A multi‐institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602)

Abstract

BackgroundProximal gastrectomy (PG) has become an increasingly preferred procedure for treating early cancer in the upper third of the stomach. However, advantages of PG in postoperative quality of life (QOL) over total gastrectomy (TG) has not fully proven.MethodsWe conducted a multi‐institutional prospective observational study (CCOG1602) of patients who undergo TG or PG for cStage I gastric cancer. We used the PGSAS‐37 and EORTC‐QLQ‐C30 to evaluate the changes in body weight and QOL over a 3‐year postoperative period. The primary endpoint was the weight loss rate 3 years after surgery.ResultsWe enrolled 109 patients from 18 institutions and selected 65 and 19 patients for inclusion in the TG and PG groups, respectively. Mean postoperative weight loss rates were 16.0% and 11.7% for the TG and PG groups, respectively (p = 0.056, Cohen's d 0.656) during postoperative year 1% and 15.0% and 10.8% for TG and PG (p = 0.068, Cohen's d 0.543), respectively, during postoperative year 3, indicating that the PG group achieved a better trend with a moderate effect size. According to the PGSAS‐37, the PG group experienced a better trend in the indigestion subscale (p < 0.001, Cohen's d −1.085) and total symptom score (p = 0.050, Cohen's d −0.59) during postoperative year 3 compared with the TG group. In contrast, the EORTC‐QLQ‐C30 detected no difference between the groups at any time point during 3‐year postoperative period.ConclusionsThis prospective study demonstrates that PG tended to be more favorable compared with TG with respect to postoperative weight loss and QOL, particularly regarding indigestion.

Prognosis and Treatment of Gastric Cancer: A 2024 Update

“…Moreover, these symptoms are closely linked to physical symptoms, indicating the importance of counselling patients to make informed decisions under the surveillance of a multidisciplinary team [56]. In regard to postoperative weight reduction and overall quality of life, particularly dyspepsia, proximal gastrectomy is generally preferable to total gastrectomy [57]. After gastrectomy, patients often return to their presurgery quality of life one year later [58].…”