Published online Feb 27, 2022. doi: 10.4240/wjgs.v14.i2.120
Peer-review started: October 7, 2021
First decision: December 4, 2021
Revised: December 15, 2021
Accepted: February 10, 2022
Article in press: February 10, 2022
Published online: February 27, 2022
For total laparoscopic distal gastrectomies for gastric cancer, the reconstruction method is critical to the clinical outcome of the procedure. We originally reported the augmented rectangle technique (ART) as a reconstruction option for total laparoscopic Billroth I reconstructions. Yet, little is known about its effect on long-term outcomes, specifically the incidence of postgastrectomy syndrome (PGS) and its impact on quality of life (QOL).
Reducing the prevalence of PGS and improving the QOL after gastrectomy for gastric cancer patients has become an important technical challenge for surgeons. ART shows good short-term results, but long-term results in terms of PGS and quality of life should be reported.
To analyze PGS and QOL after ART using the Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaire.
At Juntendo University, 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 to March 2020 completed questionnaires. Multidimensional analysis was performed comparing those 94 ART cases from our institution (ART group) to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS as part of a larger national database (PGSAS group).
Patients in the ART group had significantly better total symptom scores in all the symptom subscales (esophageal reflux, abdominal pain, meal-related distress, indigestion, diarrhea, constipation, and dumping). The loss of body weight was marginally greater for those in the ART group than in the PGSAS group (-9.3% vs -7.9%; P = 0.054). The ART group scored significantly lower in their dissatisfaction of ongoing symptoms, during meals, and with daily life.
The use of ART for Billroth I reconstruction produced beneficial long-term results with regards to PGS and QOL in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.
Further investigation of the mechanism underlying the usefulness of ART in terms of PGS and QOL is needed. Prospective studies are also needed on the involvement of factors other than the anastomotic method.