Comparison of effects of six main gastrectomy procedures on patients’ quality of life assessed by Postgastrectomy Syndrome Assessment Scale-45

Table 1 Structure of Postgastrectomy Syndrome Assessment Scale-45

Domains	Subdomains		Items		Subscales
QOL	SF-8 (QOL)	1	Physical functioning	Five or six-point Likert scale	Physical component summary (item 1-8)
		2	Role physical		Mental component summary (item 1-8)
		3	Bodily pain
		4	General health
		5	Vitality
		6	Social functioning
		7	Role emotional
		8	Mental health
Symptoms	GSRS (Symptoms)	9	Abdominal pains	Seven-point Likert scale	Esophageal reflux subscale (item 10, 11, 13, 24)
		10	Heartburn	Except item 29 and 32	Abdominal pain subscale (item 9, 12, 28)
		11	Acid regurgitation		Meal-related distress subscale (item 25-27)
		12	Sucking sensations in the epigastrium		Indigestion subscale (item 14-17)
		13	Nausea and vomiting		Diarrhea subscale (item 19, 20, 22)
		14	Borborygmus		Constipation subscale (item 18, 21, 23)
		15	Abdominal distension		Dumping subscale (item 30, 31, 33)
		16	nausea and vomiting
		17	Increased flatus		Total symptom scale (above seven subscales)
		18	Decreased passage of stools
		19	Increased passage of stools
		20	Loose stools
		21	Hard stools
		22	Urgent need for defecation
		23	Feeling of incomplete evacuation
	PGSAS (Symptoms)	24	Bile regurgitation
		25	Sense of foods sticking
		26	Postprandial fullness
		27	Early satiation
		28	Lower abdominal pains
		29	Number and type of early dumping symptoms
		30	Early dumping general symptoms
		31	Early dumping abdominal symptoms
		32	Number and type of late dumping symptoms
		33	Late dumping symptoms
Living status	Meals (amount) 1	34	Ingested amount of food per meal		-
		35	Ingested amount of food per day
		36	Frequency of main meals
		37	Frequency of additional meals
	Meals (quality)	38	Appetite	five-point Likert scale	Quality of ingestion subscale (item 38-40)
		39	Hunger feeling
		40	Satiety feeling
	Meals (amount) 2	41	Necessity for additional meals		-
	Social activity	42	Ability for working		-
QOL	Dissatisfaction (QOL)	43	Dissatisfaction with symptoms		Dissatisfaction for daily life subscale (item 43-45)
		44	Dissatisfaction at the meal
		45	Dissatisfaction at working

In italicized items or subscales, higher score indicates better condition; In non-italicized items or subscales, higher score indicates worse condition. Each subscale is calculated as the mean of composed items or subscales except physical component summary and mental component summary of 8-item short-form generic health-related quality of life questionnaire. Item 29 and 32 don't have score. Then, they were analyzed separately. GSRS: Gastrointestinal Symptom Rating Scale items; PGSAS: Postgastrectomy Syndrome Assessment Scale items; QOL: Quality of life; SF-8: 8-item short-form generic health-related QOL questionnaire.

Table 2 Patients' background

Types of gastrectomy	TGRY (n = 393)	PG (n = 193)	DGRY (n = 475)	DGBI (n = 909)	PPG (n = 313)	LR (n = 85)	Overall (n = 2368)	P value
Age (yr; mean ± SD)	63.4 ± 9.2a	63.7 ± 7.7	62.0 ± 9.1	61.6 ± 9.1	61.5 ± 8.7	60.8 ± 9.8	62.1 ± 9.1
Sex: Male/female, n (Male, %)	276/113 (71)	139/53 (72)	318/154 (67)	594/311 (66)	183/126b (59)	48/37 (56)	1558/794 (66)	0.0031
Postoperative period (mo; mean ± SD)	35.0 ± 24.6	40.5 ± 28.1	31.7 ± 18.0a	40.7 ± 30.7a	38.4 ± 27.7	42.9 ± 34.2	37.7 ± 27.4
Approach: laparoscopic/open, n (laparoscopic, %)	97b/293b (25)	33b/159b (17)	152/320 (32)	415b/489b (46)	136/173 (44)	52b/33b (61)	885/1467 (38)	< 0.00011
Celiac branch of vagus saving/cut, n (saving, %)	12b/371b (3)	83b/105b (44)	28b/442b (6)	133b/754b (15)	213b/87b (71)	84b/0b (100)	553/1759 (24)	< 0.00011

¹Chi-square test.

^aP < 0.05 vs overall mean (ANOM).

