Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2016; 22(40): 8978-8990
Published online Oct 28, 2016. doi: 10.3748/wjg.v22.i40.8978
Factors affecting the quality of life of patients after gastrectomy as assessed using the newly developed PGSAS-45 scale: A nationwide multi-institutional study
Koji Nakada, Masazumi Takahashi, Masami Ikeda, Shinichi Kinami, Masashi Yoshida, Yoshikazu Uenosono, Yoshiyuki Kawashima, Sayumi Nakao, Atsushi Oshio, Yoshimi Suzukamo, Masanori Terashima, Yasuhiro Kodera
Koji Nakada, Department of Laboratory Medicine, Daisan Hospital Jikei University School of Medicine, Tokyo 201-8601, Japan
Masazumi Takahashi, Division of Gastroenterological Surgery, Yokohama Municipal Citizen’s Hospital, Yokohama 240-8555, Japan
Masami Ikeda, Department of Surgery, Asama General Hospital, Saku 385-0022, Japan
Shinichi Kinami, Department of Surgical Oncology, Kanazawa Medical School, Kanazawa 920-0293, Japan
Masashi Yoshida, Department of Surgery, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
Yoshikazu Uenosono, Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medicine, Kagoshima 890-8620, Japan
Yoshiyuki Kawashima, Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama 362-0806, Japan
Sayumi Nakao, Department of Surgery 2, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
Atsushi Oshio, Faculty of Letters, Arts and Sciences, Waseda University, Tokyo 169-8050, Japan
Yoshimi Suzukamo, Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
Masanori Terashima, Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
Yasuhiro Kodera, Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
Author contributions: Nakada K wrote the paper; Nakada K, Takahashi M, Ikeda M, Kinami S, Yoshida M, Uenosono Y and Kodera Y designed the study; Nakada K, Takahashi M, Ikeda M, Kinami S, Yoshida M, Uenosono Y, Kawashima Y, Terashima M and Kodera Y collected the data; Nakao S contributed to establish PGSAS original items English version; Oshio A contributed to statistical analysis; Suzukamo Y supervised the PGSAS-45 questionnaire; all authors have read and approved the final version to be published.
Supported by Jikei University School of Medicine and Japanese Society for Gastro-surgical Pathophysiology.
Institutional review board statement: This study was reviewed and approved by local ethics committees at each institution.
Clinical trial registration statement: This study was registered with the University Hospital Medical Information Network’s Clinical Trials Registry (UMIN-CTR; registration number 000002116).
Informed consent statement: Written informed consent was obtained from all patients prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interests related to the publication of this study.
Data sharing statement: No additional data was available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Koji Nakada, MD, PhD, Associate Professor, Department of Laboratory Medicine, Daisan Hospital Jikei University School of Medicine, 4-11-1, Izumihoncyo, Komae-shi, Tokyo 201-8601, Japan. nakada@jikei.ac.jp
Telephone: +81-3-34801151-3401 Fax: +81-3-34805700
Received: June 28, 2016
Peer-review started: June 29, 2016
First decision: July 29, 2016
Revised: August 14, 2016
Accepted: September 6, 2016
Article in press: September 6, 2016
Published online: October 28, 2016

To identify certain clinical factors other than the type of gastrectomy which affect the postoperative quality of life (QOL) of patients after gastrectomy.


The 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.


The 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.


Several 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.

Keywords: Postgastrectomy syndrome, Quality of life, Patient- reported outcome, Effect size, Gastrectomy

Core tip: The extent of gastrectomy has been reported to substantially affect the postoperative quality of life (QOL). However, considerable differences in the QOL have been observed among patients who underwent the same type of gastrectomy, implicating that other clinical factors may have major influence over the postoperative QOL. In the present study, we first found that several clinical factors such as the symptom severity, ability for working and necessity for additional meals had significant impact on the postoperative QOL, while the influence of the extent of gastrectomy was unexpectedly small. These findings give us deeper understanding to manage the postgastrectomy syndrome appropriately.