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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Predictive factors for body weight loss and its impact on quality of life following gastrectomy
Kazuaki Tanabe, Masazumi Takahashi, Takashi Urushihara, Yoichi Nakamura, Makoto Yamada, Sang-Woong Lee, Shinnosuke Tanaka, Akira Miki, Masami Ikeda, Koji Nakada
Kazuaki Tanabe, Department of Gastroenterological Surgery, Hiroshima University Hospital, Hiroshima 734-8551, Japan
Masazumi Takahashi, Division of Gastroenterological Surgery, Yokohama Municipal Citizen’s Hospital, Yokohama 240-8555, Japan
Takashi Urushihara, Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
Yoichi Nakamura, Department of Surgery, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
Makoto Yamada, Department of Surgery, Gifu Municipal Hospital, Gifu 500-8513, Japan
Sang-Woong Lee, Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan
Shinnosuke Tanaka, Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
Akira Miki, Department of Surgery, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
Masami Ikeda, Department of Surgery, Asama General Hospital, Saku 385-8558, Japan
Koji Nakada, Department of Laboratory Medicine, the Jikei University School of Medicine, Tokyo 105-8471, Japan
Author contributions: Tanabe K, Takahashi M, Urushihara T, Nakamura Y, Yamada M, Lee SW, Tanaka S, Miki A, Ikeda M and Nakada K collected data; Nakada K managed the study; Tanabe K wrote the paper; all authors have read and approved the final version to be published.
Supported by Jikei University School of Medicine and the Japanese Society for Gastro-surgical Pathophysiology; JPGSWP and registered to UMIN-CTR #000002116 entitled.
Institutional review board statement: This study was approved by the local ethics committees at each participating institution.
Informed consent statement: Written informed consent was obtained from all enrolled patients.
Conflict-of-interest statement: The authors declare no conflicts of interest 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: Dr. Kazuaki Tanabe, Department of Gastroenterological Surgery, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
ktanabe2@hiroshima-u.ac.jp
Telephone: +81-82-2575222 Fax: +81-82-2575224
Received: February 11, 2017
Peer-review started: February 14, 2017
First decision: March 16, 2017
Revised: April 3, 2017
Accepted: May 4, 2017
Article in press: May 4, 2017
Published online: July 14, 2017
Processing time: 150 Days and 17.7 Hours
AIM
To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life (QOL).
METHODS
We applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45, which consists of 45 items including those from the Short Form-8 and Gastrointestinal Symptom Rating Scale instruments, in addition to 22 newly selected items. Between July 2009 and December 2010, completed questionnaires were received from 2520 patients with curative resection at 1 year or more after having undergone one of six types of gastrectomy for Stage I gastric cancer at one of 52 participating institutions. Of those, we analyzed 1777 eligible questionnaires from patients who underwent total gastrectomy with Roux-en-Y procedure (TGRY) or distal gastrectomy with Billroth-I (DGBI) or Roux-en-Y (DGRY) procedures.
RESULTS
A total of 393, 475 and 909 patients underwent TGRY, DGRY, and DGBI, respectively. The mean age of patients was 62.1 ± 9.2 years. The mean time interval between surgery and retrieval of the questionnaires was 37.0 ± 26.8 mo. On multiple regression analysis, higher preoperative body mass index, total gastrectomy, and female sex, in that order, were independent predictors of greater body weight loss after gastrectomy. There was a significant difference in the degree of weight loss (P < 0.001) among groups stratified according to preoperative body mass index (< 18.5, 18.5-25 and > 25 kg/m2). Multiple linear regression analysis identified lower postoperative body mass index, rather than greater body weight loss postoperatively, as a certain factor for worse QOL (P < 0.0001) after gastrectomy, but the influence of both such factors on QOL was relatively small (R2, 0.028-0.080).
CONCLUSION
While it is certainly important to maintain adequate body weight after gastrectomy, the impact of body weight loss on QOL is unexpectedly small.
Core tip: Our study of almost 1800 gastrectomy patients revealed that higher preoperative body mass index, total gastrectomy, and female sex were independent predictors of greater body weight loss after gastrectomy. Moreover, we determined lower postoperative body mass index, rather than greater postoperative weight loss, as a certain factor of worse quality of life (QOL), although the effect was not substantial. We believe that this contribution is theoretically and practically relevant in the current context of gastric cancer treatment and recovery because early diagnosis and improved treatments have led to increased long-term survival postgastrectomy, highlighting the need for better QOL.