^bP < 0.05 vs expected value (residual analysis).

TGRY: Total gastrectomy with Roux-en-Y reconstruction; PG: Proximal gastrectomy; DGRY: Distal gastrectomy with Roux-en-Y reconstruction; DGBI: Distal gastrectomy with Billroth I reconstruction; PPG: Pylorus preserving gastrectomy; LR: Local resection of the stomach; SF-8: 8-item short-form generic health-related QOL questionnaire

Table 3 Comparison of main outcome measures of Postgastrectomy Syndrome Assessment Scale-45 among six types of gastrectomy using ANOM

	Types of gastrectomy	TGRY (n = 393)	PG (n = 193)	DGRY (n = 475)	DGBI (n = 909)	PPG (n = 313)	LR (n = 85)	Overall (n = 2368)
Domain	Main outcome measures	mean ± SD	mean ± SD	mean ± SD	mean ± SD	mean ± SD	mean ± SD	mean ± SD	N
Symptoms	Esophageal reflux SS	2.0 ± 1.0b	2.0 ± 1.0b	1.5 ± 0.7a	1.7 ± 0.8	1.7 ± 0.8	1.4 ± 0.5a	1.7 ± 0.9	4
	Abdominal pain SS	1.8 ± 0.8	1.7 ± 0.7	1.7 ± 0.8	1.7 ± 0.7	1.6 ± 0.7	1.5 ± 0.6	1.7 ± 0.8	0
	Meal-related distress SS	2.6 ± 1.1b	2.6 ± 1.1b	2.1 ± 0.9a	2.1 ± 0.9a	2.1 ± 0.9	1.5 ± 0.6a	2.2 ± 1.0	5
	Indigestion SS	2.3 ± 0.9b	2.2 ± 0.8	2.0 ± 0.8	2.0 ± 0.8a	2.0 ± 0.9	1.5 ± 0.6a	2.0 ± 0.9	3
	Diarrhea SS	2.3 ± 1.2b	2.0 ± 1.0	2.1 ± 1.1	2.1 ± 1.1	1.8 ± 1.0a	1.5 ± 0.8a	2.1 ± 1.1	3
	Constipation SS	2.1 ± 0.9	2.3 ± 1.1	2.1 ± 1.0	2.2 ± 1.0	2.2 ± 1.1	1.9 ± 0.9a	2.2 ± 1.0	1
	Dumping SS	2.2 ± 1.1b	2.0 ± 1.0	2.0 ± 1.0	2.0 ± 1.0	1.8 ± 0.9a	1.3 ± 0.4a	2.0 ± 1.0	3
	Total symptom score	2.2 ± 0.7b	2.1 ± 0.7	1.9 ± 0.7	2.0 ± 0.7	1.9 ± 0.7	1.5 ± 0.4a	2.0 ± 0.7	2
Living status	Change in BW	-13.8% ± 7.9%b	-10.9% ± 8.2%b	-8.4% ± 6.6%	-7.9% ± 8.1a	-6.9% ± 7.0%a	-1.6% ± 5.7%a	-8.9% ± 8.0%	5
	Ingestion amount of food per meal	6.4 ± 1.9b	6.5 ± 1.9b	7.2 ± 2.0	7.1 ± 2.0	7.0 ± 1.9	9.0 ± 1.8a	7.0 ± 2.0	3
	Necessity for additional meals	2.4 ± 0.8b	2.0 ± 0.8	1.9 ± 0.8	1.9 ± 0.8a	1.8 ± 0.8a	1.4 ± 0.6a	1.9 ± 0.8	4
	Quality of ingestion SS	3.8 ± 1.0	3.6 ± 1.0b	3.8 ± 0.9	3.8 ± 0.9	3.8 ± 0.9	4.0 ± 0.8a	3.8 ± 0.9	2
	Ability for working	2.0 ± 0.9b	2.0 ± 0.9	1.8 ± 0.9	1.8 ± 0.9a	1.8 ± 0.9	1.4 ± 0.6a	1.8 ± 0.9	3
QOL	Dissatisfaction with symptoms	2.1 ± 1.0b	2.0 ± 0.9	1.8 ± 0.9	1.8 ± 0.9	1.8 ± 0.9	1.2 ± 0.4a	1.8 ± 0.9	2
	Dissatisfaction at the meal	2.8 ± 1.1b	2.7 ± 1.1b	2.2 ± 1.1a	2.2 ± 1.1a	2.2 ± 1.1	1.3 ± 0.6a	2.3 ± 1.1	5
	Dissatisfaction at working	2.1 ± 1.1b	2.0 ± 1.1b	1.7 ± 1.0	1.7 ± 0.9a	1.7 ± 0.9	1.1 ± 0.4a	1.8 ± 1.0	4
	Dissatisfaction for daily life SS	2.3 ± 0.9b	2.2 ± 0.9b	1.9 ± 0.9	1.9 ± 0.8a	1.9 ± 0.8	1.2 ± 0.4a	2.0 ± 0.9	4
	PCS of SF-8	49.6 ± 5.6b	49.5 ± 6.1	50.8 ± 5.6	50.5 ± 5.5	51.1 ± 5.3	52.4 ± 3.8a	50.5 ± 5.6	2
	MCS of SF-8	49.2 ± 6.0	49.0 ± 6.0	49.8 ± 5.7	49.9 ± 5.7	50.0 ± 6.1	51.6 ± 4.6a	49.7 ± 5.8	1

