Long-term Quality of Life After Distal Subtotal and Total Gastrectomy

Lee, Seung Soo; Chung, Ho Young; Kwon, Oh Kyoung; Yu, Wansik

doi:10.1097/sla.0000000000001481

Cited by 83 publications

(79 citation statements)

References 39 publications

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“…Clinical features of PGS include the occurrence of various symptoms, reduced dietary intake, weight loss, reduced physical activity, and reduced physical and mental QOL. PGS is usually the most severe after TG, and the postoperative QOL of patients is known to be better after DG, in which the proximal stomach is partially preserved, than after TG[8,10,13,18,19]. Our study also showed a significantly higher “necessity for additional meals”, greater “weight loss”, lower “ability for working” and worse “dissatisfaction for daily life SS”, “PCS” and “MCS” of SF-8 in the TG group than in the DG group.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…Multiple studies have reported a greater deterioration of the QOL after total gastrectomy (TG) than distal gastrectomy (DG)[8,10,13,18,19], and it is thought that the more extensive the resection of the stomach, the greater the severity of PGS[11]. On the other hand, function-preserving gastrectomy, in which the extent of gastrectomy is reduced, such as pylorus-preserving gastrectomy (PPG)[9,11,16,17,23] and proximal gastrectomy[20], is often used for treating early gastric cancer and has been reported to be useful to improve the QOL of patients after surgery.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

View full text Add to dashboard Cite

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“…It was inevitable that TG procedure would yield worse complications such as oesophageal reflux, diarrhea, and nausea/vomiting because of a restricted food reservoir in the TG group. Lee SS regarded that survivors after TG exhibited ongoing QoL inferiority on various functional and symptom scales at postoperative five years, beyond that time, QoL inferiority of the TG to the DG group generally disappeared except of eating restrictions implicates[34]. It is possible that some form of gastric substitute, such as jejunal interposition, might also be helpful in reducing eating restrictions following TG in the longer term[38].…”

Section: Discussionmentioning

confidence: 99%

Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

Zhang²,

Wang

et al. 2016

PLoS ONE

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Background/AimsTotal gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored. Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer.MethodologyA search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed. Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis. Review Manager 5.2 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 12.0 software for meta-regression analysis.ResultsTen retrospective cohort studies and one randomized control trial involving 5447 patients were included. The meta-analysis showed no significant difference of postoperative mortality (RR = 1.48, 95%CI = 0. 90–2.44,p = 0.12), intraoperative blood loss (MD = 24.34, 95%CI = -3.31–51.99, p = 0.08) and length of hospital stay(MD = 0.76, 95%CI:-0.26–1.79, p = 0.15). TG procedure could retrieve more lymph nodes than DG(MD = 4.33, 95% CI = 2.34–6.31, p<0.0001). According to different postoperative complications, we performed subgroup analysis, subgroup analysis revealed that patients in TG group tended to have a higher rate of postoperative intra-abdominal abscess than DG procedure (RR = 3.41, 95% CI = 1.21–9.63,p<0.05). No statistical differences were found in leakage, intestinal obstruction, postoperative bleeding, anastomotic stricture and wound infection between the two groups (p>0.05). We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 49.6% (919/1852) vs.55.9%(721/1290) respectively. Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 0.91,95% CI = 0.85–0.97,p = 0.006).ConclusionBased on current retrospective evidences, we found that in spite of similar postoperative mortality, TG for distal gastric cancer provided a high risk of five-year Overall Survival rate. DG procedure can be a recommendation for distal gastric cancer, whereas due to lack of high quality RCTs in multicenter and the relatively small sample size of long-term outcomes, further comparative studies are still needed.

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“…The incidence of metachronous lesions is one of the concerns after endoscopic resection as almost all the gastric mucosa is preserved. However, considering that total gastrectomy has a significantly negative impact on patient quality of life, the preservation of gastric function might outweigh the possible disease burden of metachronous recurrence [25]. Moreover, with scheduled surveillance endoscopy, metachronous lesions can be detected at an early stage and so can be suitable candidates for endoscopic resection [26].…”

Section: Data Represent the Number Of Patients (%) Or The Median (Intmentioning

confidence: 99%

Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for esophagogastric junction adenocarcinoma

et al. 2016

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Background Endoscopic submucosal dissection (ESD) has become accepted as the standard treatment for early gastric cancer. However, comparative outcomes of ESD and surgery have not been evaluated for adenocarcinoma in the esophagogastric junction (EGJ). We investigated the longterm outcomes of ESD compared with those of surgery for adenocarcinoma in the EGJ. Methods Patients who underwent ESD or surgery for Siewert type II adenocarcinoma between 2005 and 2010 and who met the absolute and expanded criteria for endoscopic resection were eligible. Clinical features and treatment outcomes were retrospectively reviewed using medical records. Results Of the 79 patients included, 40 underwent ESD and 39 underwent surgery. During the median follow-up period of 60.9 months (range, 13.1-125.4 months), the 5-year overall survival rates were 93.9% and 97.3% for the ESD and surgery groups, respectively (p = 0.376). There were no gastric cancer-related deaths in either group. Adverse events occurred in 11 patients (13.9%) overall, and the incidence of treatment-related adverse events was similar between the two groups (10.0% vs. 17.9%, p = 0.308).Conclusions ESD may be an effective alternative to surgery for the treatment of early gastric cancer in the EGJ based on the comparable long-term outcomes.

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Long-term Quality of Life After Distal Subtotal and Total Gastrectomy

Cited by 83 publications

References 39 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

Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for esophagogastric junction adenocarcinoma

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