Quality of Life after Gastrectomy for Gastric Carcinoma: Controlled Study of Reconstructive Procedures

Abstract

The choice of reconstruction after gastrectomy and the significance of remaining reservoir function is a matter of controversy. To broaden the criteria for choice of treatment, we conducted a prospective randomized clinical trial to determine the impact of various gastrectomy procedures on quality of life. Consecutive patients (n = 64) eligible for curative gastric cancer surgery were randomized to have either a total (n = 31) or subtotal (n = 13) gastrectomy or a jejunal S-shaped pouch (n = 20) implanted as a gastric substitute. The quality-of-life evaluation was based on a battery of questionnaires covering both general and specific aspects of life. The patients were rated by one of two psychiatrists who were blinded to the patients' group affiliation. Assessments were made on three occasions: during the week prior to surgery and 3 and 12 months after the surgical intervention. The postoperative complication and mortality rates were similar in all treatment groups, with few serious complications recorded. Irrespective of type of treatment, the patients suffered from alimentary symptoms and functional limitations in everyday life, whereas their mental well-being improved after surgery. Patients who underwent subtotal gastrectomy had the best outcome, especially with respect to complaints of diarrhea. Patients given a gastric substitute after gastrectomy showed no difference from those who had only a total gastrectomy. We conclude that despite significant unfavorable consequences that follow gastrectomy, patients recover with an improved mental status. A pouch reconstruction after total gastrectomy does not improve quality of life, but a subtotal gastrectomy has advantages that must be considered when the procedure is clinically feasible.

Quality of life beyond the early postoperative period after laparoscopy-assisted distal gastrectomy: the level of patient expectation as the essence of quality of life

“…There have been studies comparing the QoL of gastric cancer patients after distal subtotal gastrectomy and total gastrectomy [18][19][20]. In the early postoperative period, patients who underwent distal subtotal gastrectomy experienced better QoL than patients who underwent total gastrectomy, but the QoL benefits of distal subtotal gastrectomy were lost as time elapsed.…”

Impact of surgical procedure for gastric cancer on quality of life

“…In footnotes to the papers published by Davies et al 10 and Svendlund et al 12 , Maruyama and Sasako respectively stated that the differences in quality of life of patients undergoing curative resection become smaller with longer follow-up. They referred to the role of other variables such as age, gender, baseline gastrointestinal function, social class or the type of lymphadenectomy when explaining the differences found.…”

Characteristics and clinical relevance of postgastrectomy syndrome assessment scale (PGSAS)-45: newly developed integrated questionnaires for assessment of living status and quality of life in postgastrectomy patients

“…This goal is particularly important in the Far East where gastric cancer is often found at early clinical stages so that more patients manage to survive their cancer and consequently need to face the PGS in the long term [9]. It is known that the type of gastrectomy affects the incidence and severity of PGS [10][11][12][13][14][15][16][17][18][19][20][21], and various procedures to preserve or reconstruct gastric function have been proposed to confront these problems [7,8]. To gain deeper understanding of the PGS, a group of iatrogenic disorders, and treat them appropriately, it is important to grasp the impact of various symptoms, along with feeding problems and body weight loss, to the living status and QOL of the patients.…”

“…Consequently, the 23 items were stratified into seven subgroups in which factor loading took maximal values for all the items and sufficiently large values of 0.7 or higher for most of the items. Thus, factor analysis identified seven clinically relevant subscales, which were named from their content as follows: esophageal reflux subscale (items 10, 11, 13, 24), abdominal pain subscale (items 9, 12, 28), meal-related distress subscale (items 25-27), indigestion subscale (items 14-17), diarrhea subscale (items 19,20,22), constipation subscale (items 18, 21, 23), and dumping subscale (items 30, 31, 33). Five of these seven subscales were named the same way as the subgroups of the GSRS, which are termed syndromes, of which three subscales (indigestion, diarrhea, and constipation) had similar content with the corresponding syndromes whereas two other subscales (esophageal reflux and abdominal pain) were dissimilar.…”