Quality of life after total vs distal gastrectomy with Roux-en-Y reconstruction: Use of the Postgastrectomy Syndrome Assessment Scale-45

Table 1 Uni-variate analysis of main outcome measures following total gastrectomy and distal gastrecrtomy procedures

Domains	Subdomains	Main outcome measures	TGRY		DGRY		Uni-variate analysis
			mean	SD	mean	SD	P value	Cohen's d
Symptoms	PGSAS subscales (GSRS and PGSAS items)	Esophageal reflux subscale (items 10, 11, 13, 24)2	2.0	1.0	1.5	0.7	< 0.0001	0.58
		Abdominal pain subscale (items 9, 12, 28)2	1.8	0.8	1.7	0.8	0.0571	(0.13)
		Meal-related distress subscale (items 25-27)2	2.6	1.1	2.1	0.9	< 0.0001	0.56
		Indigestion subscale (items 14-17)2	2.3	0.9	2.0	0.8	< 0.0001	0.29
		Diarrhea subscale (items 19, 20, 22)2	2.3	1.2	2.1	1.1	0.0066	(0.19)
		Constipation subscale (items 18, 21, 23)2	2.1	0.9	2.1	1.0	≥ 0.1
		Dumping subscale (items 30, 31, 33)2	2.3	1.1	2.0	1.0	< 0.0001	0.31
	Total	Total symptom score (above seven subscales)2	2.2	0.7	1.9	0.7	< 0.0001	0.38
Living status	Body weight	Change in body weight	-13.8%	7.9%	-8.9%	6.6%	< 0.0001	0.66
	Meals(amount)	Ingested amount of food per meal	6.4	1.9	7.2	2.0	< 0.0001	0.42
		Necessity for additional meals	2.4	0.8	1.9	0.8	< 0.0001	0.57
	Meals (quality)	Quality of ingestion subscale1 (items 38-40)2	3.8	0.9	3.8	0.9	≥ 0.1
	Social activity	Ability for working	2.0	0.9	1.8	0.9	0.0006	0.24
QOL	Dissatisfaction	Dissatisfaction with symptoms	2.1	1.0	1.8	0.9	< 0.0001	0.28
		Dissatisfaction at the meal	2.8	1.1	2.2	1.1	< 0.0001	0.57
		Dissatisfaction at working	2.1	1.1	1.7	1.0	< 0.0001	0.41
		Dissatisfaction for daily life subscale (items 43-45)2	2.3	0.9	1.9	0.9	< 0.0001	0.51
	SF-8	Physical component summary (PCS)1 (items 1-8)2	49.6	5.6	50.8	5.6	0.0029	0.21
		Mental component summary (MCS)1 (items 1-8)2	49.2	6.0	49.8	5.7	0.0974	(0.11)
					The interpretation of effect size			Cohen's d
					(none-very small)			(0.20 >)
					Small			0.20 ≤
					Medium			0.50 ≤
					Large			0.80 ≤

Outcome measures with¹: higher score indicating better condition. Outcome measures without¹: higher score indicating worse condition. The main outcomes with² are integrated subscales. Each subscale is calculated as the mean of composed items or subscales, except PCS or MCS of SF-8.

Table 2 Patient characteristics

		TGRY	DGRY	P value
Number of patients		393	475
Postoperative period	(mo)	35.0 ± 24.61	31.7 ± 18.01	0.02464
Age		63.4 ± 9.21	62.0 ± 9.11	0.02444
Gender	Male	276	318	≥ 0.15
	Female	113	154
Preoperative BMI2		23.0 ± 3.31	22.9 ± 3.01	≥ 0.14
Postoperative BMI2		19.8 ± 2.51	20.8 ± 2.71	< 0.00014
Approach	Open	293	320	0.01815
	Laparoscopic	97	152
Extent of lymph node	D0	0	0	0.01595
dissection3	D1	4	3
	D1a	28	60
	D1b	192	246
	D2	164	163
Celiac branch of vagal nerve	Preserved	12	28	0.05235
	Divided	371	442
Combined resection	None	246	402	< 0.00015
	Gallbladder	83	51
	spleen	52	2
	Miscellaneous	4	2
Length of Roux-en-Y loop	(cm)	42 ± 4.21	32.2 ± 7.11	< 0.00014
Route of Roux-en-Y	Anterior	179	292	< 0.00014
	Posterior	206	175

¹Mean ± SD;

²Body mass index;

³According to Japanese gastric cancer treatment guidelines;

⁴Unpaired t-test;

⁵χ² test. TGRY: Total gastrectomy; DGRY: Distal gastrectomy.

