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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Defecation disorders are crucial sequelae that impairs the quality of life of patients after conventional gastrectomy
Koji Nakada, Masami Ikeda, Masazumi Takahashi, Shinichi Kinami, Masashi Yoshida, Yoshikazu Uenosono, Masanori Terashima, Atsushi Oshio, Yasuhiro Kodera
Koji Nakada, Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Masami Ikeda, Department of Surgery, Asama General Hospital, Saku 385-0022, Japan
Masazumi Takahashi, Division of Gastroenterological Surgery, Yokohama Municipal Citizen’s Hospital, Yokohama 240-8555, 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, Imamura General Hospital, Kagoshima 890-0064, Japan
Masanori Terashima, Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
Atsushi Oshio, Faculty of Letters, Arts and Sciences, Waseda University, Tokyo 169-8050, Japan
Yasuhiro Kodera, Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
Author contributions: Nakada K, Ikeda M, Takahashi M, Kodera Y designed the study, and collected and managed the data; Kinami S, Yoshida M, Uenosono Y, Terashima M collected and managed the data; Oshio A contributed to statistical analysis; Nakada K wrote the paper; All authors have read and approved the final version to be published.
Supported by Jikei University; 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.
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.
STROBE statement: The manuscript was revised according to the STROBE statement.
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: Koji Nakada, MD, PhD, Professor, Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan.
nakada@jikei.ac.jp
Received: April 29, 2021
Peer-review started: April 29, 2021
First decision: June 17, 2021
Revised: June 26, 2021
Accepted: October 31, 2021
Article in press: October 31, 2021
Published online: November 27, 2021
Processing time: 211 Days and 11.4 Hours
BACKGROUND
Defecation disorders are obscure sequelae that occurs after gastrectomy, and its implication on daily lives of patients have not been sufficiently investigated.
AIM
To examine the features of defecation disorders after gastrectomy and to explore its implication on daily lives of patients in a large cohort using the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45.
METHODS
We conducted a nationwide multi-institutional study using PGSAS-45 to examine the prevalence of postgastrectomy syndrome and its impact on daily lives of patients after various types of gastrectomy. Data were obtained from 2368 eligible patients at 52 institutions in Japan. Of these, 1777 patients who underwent total gastrectomy (TG; n = 393) or distal gastrectomy (DG; n = 1384) were examined. The severity of defecation disorder symptoms, such as diarrhea and constipation, and their correlation with other postgastrectomy symptoms were examined. The importance of defecation disorder symptoms on the living states and quality of life (QOL) of postgastrectomy patients, and those clinical factors that affect the severity of defecation disorder symptoms were evaluated using multiple regression analysis.
RESULTS
Among seven symptom subscales of PGSAS-45, the ranking of diarrhea was 4th in TG and 2nd in DG. The ranking of constipation was 5th in TG and 1st in DG. The symptoms that correlated well with diarrhea were dumping and indigestion in both TG and DG; while those with constipation were abdominal pain and meal-related distress in TG, and were meal-related distress and indigestion in DG. Among five main outcome measures (MOMs) of living status domain, constipation significantly impaired four MOMs, while diarrhea had no effect in TG. Both diarrhea and constipation impaired most of five MOMs in DG. Among six MOMs of QOL domain, diarrhea impaired one MOM, whereas constipation impaired all six MOMs in TG. Both diarrhea and constipation equally impaired all MOMs in DG. Male sex, younger age, division of the celiac branch of vagus nerve, and TG, independently worsened diarrhea, while female sex worsened constipation.
CONCLUSION
Defecation disorder symptoms, particularly constipation, impair the living status and QOL of patients after gastrectomy; therefore, we should pay attention and adequately treat these relatively modest symptoms to improve postoperative QOL.
Core Tip: Symptoms of defecation disorders, such as diarrhea and constipation, are relatively modest and have not received sufficient attention among various postgastrectomy symptoms; therefore, their implication on the daily lives of patients have not been adequately investigated. We evaluated these symptoms using a nationwide multi-institutional collaborative study called the Postgastrectomy Syndrome Assessment Study. The severity of symptoms of defecation disorders were unexpectedly high and both symptoms, particularly constipation, impaired the living status and quality of life (QOL) of patients after gastrectomy; therefore, we should also pay attention and adequately treat these symptoms to improve postoperative QOL.
