Quality of Life After Gastrectomy for Adenocarcinoma

Abstract

Background Gastrectomy remains a major operation with potential for significant deterioration in patients’ health-related quality of life (QOL). This study assessed differences in QOL among patients following distal (DG), proximal (PG) or total (TG) gastrectomy. Methods We prospectively enrolled patients undergoing gastrectomy at our institution between 2002 and 2007. Participants completed the EORTC cancer (QLQ-C30) and gastric (QLQ-STO22) questionnaires preoperatively and at five postoperative intervals up to 18 months. We compared changes from baseline in patients based on extent of resection (proximal, distal, or total) using generalized linear models, adjusting for age, stage of disease, and (neo)adjuvant therapy. We converted QOL raw scores to reflect the proportion of patients with clinically significant deterioration based on the minimal important difference (MID). Results We included 134 patients: 82 DG, 16 PG, and 36 TG. In the immediate postoperative period, 55% of patients suffered significant impairment in their global QOL. This improved in most patients by six months, although 20-35% continued to have substantially worse QOL than prior to surgery. Patients who underwent PG suffered from significantly more clinical reflux (70% vs 35% (DG), 40% (TG)), nausea/vomiting (60% vs 25%, 30%), and global QOL impairment (60% vs 30%, 30%) than DG or TG patients, whose QOL scores were similar. These differences persisted up to 18 months postoperatively. Conclusions Surgeons should discuss expectations of QOL impairment with their patients prior to gastrectomy and reassure them that most symptoms resolve by six months following operation. Patients who undergo PG suffer from worse QOL impairment than patients who undergo DG or TG.

Weight loss and quality of life in patients surviving 2 years after gastric cancer resection

“…In agreement with these previous studies, our results show that more than half of the patients experienced at least 10% of BWL after gastric cancer resection. In line with our results, previous studies have found a high prevalence of diarrhoea after gastric cancer resection ranging from 20% to 30% (6,7,10,11). In the present study, severe diarrhoea was more common in the group of patients with >10% BWL (13% versus 0%).…”

“…A number of studies have described the great impact of gastric resection on HRQL in patients with curable gastric cancer (6,10). It has been shown that HRQL is influenced by the extent of resection (total vs. subtotal or proximal gastrectomy) (4,6) and there is a significant impairment of several aspects of HRQL reported by patients in the immediate postoperative period (6).…”

“…It has been shown that HRQL is influenced by the extent of resection (total vs. subtotal or proximal gastrectomy) (4,6) and there is a significant impairment of several aspects of HRQL reported by patients in the immediate postoperative period (6). Whilst studies show that symptoms improve after 6 or 12 months postoperatively, there is also evidence that some symptoms such as fatigue, nausea, pain or diarrhoea remain at 2 years after surgery as we observed in the present study (6,7). Other authors have investigated how baseline HRQL assessment may predict clinical outcomes(9,10).…”

“…Gavazzi et al(5) analysed the nutritional status at the beginning of gastric cancer treatment and reported a body weight loss (BWL) ≥ 10% of usual weight in 17% of patients, having a negative influence on health-related quality of life (HRQL). Several studies have defined HRQL as an important additional outcome measure in gastric cancer patients undergoing resection, showing differences between surgical techniques (6)(7)(8) as well as providing prognostic information (9)(10)(11).…”

Unplanned admission after gastrectomy as a consequence of fast-track surgery: a comparative risk analysis

“…What should be considered a specific problem for patients who undergo gastrectomy is that various postoperative symptoms that often lead to eating problems, malnutrition, and weight loss during the early postoperative period [8][9][10]. Besides, these consequences could eventually affect the prognosis of patients through decreasing their tolerance to evidence-based postoperative chemotherapy [11].…”