnant cancer.…”