Factors that minimize postgastrectomy symptoms following pylorus-preserving gastrectomy: assessment using a newly developed scale (PGSAS-45)

Abstract

Background Pylorus-preserving gastrectomy (PPG) is sometimes performed as a function-preserving surgery for the treatment of early gastric cancer. The aim of this study was to use an integrated assessment scale for postgastrectomy syndrome to determine the appropriate indicators and optimal methods for PPG. Methods The Postgastrectomy Syndrome Assessment Study (PGSAS) is a multicenter survey based on an integrated questionnaire (PGSAS-45) consisting of 45 items. Questionnaire responses were retrieved from a total of 2,520 patients, each of whom had undergone one of six different types of gastrectomy procedures; 313 responses from patients who had received PPG were analyzed here. Results The size of the proximal gastric remnant (less than one-quarter, about one-third, or more than one-half of the original size) significantly influenced the change in body weight, the scores for dissatisfaction at the meal, and dissatisfaction for daily life subscale (P = 0.030, P = 0.005, P = 0.034, respectively). The nausea score in patients who underwent hand-sewn anastomosis was significantly lower than in those who underwent anastomosis with a linear stapler (P = 0.006). The scores for diarrhea subscale, increased passage of stools, and sense of foods 123Gastric Cancer (2015) 18:397-406 DOI 10.1007/s10120-014-0366-y sticking differed significantly depending on the length of the preserved pyloric cuff (P = 0.047, P = 0.021, P = 0.046, respectively). Conclusions The results suggest that preservation of a sufficient proximal gastric remnant is recommended when utilizing PPG as function-preserving surgery.

Assessment of postoperative quality of life following pylorus-preserving gastrectomy and Billroth-I distal gastrectomy in gastric cancer patients: results of the nationwide postgastrectomy syndrome assessment study

“…This may be the primary reason why PPG patients required fewer additional meals and why body weight loss was smaller in the PPG than the DGBI group (-6.9 ± 7.0 % vs. -7.9 ± 8.1 %, P = 0.052). Namikawa et al [25] used the PGSAS-45 to conduct a more detailed analysis of PPG patients and reported that larger proximal gastric remnants resulted in less body weight loss and dissatisfaction at meals and in daily life. Despite these positive findings, a typical adverse outcome after PPG is delayed gastric emptying.…”

Quality of life and nutritional consequences after aboral pouch reconstruction following total gastrectomy for gastric cancer: randomized controlled trial CCG1101

“…Several instruments that more specifically address patient-reported outcomes following gastrectomy are now available, albeit in Japanese [23,24], and studies using these instruments that have shown some noteworthy results are now starting to be published [25][26][27]. Furthermore, pouch reconstruction in general has been proposed to improve long-term QOL when evaluated after as long as 30 months postsurgery [1].…”

Function-preserving surgery for gastric cancer: current status and future perspectives

“…A multicenter survey-based study in Japan, which utilized the newly developed postgastrectomy syndrome assessment scale (PGSAS)-45, found that factors including a sufficient proximal gastric remnant minimized postgastrectomy symptoms following PPG (30).…”