Long-term quality of life and nutrition status of the aboral pouch reconstruction after total gastrectomy for gastric cancer: a prospective multicenter observational study (CCOG1505)

Abstract

Background Several efforts have been made to alleviate harms and symptoms after gastrectomy for gastric cancer. We previously conducted a randomized controlled trial (CCOG1101) to compare quality of life (QOL) and nutritional status between Roux-en-Y (RY) and aboral pouch (AP) reconstructions for up to 1 year after total gastrectomy. However, long-term outcomes after AP reconstruction remain unclear. Methods A prospective multicenter observational study was conducted to compare QOL, body composition, and nutritional indicators between the RY and AP reconstructions at 5 years after surgery among patients who were enrolled in the CCOG1101 trial. QOL was assessed by the PGSAS-37 questionnaires as well as the EORTC QLQ-C30 and STO22. Results Sixty patients (31 for RY and 29 for AP) were recruited for analysis. There were no significant differences in baseline and perioperative characteristics between the two groups. No significant differences were found in the EORTC QLQ-C30 global health status and functional scales. Regarding symptom scales in the QLQ-C30 and STO22, a more favorable score for the diarrhea scale was observed in the AP group. Diarrhea was also the only item in the PGSAS-37 questionnaires in which significant benefit of AP was observed. Body weight and lean body mass continued to decrease throughout the postoperative 5 years in both groups. None of the conventional nutritional indicators using the serum samples showed significant difference between the two groups. Conclusions Long-term observation suggested little benefit of AP reconstruction after total gastrectomy other than in alleviating diarrhea.

In Search of the Optimal Reconstruction Method after Total Gastrectomy. Is Roux-en-Y the Best? A Review of the Randomized Clinical Trials

“…Weight gain was statistically significant in 5 studies (11,12,16,19,20) and statistically insignificant in 9 studies (13,14,15,17,18,21,22,24,25). 5 studies (11,12,16,19,20) reported a significant weight gain in the pouch group compared to simple eso-jejunostomy, and no differences were found in 5 studies (14,15,17,22,25). In the group that compared the Rouxen-Y with the jujunal interposition, only two study (12,20) reported a significant weight gain, while 5 studies (13,18,21,24) found no significant differences.…”

“…Comparing the quality of life between studies was difficult, as six types of indicators were used (Visick, Spitzer, QLQ-C30, GSRS (Gastrointestinal Symptom Rating Scale), Cushieri and institutional questionnaires). The QLQ-C30 questionnaire was used in 4 studies (18,22,23,25), GSRS questionnaire in two studies (17,19), Cushieri questionnaire (15) in one study, and nonstandardizated questionnaires in 6 studies (11,14,16,20,21,24). The quality of life was assessed with the Visick scale in a single study (13).…”

“…No patient reported (20) Some authors noted that in the first six months postoperatively, at patients with total gastrectomy food intake was reduced to less than half the values before the operation.79% of the patients in the pouch group were able to eat normal sized meals, compared with 14% of the patients in the Roux-en-Y group (15). The quality of life was statistically significant in 8 studies (11,15,16,17,18,19,20,23) and statistically insignificant in 7 studies (12,13,14,21,22,24,25). Pouch Roux-en-Y was compared to simple esojejunostomy in 11 studies (11,12,14,15,16,17,19,20,22,23,25).…”

“…The quality of life was statistically significant in 8 studies (11,15,16,17,18,19,20,23) and statistically insignificant in 7 studies (12,13,14,21,22,24,25). Pouch Roux-en-Y was compared to simple esojejunostomy in 11 studies (11,12,14,15,16,17,19,20,22,23,25). In studies that analyzed the pouch Roux-en-Y compared to simple esojejunostomy there was a better quality of life in 7 studies (11,15,16,17,18,19,20,23), and in 4 studies (12,13 , 22, 25) no significant differences were found.…”

Nutritional and Clinical Factors Affecting Weight and Fat-Free Mass Loss after Gastrectomy in Patients with Gastric Cancer

“…This increase is attributed to early detection and the development of treatment. In addition, quality of life and nutritional management may affect the survival rate of patients who undergo gastric cancer surgery [ 3 ].…”