Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2021; 13(5): 461-475
Published online May 27, 2021. doi: 10.4240/wjgs.v13.i5.461
Comparison of effects of six main gastrectomy procedures on patients’ quality of life assessed by Postgastrectomy Syndrome Assessment Scale-45
Koji Nakada, Yoshiyuki Kawashima, Shinichi Kinami, Ryoji Fukushima, Hiroshi Yabusaki, Akiyoshi Seshimo, Naoki Hiki, Keisuke Koeda, Mikihiro Kano, Yoshikazu Uenosono, Atsushi Oshio, Yasuhiro Kodera
Koji Nakada, Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Yoshiyuki Kawashima, Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama 362-0806, Japan
Shinichi Kinami, Department of Surgical Oncology, Kanazawa Medical University, Kahoku-gun 920-0293, Ishikawa, Japan
Ryoji Fukushima, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan
Hiroshi Yabusaki, Department of Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
Akiyoshi Seshimo, Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
Naoki Hiki, Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
Keisuke Koeda, Department of Medical Safety Science, Iwate Medical University, Iwate 028-3695, Japan
Mikihiro Kano, Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima 731-0293, Japan
Yoshikazu Uenosono, Department of Digestive Surgery, Imamura General Hospital, Kagoshima 890-0064, Japan
Atsushi Oshio, Faculty of Letters, Arts and Sciences, Waseda University, Tokyo 162-8644, Japan
Yasuhiro Kodera, Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
Author contributions: Nakada K, Kinami S, Uenosono Y, Kodera Y designed the study, collected and managed the data; Kawashima Y, Fukushima R, Yabusaki H, Seshimo A, Hiki N, Koeda K, Kano 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 The Jikei University School of Medicine; and the Japanese Society for Gastro-surgical Pathophysiology.
Institutional review board statement: This study was approved by the local ethics committees of each participating institution and was in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1964 and later versions.
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 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: 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: January 19, 2021
Peer-review started: January 19, 2021
First decision: February 14, 2021
Revised: February 21, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: May 27, 2021
Processing time: 121 Days and 16.7 Hours
Abstract
BACKGROUND

The effects of various gastrectomy procedures on the patient’s quality of life (QOL) are not well understood. Thus, this nationwide multi-institutional cross-sectional study using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), a well-established questionnaire designed to clarify the severity and characteristics of the postgastrectomy syndrome, was conducted.

AIM

To compare the effects of six main gastrectomy procedures on the postoperative QOL.

METHODS

Eligible questionnaires retrieved from 2368 patients who underwent either of six gastrectomy procedures [total gastrectomy with Roux-en-Y reconstruction (TGRY; n = 393), proximal gastrectomy (PG; n = 193), distal gastrectomy with Roux-en-Y reconstruction (DGRY; n = 475), distal gastrectomy with Billroth-I reconstruction (DGBI; n = 909), pylorus-preserving gastrectomy (PPG; n = 313), and local resection of the stomach (LR; n = 85)] were analyzed. Among the 19 main outcome measures of PGSAS-45, the severity and characteristics of postgastrectomy syndrome were compared for the aforementioned six gastrectomy procedures using analysis of means.

RESULTS

TGRY and PG significantly impaired the QOL of postoperative patients. Postoperative QOL was excellent in LR (cardia and pylorus were preserved with minimal resection). In procedures removing the distal stomach, diarrhea subscale (SS) and dumping SS were less frequent in PPG than in DGBI and DGRY. However, there was no difference in the postoperative QOL between DGBI and DGRY. The most noticeable adverse effects caused by gastrectomy were meal-related distress SS, dissatisfaction at the meal, and weight loss, with significant differences among the surgical procedures.

CONCLUSION

Postoperative QOL greatly differed among six gastrectomy procedures. The severity and characteristics of postgastrectomy syndrome should be considered to select gastrectomy procedures, overcome surgical shortcomings, and enhance postoperative care.

Keywords: Gastrectomy; Quality of life; Postgastrectomy syndromes; Patient reported outcome measures

Core Tip: For surgeons, to understand the general aspects of how the site and extent of gastrectomy affect postoperative patient’s quality of life (QOL) is important. Therefore, we investigated this concern by the nationwide multi-institutional collaborative study called Postgastrectomy Syndrome Assessment Study. The overview of the effects of the six main gastrectomy procedures on the patient’s dairy living revealed that the postoperative QOL differed greatly depending on the site and extent of gastrectomy. The severity and characteristics of postgastrectomy syndrome should be considered to select gastrectomy procedures, overcome surgical shortcomings, and enhance postoperative care.