Long-term outcomes of postgastrectomy syndrome after total laparoscopic distal gastrectomy using the augmented rectangle technique

Abstract

BACKGROUND For total laparoscopic distal gastrectomies for gastric cancer, the reconstruction method is critical to the clinical outcome of the procedure. However, which reconstruction technique is optimal remains controversial. We originally reported the augmented rectangle technique (ART) as a reconstruction option for total laparoscopic Billroth I reconstructions. Still, little is known about its effect on long-term outcomes, specifically the incidence of postgastrectomy syndrome and its impact on quality of life. AIM To analyze postgastrectomy syndrome and quality of life after ART using the Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaire. METHODS At Juntendo University, a total of 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 and March 2020 completed the PGSAS-37 questionnaire. Multidimensional analysis was performed, comparing those 94 ART cases from our institution (ART group) to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS-37 as part of a larger national database (PGSAS group). RESULTS Patients in the ART group had significantly better total symptom scores in all the symptom subscales ( i.e. , esophageal reflux, abdominal pain, meal-related distress, indigestion, diarrhea, constipation, and dumping). The loss of body weight was marginally greater for those in the ART group than in the PGSAS group (-9.3% vs -7.9%, P = 0.054). The ART group scored significantly lower in their dissatisfaction of ongoing symptoms, during meals, and with daily life. CONCLUSION ART for Billroth I reconstruction provided beneficial long-term results for postgastrectomy syndrome and quality of life in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.

Impact of the Aboral Pouch in Roux-en-Y Reconstruction after Laparoscopic Total Gastrectomy for Elderly Patients

“…Second, this study assessed outcomes 1 year after total gastrectomy procedures, and longterm follow-up is necessary. However, the nutritional indices, PGS, and QOL investigated herein stabilized at 1 year postoperatively; therefore, no major problems should be expected during the observation period 5) . Third, it was difficult to rationally explain all findings observed.…”

“…These elderly patients are at high risk for postoperative complications, nutritional disorders, PGS, and reduced QOL postoperatively [2][3][4] . Therefore, we focused on aboral- According to several studies, there is 10-15% weight loss after total gastrectomy procedures, especially in elderly patients, which is a serious concern that needs to be addressed 1,5,8) . The current study indicated no significant difference in the rate of postoperative weight loss between the elderly and non-elderly groups, although the rate of weight loss tended to be lower in the elderly group.…”

“…Furthermore, elderly patients who have undergone gastrectomy procedures have a high weight-loss rate and are more prone to developing severe postoperative nutritional problems 4) . Postgastrectomy syndrome (PGS), which is specific to gastric surgery, occurs frequently after gastrectomy and requires attention as a clinical condition, because it is closely related to weight loss and nutritional disorders and adversely affects quality of life (QOL) [5][6][7] . Specifically, compared with other gastrectomy procedures, total gastrectomy, wherein removal of the entire stomach significantly reduces reservoir capacity, is associated with more frequent weight loss, nutritional disorders, and decreased QOL due to PGS 6,7) .…”

“…Weight loss after total gastrectomy occurs in approximately 10-15% of cases. Decreased food intake and esophageal reflux symptoms due to bile reflux are particularly well-known causes [5][6][7][8] . Several reconstructive innovations reportedly improve PGS and QOL postoperatively in patients who have undergone total gastrectomy procedures.…”

Totally Laparoscopic Pylorus-Preserving Gastrectomy (TLPPG) is Safe and Effective for Early Gastric Cancer Treatment

“…In order to initiate the use of TLPPG in China, it is necessary to ensure that newly learned TLPPG procedures are done properly and can yield similar results to procedures done regularly. Therefore, we performed TLPPG on three Chinese patients (TLPPG group) and quantitatively observed their postoperative conditions and QOL status to see if we could produce similar results to the CLASS-02 study 7) (LTG group) in China 8) the multicenter data PGSAS-37 (PGSAS group) in Japan.…”