Total or Subtotal Gastrectomy for Gastric Carcinoma? A Study of Quality of Life

Abstract

The aim of this study was to compare quality of life after total gastrectomy (TG) with that after subtotal gastrectomy (STG) for gastric carcinoma. The value of the routine use of TG de principe in the treatment of gastric carcinoma, wherever the tumor may be sited in the stomach, remains controversial. The advocates of TG contend that when it can be performed safely, with relatively low operative mortality and morbidity, it yields better long-term survival than STG. Most surgeons, however, believe that the routine use of TG increases both operative mortality and morbidity and the risk of nutritional deficiency in the long term, without improving survival. TG may also be associated with poorer outcome in terms of quality of life (QOL), but the evidence for this is tenuous. Forty-seven consecutive patients who had undergone potentially curative (R0) gastric resection for carcinoma were studied: 26 had undergone TG and 21 STG. A radical D2 lymph node dissection had been performed in each, and all patients were free from recurrence at the time of the study. QOL was measured before operation and 1, 3, 6, and 12 months after operation by means of five questionnaires to measure functional outcome: the Rotterdam symptom checklist (RSCL), the Troidl index, the hospital anxiety and depression (HAD) scale, activities of daily living score, and Visick grades. Before operation there was no significant difference in QOL between the two groups of patients. At 1 year after operation, however, patients who had undergone STG had a significantly better QOL than patients who had undergone TG: Their median RSCL score was lower (10 versus 19 respectively, p < 0.05), and their Troidl index was higher (11 versus 9 respectively, p < 0.05). The QOL of patients who underwent STG was also significantly better after operation than it had been before operation, whereas the QOL of the TG group was not significantly better after operation than before operation. The QOL of patients was found to be significantly better after STG than after TG for gastric carcinoma. Because operative mortality is greater and long-term survival is no better after TG than after STG, the latter is recommended as the treatment of choice for tumors of the distal stomach.

Quality of life after curative gastrectomy for gastric cancer in a randomised controlled trial

“…Similar to other observations (Jentschura et al, 1997;Wu et al, 1997a;Davies et al, 1998), patients after a total gastrectomy tended to suffer poorer tolerance of normal food, need for more frequent eating and loss of more body weight than those after a subtotal gastrectomy. And younger patients had better QOL than older (Koster et al, 1987;Wu et al, 1997a).…”

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.…”

Advances in the management of gastric cancer

“…More radical total gastrectomy for distal gastric cancers does not offer any oncological superiority and is associated with signifi cant nutritional defi ciency and inferior quality-of-life, which persists even beyond 1 year of surgery [41]. Total gastrectomy continues to be the recommended procedure for proximal tumours.…”