Table 3 Multi-variate analysis of main outcome measures

		Main outcome measures	Multiple regression analysis
Domains	Subdomains		Type of gastrectomy [TGRY]		Postoperative period (mo)		Age (yr)		Gender [male]		Approach [laparoscopic]		Celiac branch of vagal nerve [preserved]
			β	P value	β	P value	β	P value	β	P value	β	P value	β	P value	R2	P value
Symptoms	Subscales (GSRS and PGSAS items)	Esophageal reflux SS2	0.298	< 0.0001		≥ 0.1		≥ 0.1	(-0.079)	0.0179	(-0.060)	0.0828		≥ 0.1	0.096	< 0.0001
		Abdominal pain SS2	(-0.089)	0.0096	(-0.060)	0.0932		≥ 0.1	-0.181	< 0.0001		≥ 0.1		≥ 0.1	0.045	< 0.0001
		Meal-related distress SS2	0.295	< 0.0001		≥ 0.1	(-0.064)	0.0531	-0.114	0.0006		≥ 0.1		≥ 0.1	0.101	< 0.0001
		Indigestion SS2	0.166	< 0.0001	-0.114	0.0012		≥ 0.1	(-0.083)	0.0138	(-0.071)	0.0436	(-0.063)	0.0639	0.057	< 0.0001
		Diarrhea SS2	0.107	0.0020	(-0.063)	0.0774		≥ 0.1	(-0.092)	0.0074		≥ 0.1		≥ 0.1	0.024	0.0026
		Constipation SS2
		Dumping SS2	0.189	< 0.0001		≥ 0.1	-0.123	0.0006	-0.129	0.0003		≥ 0.1		≥ 0.1	0.071	< 0.0001
	Total	Total symptom score2	0.216	< 0.0001		≥ 0.1		> 0.1	(-0.092)	0.0115		≥ 0.1		> 0.1	0.059	< 0.0001
Living status	Body weight	Change in body weight	0.315	< 0.0001		≥ 0.1	(-0.068)	0.0449	(-0.088)	0.0086		≥ 0.1		≥ 0.1	0.114	< 0.0001
	Meals (amount)	Ingested amount of food per meal1	0.202	< 0.0001		≥ 0.1	(-0.060)	0.0838		> 0.1		≥ 0.1		≥ 0.1	0.048	< 0.0001
		Necessity for additional meals	0.273	< 0.0001		≥ 0.1	-0.083	0.0142	(-0.093)	0.0057		≥ 0.1		≥ 0.1	0.090	< 0.0001
	Meals (quality)	Quality of ingestion SS1,2
	Social activity	Ability for working	0.127	0.0003	(-0.079)	0.0289	0.163	< 0.0001	(-0.073)	0.0371		≥ 0.1		≥ 0.1	0.052	< 0.0001
QOL	Dissatisfaction	Dissatisfaction with symptoms	0.158	< 0.0001	(-0.083)	0.0199		≥ 0.1	-0.105	0.0022		≥ 0.1		≥ 0.1	0.041	< 0.0001
		Dissatisfaction at the meal	0.291	< 0.0001	(-0.081)	0.0193		≥ 0.1	(-0.072)	0.0313		≥ 0.1		≥ 0.1	0.093	< 0.0001
		Dissatisfaction at working	0.220	< 0.0001		≥ 0.1		≥ 0.1		> 0.1		≥ 0.1		≥ 0.1	0.051	< 0.0001
		Dissatisfaction for daily life SS2	0.268	< 0.0001	(-0.086)	0.0145		≥ 0.1	(-0.087)	0.0097		≥ 0.1		≥ 0.1	0.083	< 0.0001
	SF-8	Physical component summary1,2	0.109	0.0016		≥ 0.1	-0.124	0.0004	(-0.079)	0.0210		≥ 0.1		≥ 0.1	0.034	< 0.0001
		Mental component summary1,2		≥ 0.1		≥ 0.1		≥ 0.1		≥ 0.1		≥ 0.1		≥ 0.1
									The interpretation of effect size				r, β		R2
									(none-very small)				(0.100) >		(0.020) >
									Small				0.100 ≤		0.020 ≤
									Medium				0.300 ≤		0.130 ≤
									Large				0.500 ≤		0.260 ≤

Outcome measures with¹: higher score indicating better condition. Outcome measures without¹: higher score indicating worse condition. The main outcomes with² are integrated subscales. If β is positive, the score of the outcome measure of the patients belonging to the category in [brackets] is higher in cases when the factor is a nominal scale, and he score of outcome measure of the patients with larger values is higher in cases when the factor is a numeral scale.