Advantages of Distal Subtotal Gastrectomy over Total Gastrectomy in the Quality of Life of Long-Term Gastric Cancer Survivors

Abstract

Purpose: This study evaluated differences and shifting patterns in the health-related quality of life (HRQoL) of 5-year gastric cancer survivors after either a distal subtotal gastrectomy (DSG) or total gastrectomy (TG). Materials and Methods: We analyzed the prospectively collected HRQoL data of 528 patients who survived 5 years without recurrence using the European Organization for the Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC Quality of Life Questionnaire-Stomach module according to the type of surgery. The purpose was to identify the proportion of patients with deteriorating HRQoL and to assess the clinical significance of these changes. Results: Deteriorating HRQoL was prevalent in both groups, including a large proportion of the DSG group. Decreased overall health status and scores on several function scales were less in the DSG group, while increases on the symptom scales were higher in the TG group. For most of the scales, gaps in HRQoL during the early postoperative period did not merge within the 5 years. Scores on the diarrhea and body image scales revealed "moderate changes" in both groups. Conclusions: During the 5-year period after surgery, the TG group suffered from inferior HRQoL compared to the DSG group. However, a large proportion of the DSG group also suffered HRQoL deterioration. In general, the TG group experienced more HRQoL decline, with diarrhea and body image being the major concerns for both groups. To improve HRQoL after gastrectomy, patients must be better informed about post-gastrectomy symptoms. These symptoms must be vigorously investigated, and medical interventions should be available parallel to nutritional support. Favorable evidence of function-preserving gastrectomy should be established and disseminated to improve the HRQoL of early gastric cancer patients.

Health-related quality of life after curative resection for gastric adenocarcinoma

“…Our data show that proximal gastric preservation has marginal advantages for improving patients’ quality of life by reducing dysphagia and eating restrictions postoperatively whereas no differences in daily functioning were found. In line with our finding, subtotal distal gastrectomy was generally better tolerated in several previous studies, especially due to a higher symptom burden reported with total gastrectomy such as nausea and vomiting, dysphagia, eating restrictions and reflux[ 16 , 21 ]. In subtotal gastrectomy, gastric physiology is at least partly preserved, possibly leading to superior HRQoL.…”

“…Previous studies evaluated longitudinal changes of HRQoL after gastrectomy for gastric cancer and used preoperative scores as a reference[ 14 - 21 ]. However, these scores are highly influenced by circumstances surrounding the diagnosis as well as symptoms associated with the disease itself, such as nausea and vomiting, dysphagia, postprandial fullness, loss of appetite, fatigue due to anaemia and so on, resulting in worse HRQoL[ 16 , 17 ].…”

Health related quality of life following open versus minimally invasive total gastrectomy for cancer: Results from a randomized clinical trial

“…Another cross-sectional study revealed improved HRQoL in gastric cancer patients operated with minimally invasive techniques. It should be noted that the study included both distal and total gastrectomies, whereas total gastrectomy is associated with overall worse HRQoL outcomes in comparison to subtotal or distal gastrectomy [8,9]. Alongside, more than a third of patients did not receive neoadjuvant therapy, which might affect HRQoL data.…”

Real-World Therapeutic Outcomes of S-1 Adjuvant Chemotherapy for pStage II/III Gastric Cancer in the Elderly

“…In this study, we did not find significant differences in both OS and RFS between distal and total gastrectomy although distal gastrectomy independently predicted completion of S-1 administration. Total gastrectomy actually diminishes quality of life of patients compared to partial gastrectomy [22], and so medical intervention in addition to nutritional support should be available. However, some other factors like preoperative immunonutritional status and pathological stage robustly affect survival.…”