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

Abstract

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.

Laparoscopic sentinel node navigation surgery for early gastric cancer

“…Accordingly, several studies have used the PGSAS-45 to assess QoL after laparoscopic gastrectomy. Notably, the QoL of patients after laparoscopic gastrectomy after 1 year is similar to that of patients after open standard gastrectomy (5)(6)(7)(8).…”

“…The advantage of local resection is that it minimizes functional impairment. Local resection was shown by the PGSAS studies to be more superior to standard gastrectomy in terms of almost all subscales of the PGSAS (5,6).…”

Severity of postgastrectomy syndrome and quality of life after advanced gastric cancer radical gastrectomy

“…Although many postgastrectomy symptoms are subjective and scientific approaches to quantify them have been difficult, a specific questionnaire, the postgastrectomy syndrome assessment scale-45 (PGSAS-45), was developed as a psychometric measurement of PGS. PGSAS-45 measures outcomes from the patient's point of view, and nearly 2,400 questionnaires were collected during the PGS assessment study (PGSAS study), thus providing essential data to verify PGS scientifically (4)(5)(6)(7). The subjects of the PGSAS study were stage IA or IB cases at least one year after surgery.…”

Lower oesophageal sphincter‐preserving Roux‐en‐Y esophagojejunostomy with a jejunal J‐pouch reconstruction‐added His angle formation after total gastrectomy in patients with gastric cancer

“…Roux‐en‐Y esophagojejunostomy (RY) with D2 lymph node resection for advanced gastric cancer has been widely employed as a standard reconstruction after total gastrectomy (TG) in Japan . However, RY is often associated with postoperative disorders, especially a decrease or loss of appetite, alkaline reflux esophagitis (ARE), early dumping syndrome (EDS) and microgastria (decreased food intake), because of defects of the lower oesophageal sphincter (LES), pyloric sphincter and food reservoir functions after TG . Therefore, it is important for surgeons to prevent ARE, EDS and microgastria, which can markedly impair the quality of life (QOL) and nutritional status of patients after TG.…”

“…1 However, RY is often associated with postoperative disorders, especially a decrease or loss of appetite, alkaline reflux esophagitis (ARE), early dumping syndrome (EDS) and microgastria (decreased food intake), because of defects of the lower oesophageal sphincter (LES), pyloric sphincter and food reservoir functions after TG. [1][2][3][4][5] Therefore, it is important for surgeons to prevent ARE, EDS and microgastria, which can markedly impair the quality of life (QOL) and nutritional status of patients after TG. We previously reported that RY after TG, preserving the LES, can restore physiological conditions, and thus prevent ARE in patients.…”