Serial Comparisons of Quality of Life after Distal Subtotal or Total Gastrectomy: What Are the Rational Approaches for Quality of Life Management?

Abstract

PurposeThe aims of this study were to make serial comparisons of the quality of life (QoL) between patients who underwent total gastrectomy and those who underwent distal subtotal gastrectomy for gastric cancer and to identify the affected scales with consistency.Materials and MethodsQoL data of 275 patients who were admitted for surgery between September 2008 and June 2011 and who underwent subtotal gastrectomy or total gastrectomy were obtained preoperatively and postoperatively at 3, 6, 9, 12, 18, and 24 months. The Korean versions of the European Organization for Research and Treatment (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and the gastric cancer specific module, the EORTC QLQ-STO22, were used to assess QoL.ResultsQoL, as assessed by the global health status/QoL and physical functioning, revealed a brief divergence with worse QoL in the total gastrectomy group 3 months postoperatively, followed by rapid convergence. QoL related to restrictive symptoms (nausea/vomiting, dysphagia, reflux, and eating restrictions) and dry mouth was consistently worse in the total gastrectomy group during the first 2 postoperative years.ConclusionsThe general QoL of patients after gastrectomy is highly congruent with subjective physical functioning, and the differences between patients who undergo total gastrectomy and subtotal gastrectomy are no longer valid several months after surgery. In order to further reduce the differences in QoL between patients who underwent total gastrectomy and subtotal gastrectomy, definitive preoperative informing, followed by postoperative symptomatic management, of restrictive symptoms in total gastrectomy patients is the most rational approach.

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

“…Date regarding to patient 30-day mortality at postoperation were reported in eight studies[6,7,9,11–13,15,16] involving 1866 patients of TG and 2424 patients of DG. The accumulated mortality rates of TG and DG groups were 2.14% (40/1866) and 1.16% (28/2424) respectively.…”

“…With the improvement of surgical techniques and the development of the instruments, the number of long-term survivors after resection for gastric cancer has been increasing and their QoL has become an important issue. In this study, due to lacking of QoL questionnaire standard scales, several articles we searched in comparison to short- or long-term QoL after undergone TG and DG could not be system evaluated[16,27,31–36]. Studies have shown that patients who undergone DG have a better QoL than those who undergone TG in shroter postoperative follow-up period[36].…”

“…Studies have shown that patients who undergone DG have a better QoL than those who undergone TG in shroter postoperative follow-up period[36]. However, along with time frame, these differences diminished whether patients underwent TG or DG[16,32,35]. Jentschura D et al reported that there were no differences between aged and younger patients indicates that age alone is no contraindication to major surgery, among the long-term survivors aged patients can have the same postoperative QoL as young people[31].…”

Factors affecting the quality of life of patients after gastrectomy as assessed using the newly developed PGSAS-45 scale: A nationwide multi-institutional study

“…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.…”

“…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.…”