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

Abstract

BACKGROUND With improved survival in gastric cancer patients, health-related quality of life has become an important clinical endpoint alongside primary oncological outcomes. AIM To investigate health-related quality of life after various surgical procedures for gastric cancer treatment. METHODS The validated Slovenian version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30) and its gastric cancer-specific module (QLQ STO-22) was sent for self-completion to patients that underwent curative resection for gastric adenocarcinoma between January 2014 and December 2018 at our centre. In total, 116 patients responded. Scores were compared between patients after subtotal distal vs total gastrectomy and patients after subtotal distal gastrectomy with Billroth II vs Roux-en-Y reconstruction. RESULTS Interestingly, the extent of resection did not influence daily functioning; however, more dysphagia and eating restrictions were reported in patients after total gastrectomy when compared to patients after subtotal distal gastrectomy. Moreover, patients with Billroth II reconstruction after subtotal distal resection experienced worse physical and role functioning and reported more pain, fatigue and reflux compared to Roux-en-Y reconstruction. CONCLUSION Based on our results, Roux-en-Y reconstruction after subtotal distal gastrectomy should be preferred over Billroth II reconstruction. The data obtained from this study will help surgeons when preoperatively informing their patients about expected functional outcomes after gastrectomy and enable them to ensure proper supportive care of their patients in the postoperative period.

Clinical Efficacy of Laparoscopic Billroth II Subtotal Gastrectomy Plus Lienal Polypeptide Injection for Gastric Cancer

“…Chemotherapy is commonly used postoperatively to eliminate small lesions and tumor cells that are unresectable, but it is associated with toxic side effects and leads to poor prognosis. The prognosis of gastric cancer is related to the pathological stage, site, tissue type, biological behavior, and therapeutic measures of gastric cancer [ 9 ]. Lienal polypeptide injection is a sterile aqueous solution of peptides, free amino acids, nucleic acids, and total sugars with a molecular weight of fewer than 6,000 daltons made from healthy calf spleen extracts, mostly used in primary and secondary cellular immunodeficiency diseases [ 10 ].…”

Quality of Life in Patients Undergoing Surgery for Upper GI Malignancies

“…It features a 3-month decline in HRQL succeeded by evidence of long-term recovery, during the period between the 6th and the 12th month following gastrectomy [ 75 ]. Nowadays, a vast variety of newly introduced surgical techniques promises to achieve radical excision of tumors [ 76 ]. The tumor site, preoperative staging, the patient’s overall physical condition, and the surgeon’s choice based on experience are all taken into account when choosing the best course of action.…”

“…The tumor site, preoperative staging, the patient’s overall physical condition, and the surgeon’s choice based on experience are all taken into account when choosing the best course of action. Newly introduced HRQL scales give rise to a better assessment of quality of life, as they effectively reflect the patients’ self-reported evaluation of their post-operative mental and physical health, promoting the most efficient therapeutic interventions [ 76 ]. The approach of only objectively assessing the postoperative consequences should be progressively abandoned.…”

“…More and more anastomotic methods after gastrectomy are being studied to determine whether they have a beneficial effect on the postoperative quality of life of patients over time [ 76 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ]. Controversial findings on pouch repair following TG have been reported.…”

“…Conversely, pouch reconstruction according to Svedlund et al [ 94 ] and Kalmar et al [ 95 ] offers higher postoperative HRQL and should be considered mainly for patients with well-differentiated, low-stage tumors, providing a fair likelihood of long-term survival [ 94 , 95 ]. Various studies have investigated Roux-en-Y (R-Y) and Billroth repair with respect to their postoperative HRQL benefits [ 76 , 96 , 97 , 98 , 99 , 100 , 101 , 102 ]. Patients who have R-Y reconstruction may experience improved QoL, a lower incidence of reflux esophagitis, as well as a lower incidence of epigastric pain and better HRQL findings because of the decreased angle of His in patients following RY compared with Billroth repair [ 76 , 96 , 105 ].…”