Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2021; 27(16): 1816-1827
Published online Apr 28, 2021. doi: 10.3748/wjg.v27.i16.1816
Health-related quality of life after curative resection for gastric adenocarcinoma
Jan Grosek, Hana Zavrtanik, Aleš Tomažič
Jan Grosek, Hana Zavrtanik, Aleš Tomažič, Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
Jan Grosek, Aleš Tomažič, Medical Faculty, University of Ljubljana, Ljubljana 1000, Slovenia
Author contributions: Grosek J and Tomažič A made substantial contributions to the conception and design of the study; Zavrtanik H contributed to the acquisition, analysis and interpretation of the data; all authors participated in drafting the manuscript; Grosek J and Tomažič A revised it critically; all authors read and approved the final version of the manuscript.
Institutional review board statement: The study was approved by the National Medical Ethics Committee of Republic of Slovenia (approval No. 0120-315/2019/3).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no financial or non- financial competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Aleš Tomažič, MD, PhD, Chief Doctor, Professor, Surgeon, Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloška cesta 7, Ljubljana 1000, Slovenia. ales.tomazic@kclj.si
Received: January 31, 2021
Peer-review started: January 31, 2021
First decision: February 22, 2021
Revised: March 5, 2021
Accepted: April 13, 2021
Article in press: April 13, 2021
Published online: April 28, 2021
Processing time: 79 Days and 16.8 Hours
ARTICLE HIGHLIGHTS
Research background

Gastrectomy is a major operation that alters the physiological functions of the digestive tract. Consequently, these patients experience malnutrition, weight loss and several postgastrectomy symptoms that negatively impact patients’ wellbeing.

Research motivation

With improved survival in gastric cancer patients, health-related quality of life has become an important clinical endpoint alongside oncological outcomes.

Research objectives

The aim of this study was to investigate health-related quality of life after various surgical procedures for gastric cancer treatment.

Research methods

Patients that underwent curative resection for gastric adenocarcinoma at a tertiary centre between January 2014 and December 2018 were recruited for inclusion in this cross-sectional survey. The validated Slovenian version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30) and its gastric cancer specific module (QLQ STO-22) were sent to all eligible patients for self-completion. The scores of both questionnaires were compared between patients after subtotal distal vs total gastrectomy and patients after subtotal distal gastrectomy with Billroth II vs Roux-en-Y reconstruction using the Mann-Whitney U test. The association between the type of operation and general health status adjusted for some demographic and clinical characteristics was assessed with multiple linear regression.

Research results

Out of 234 patients that were eligible for study inclusion, 116 (49.6%) patients completed the questionnaires. No statistically significant differences were observed in scores on global or functional scales among patients after total or subtotal distal gastrectomy. However, patients after total vs subtotal gastrectomy did experience more dysphagia (P = 0.020) and eating restrictions (P = 0.017). Patients after subtotal distal gastrectomy with Billroth II reconstruction reported significantly worse scores on the physical (P = 0.038) and role functioning (P = 0.034) scales and had more problems with pain (P = 0.010), fatigue (P = 0.028) and reflux (P = 0.001). When adjusted for demographic data, disease stage and postoperative complications, no differences were observed in reported global health status/quality of life scores among different surgical procedures. However, Roux-en-Y was superior over Billroth II reconstruction in emotional (β = 0.24, P = 0.041), role (β = 0.24, P = 0.034) and physical (β = 0.23, P = 0.048) functioning when adjusted for other variables in a regression model.

Research conclusions

Patients after gastrectomy for gastric cancer experience several functional and symptom complaints. Based on our results, subtotal distal gastrectomy with Roux-en-Y reconstruction should be preferred over subtotal distal gastrectomy with Billroth II reconstruction.

Research perspectives

The data obtained from this study will help surgeons when preoperatively informing their patients about expected functional outcomes after gastrectomy and enable them to ensure proper supportive care for their patients in the postoperative period.