Effects of Emptying Function of Remaining Stomach on QOL in Postgastrectomy Patients

Hayami, Masaru; Seshimo, Akiyoshi; Miyake, K; Shimizu, Satoru; Kameoka, Shingo

doi:10.1007/s00268-011-1379-x

Cited by 15 publications

(16 citation statements)

References 19 publications

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“…For this purpose, existing general-purpose disease or symptom specific QOL questionnaires, such as GSRS[26,31,32], Gastrointestinal Quality of Life Index[12,33] and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; EORTC QLQ-C30 + QLQ-STO22[10,13,18,19,21,34-36], which were established for other purposes and had verified reliability and validity, have been mainly used, because there have been no established questionnaires specified for the postgastrectomy evaluation. However, these questionnaires are likely to be inadequate for the clinical evaluation of postgastrectomy patients, because they do not contain “dumping” and/or “meal-related distress”, which are symptoms that are well-recognized as significantly affecting the postoperative QOL of gastrectomy patients.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the quality of life of patients after gastrectomy as assessed using the newly developed PGSAS-45 scale: A nationwide multi-institutional study

Nakada

Takahashi

Ikeda

et al. 2016

WJG

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AIMTo identify certain clinical factors other than the type of gastrectomy which affect the postoperative quality of life (QOL) of patients after gastrectomy.METHODSThe postgastrectomy syndrome assessment scale (PGSAS)-45 was designed to assess the severity of symptoms, the living status and the QOL of gastrectomized patients. It consists of 45 items, of which 22 are original items while 23 were retrieved from the SF-8 and Gastrointestinal Symptoms Rating Scale questionnaires with permission. A nationwide surveillance study to validate PGSAS was conducted and 2368 gastric cancer patients who underwent various types of gastrectomy at 52 medical institutions were enrolled. Of these, 1777 patients who underwent total gastrectomy (TG) reconstructed with Roux-Y (n = 393), distal gastrectomy (DG) reconstructed with Billroth-I (n = 909), or DG reconstructed with Roux-Y (n = 475) were evaluated in the current study. The influence of the type of gastrectomy and other clinical factors such as age, sex, duration after surgery, the symptom severity, the degree of weight loss, dietary intake, and the ability for working on the postoperative QOL (i.e., dissatisfaction for daily life subscale, physical component summary and mental component summary of the SF-8) were examined by multiple regression analysis (MRA). In addition, importance of various symptoms such as esophageal reflux, abdominal pain, meal-related distress, indigestion, diarrhea, constipation and dumping on the postoperative living status and QOL were also appraised by MRA.RESULTSThe postoperative QOL were significantly deteriorated in patients who underwent TG compared to those after DG. However, the extent of gastrectomy was not an influential factor on patients’ QOL when adjusted by the MRA. Among various clinical factors, the symptom severity, ability for working, and necessity for additional meals were the most influential factors to the postoperative QOL. As for the individual symptoms, meal-related distress, dumping, abdominal pain, and esophageal reflux significantly affected the postoperative QOL in that order, while the influence of indigestion, diarrhea and constipation was insignificant.CONCLUSIONSeveral clinical factors such as the symptom severity (especially in meal-related distress and dumping), ability for working and necessity for additional meals were the main factors which affected the patients’ well-being after gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Factors affecting the quality of life of patients after gastrectomy as assessed using the newly developed PGSAS-45 scale: A nationwide multi-institutional study

