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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Quality of life after total vs distal gastrectomy with Roux-en-Y reconstruction: Use of the Postgastrectomy Syndrome Assessment Scale-45
Masazumi Takahashi, Masanori Terashima, Hiroshi Kawahira, Eishi Nagai, Yoshikazu Uenosono, Shinichi Kinami, Yasuhiro Nagata, Masashi Yoshida, Keishiro Aoyagi, Yasuhiro Kodera, Koji Nakada
Masazumi Takahashi, Division of Gastroenterological Surgery, Yokohama Municipal Citizen’s Hospital, Yokohama 240-8555, Japan
Masanori Terashima, Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
Hiroshi Kawahira, Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
Eishi Nagai, Department of Surgery and Science, Graduate school of medicine, KyushuUniversity, Fukuoka 812-8582, Japan
Yoshikazu Uenosono, Department of Digestive Surgery, Kagoshima University Graduate School of Medicine, Kagoshima 890-8544, Japan
Shinichi Kinami, Department of Surgical Oncology, Kanazawa Medical School, Kanazawa 920-0265, Japan
Yasuhiro Nagata, Center for Comprehensive Community Care Education, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan
Masashi Yoshida, Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
Keishiro Aoyagi, Department of Surgery, Kurume University School of Medicine, Kurume 830-0011, Japan
Yasuhiro Kodera, Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
Koji Nakada, Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo 105-8471, Japan
Author contributions: Takahashi M, Terashima M, Kawahira H, Nagai E, Uenosono Y, Kinami S, Nagata Y, Yoshida M, Aoyagi K, Kodera Y, Nakada K collected the data; Nakada K managed the study; Takahashi M wrote the paper; all authors have read and approved the final version to be published.
Supported by a grant from The Jikei University School of Medicine and Japanese Society for Gastro-surgical Pathophysiology.
Institutional review board statement: This study was approved by local ethics committees at each institution.
Informed consent statement: Written informed consent was obtained from all enrolled patients.
Clinical trial registration statement: This study was registered with the University Hospital Medical Information Network’s Clinical Trials Registry (UMIN-CTR; registration number 000002116).
Conflict-of-interest statement: The authors declare no conflicts of interests related to the publication of this study.
Data sharing statement: No additional data are 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: Masazumi Takahashi, MD, PhD, Chief, Division of Gastroenterological Surgery, Yokohama Municipal Citizen’s Hospital, 45 Okazawa-cho, Hodogaya-ku, Yokohama 240-8555, Japan.
ma06-takahashi@city.yokohama.jp
Telephone: +81-45-3311961 ext. 6330 Fax: +81-45-3311960
Received: December 18, 2016
Peer-review started: December 20, 2016
First decision: February 9, 2017
Revised: February 15, 2017
Accepted: March 2, 2017
Published online: March 21, 2017
Processing time: 91 Days and 0 Hours
AIM
To investigate the detrimental impact of loss of reservoir capacity by comparing total gastrectomy (TGRY) and distal gastrectomy with the same Roux-en-Y (DGRY) reconstruction. The study was conducted using an integrated questionnaire, the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, recently developed by the Japan Postgastrectomy Syndrome Working Party.
METHODS
The PGSAS-45 comprises 8 items from the Short Form-8, 15 from the Gastrointestinal Symptom Rating Scale, and 22 newly selected items. Uni- and multivariate analysis was performed on 868 questionnaires completed by patients who underwent either TGRY (n = 393) or DGRY (n = 475) for stage I gastric cancer (52 institutions). Multivariate analysis weighed of six explanatory variables, including the type of gastrectomy (TGRY/DGRY), interval after surgery, age, gender, surgical approach (laparoscopic/open), and whether the celiac branch of the vagus nerve was preserved/divided on the quality of life (QOL).
RESULTS
The patients who underwent TGRY experienced the poorer QOL compared to DGRY in the 15 of 19 main outcome measures of PGSAS-45. Moreover, multiple regression analysis indicated that the type of gastrectomy, TGRY, most strongly and broadly impaired the postoperative QOL among six explanatory variables.
CONCLUSION
The results of the present study suggested that TGRY had a certain detrimental impact on the postoperative QOL, and the loss of reservoir capacity could be a major cause.
Core tip: The influence of postgastrectomy syndrome after total gastrectomy (TG) is believed to be more intense than that after distal gastrectomy (DG). However, the precise features and the degree of interference with quality of life after TG against DG have not been clarified. Then, we weighed DG against TG to determine pure influence of whether presence or absence of remaining stomach (as the reservoir capacity) by employing the same reconstruction route. Moreover, we reinforced the findings by multivariable analysis including other clinical factors, and defined the effect sizes of each variable in the unprecedented examination with large number cases using newly developed Postgastrectomy Syndrome Assessment Scale-45.
