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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
ARTICLE HIGHLIGHTS
Research background
Various symptoms that can interfere with the postoperative quality of life (QOL) of patients occur after gastrectomy. The symptoms of defecation disorders, particularly constipation, are relatively modest compared to other postgastrectomy symptoms; therefore, their features and implications on the daily lives of patients have not been adequately investigated.
Research motivation
Several studies have investigated the effect of characteristic postgastrectomy symptoms, such as dumping, small stomach syndrome, and esophageal reflux on the daily lives of patients. However, the implications of symptoms of defecation disorders on patient’s QOL postgastrectomy are poorly understood.
Research objectives
The central goal of this research was to reveal the features of symptoms of defecation disorders and their effects on the daily lives of patients in a large population of gastrectomized patients using the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, and analyze the data derived using multivariate analysis.
Research methods
The 1777 patients who underwent total gastrectomy (TG; n = 393) or distal gastrectomy (DG; n = 1384) were enrolled in this study. 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 QOL of postgastrectomy patients, and those clinical factors that affect the severity of defecation disorder symptoms were evaluated using multiple regression analysis.
Research results
The ranking of defecation disorder symptoms were unexpectedly high in DG among seven symptom subscales of PGSAS-45. There were significant correlation between defecation disorder symptoms and other postgastrectomy symptoms. The defecation disorder symptom, constipation in particular, impaired postgastrectomy living status and QOL. Male sex, younger age, division of the celiac branch of vagus nerve, and TG, independently worsened diarrhea, while female sex worsened constipation.
Research conclusions
The severity of symptoms of defecation disorders were unexpectedly high and both symptoms, particularly constipation, impaired the living status and QOL of patients after gastrectomy.
Research perspectives
Paying attention to the symptoms of defecation disorders as well as characteristic postgastrectomy symptoms and treating these symptoms adequately may improve the QOL of patients after gastrectomy.