Nakada

Takahashi

Ikeda

et al. 2016

WJG

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, investigators turned to the established and authorized questionnaires for comparisons between gastric surgery procedures [10-15, 18, 20], because there are several combinations of core questionnaires and disease-specific modules that are considered appropriate and have been approved for evaluation of QOL [23,24]. A combination of SF-36, a core questionnaire, and GSRS, a symptom-specific QOL, has been one of the examples [11,14], but the GSRS may have a tendency to overlook some of the symptoms that are peculiar to the patients who have undergone gastrectomy and are unusual for other disorders of the gastrointestinal tract. EORTC QLQ-C30 [25], a cancer-specific core questionnaire, and STO-22 [26] is another combination that has been used to evaluate postgastrectomy patients [12,13].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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Background Lack of a suitable instrument to comprehensively assess symptoms, living status, and quality of life in postgastrectomy patients prompted the authors to develop postgastrectomy syndrome assessment scale (PGSAS)-45. Methods PGSAS-45 consists of 45 items in total: 8 items from SF-8, 15 items from GSRS, and an additional 22 items selected by 47 gastric surgeons. Using the PGSAS-45, a multi-institutional survey was conducted to determine the prevalence of postgastrectomy syndrome and its impact on everyday life among patients who underwent various types of gastrectomy. Eligible data were obtained from 2,368 patients operated and followed at 52 institutions in Japan. Of these, data from 1,777 patients were used in the current study in which symptom subscales of the PGSAS-45 were determined. We also considered the characteristics of the postgastrectomy syndrome and to what extent these symptoms influence patients' living status and quality of life (QOL).Results By factor analysis, 23 symptom-related items of PGSAS-45 were successfully clustered into seven symptom subscales that represent esophageal reflux, abdominal pain, meal-related distress, indigestion, diarrhea, constipation, and dumping. These seven symptom subscales and two other subscales measuring quality of ingestion and dissatisfaction for daily life, respectively, had good internal consistency in terms of Cronbach 0 s a (0.65-0.88).

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“…A weak negative correlation of À0.4 (P ¼ 0.0384) was seen between total score and Tmax. In addition, from a previous report that Tmax was less than 21 minutes and the total score showed significant worsening of symptoms in an investigation of cases of reconstruction after various gastric resections, 14 the relationship with total score was investigated with the same 21-minute increments as for Tmax. The results showed that the rate of scores !2 (indicating symptoms) was only 15.4% (2 of 13 patients) when Tmax was !21 minutes.…”

Section: Gsrsmentioning

confidence: 99%

“…Therefore, Tmax seemed to have less effect on symptoms of diarrhea. Based on a previous report of higher symptom rates in 72 patients who underwent various types of gastrectomy when the Tmax was ,21 minutes, 14 the correlation of Tmax with total scores was also investigated in the present patients after 12 months PO, and an increased rate of symptoms was found with Tmax ,21 minutes. Therefore, when Tmax falls below a certain threshold value, this appears to lead to an increase in symptoms.…”

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confidence: 99%

Examination of the Relationship Between Postoperative Quality of Life and Gastric Emptying Function After Pylorus-Preserving Gastrectomy and Distal Gastrectomy

Kaneshima

Seshimo

Miyake

et al. 2015

International Surgery

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The objective of this study was to compare postoperative quality of life (QOL) of patients with early cancer of the body of the stomach who were treated with pylorus-preserving gastrectomy (PPG) and those treated with distal gastrectomy (DGR), and to evaluate the relationship between postoperative QOL and gastric emptying function (GEF). Patients with early cancer of the body of the stomach are often treated with PPG to preserve gastric function, and their QOL appears to be better after PPG than after DGR. Differences in postoperative GEF are thought to be a factor, but the relationship between GEF and postoperative QOL has not been well investigated. A total of 60 patients [23 PPG and 37 DGR (Billroth I)] completed QOL surveys [SF-36, Gastrointestinal Symptom Rating Scale (GSRS)] and underwent 13 C-breath tests to evaluate GEF in two groups ( 12 months postoperatively and .12 months postoperatively). The time until the percentage of breath 13 CO 2 reaches a peak during the 13 C-breath test (Tmax), which is an index of gastric emptying velocity, was evaluated. For the SF-36, there were no significant differences between the two procedures. For GSRS, a trend toward better scores was seen after PPG; abdominal pain and total scores at .12 months postoperatively were significantly better with PPG. Tmax was significantly longer for PPG patients. For each procedure, symptoms significantly worsened when Tmax was ,21 minutes at .12 months after surgery. Although postoperative GEF evaluated by 13 C-breath tests did not affect overall QOL measured by the SF-36, it did affect disease-specific QOL measured by GSRS.

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Effects of Emptying Function of Remaining Stomach on QOL in Postgastrectomy Patients

Abstract: Gastrointestinal symptoms in postgastrectomy patients were associated with the function of the remaining stomach. The (13)C breath test is useful for objectively assessing such symptoms.

Cited by 15 publications

References 19 publications

Factors affecting the quality of life of patients after gastrectomy as assessed using the newly developed PGSAS-45 scale: A nationwide multi-institutional study

Factors affecting the quality of life of patients after gastrectomy as assessed using the newly developed PGSAS-45 scale: A nationwide multi-institutional study

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

Examination of the Relationship Between Postoperative Quality of Life and Gastric Emptying Function After Pylorus-Preserving Gastrectomy and Distal Gastrectomy

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