^aP < 0.05, better than overall mean (ANOM).

^bP < 0.05, worse than overall mean (ANOM).

In italicized items or subscales, higher score indicates better condition. In non-italicized items or subscales, higher score indicates worse condition. N: The number of the type of gastrectomy mean differ from the overall mean; TGRY: Total gastrectomy with Roux-en-Y reconstruction; PG: Proximal gastrectomy; DGRY: Distal gastrectomy with Roux-en-Y reconstruction; DGBI: Distal gastrectomy with Billroth I reconstruction; PPG: Pylorus preserving gastrectomy; LR: Local resection of the stomach; QOL: Quality of life; SF-8: 8-item short-form generic health-related QOL questionnaire; SS: Subscale.

Table 4 The percentage and point against overall mean of the main outcome measures of Postgastrectomy Syndrome Assessment Scale-45 among six types of gastrectomy

	Types of gastrectomy	TGRY		PG		DGRY		DGBI		PPG		LR		Overall
Domain	Main outcome measures	%a	Pointb	%a	Pointb	%a	Pointb	%a	Pointb	%a	Pointb	%a	Pointb	%a
Symptoms	Esophageal reflux SS	115.5	-3	116.4	-3	86.6	2	99.1	0	99.1	0	79.6	4	100
	Abdominal pain SS	105.0	-1	99.5	0	98.9	0	100.5	0	97.7	0	87.6	2	100
	Meal-related distress SS	120.8	-4	120.2	-4	95.2	0	93.7	1	96.3	0	67.3	6	100
	Indigestion SS	112.0	-2	105.5	-1	99.8	0	97.0	0	98.0	0	72.5	5	100
	Diarrhea SS	110.4	-2	94.9	1	99.9	0	102.8	0	89.3	2	73.6	5	100
	Constipation SS	96.2	0	105.9	-1	97.2	0	102.2	0	103.0	0	85.6	2	100
	Dumping SS	116.3	-3	103.3	0	99.5	0	99.4	0	88.6	2	64.2	7	100
	Total symptom score	111.0	-2	105.8	-1	97.2	0	99.4	0	95.6	0	74.4	5	100
Living status	Change in BW	153.1	-10	121.8	-4	99.4	0	88.2	2	76.6	4	18.1	16	100
	Ingestion amount of food per meal	91.4	-1	92.2	-1	102.9	0	101.3	0	99.8	0	127.6	5	100
	Necessity for additional meals	121.6	-4	105.3	-1	98.3	0	96.3	0	90.7	1	73.3	5	100
	Quality of ingestion SS	99.8	0	94.7	-1	99.8	0	100.7	0	99.8	0	107.1	1	100
	Ability for working	112.3	-2	107.5	-1	100.5	0	96.2	0	97.2	0	77.4	4	100
QOL	Dissatisfaction with symptoms	112.7	-2	108.8	-1	97.8	0	98.1	0	97.2	0	64.9	7	100
	Dissatisfaction at the meal	122.2	-4	116.6	-3	94.6	1	95.0	1	96.9	0	54.7	9	100
	Dissatisfaction at working	121.1	-4	115.2	-3	97.2	0	94.7	1	94.2	1	62.5	7	100
	Dissatisfaction for daily life SS	118.9	-3	113.6	-2	96.4	0	95.9	0	96.1	0	60.2	7	100
	PCS of SF-8	98.3	0	98.1	0	100.6	0	100.1	0	101.1	0	103.9	0	100
	MCS of SF-8	98.8	0	98.5	0	100.2	0	100.2	0	100.5	0	103.6	0	100
	QOL score (Total point)		-47		-26		3		5		10		97

^aTo the overall mean.

^bIf the QOL is better more than 5% compared to the overall mean, +1 point is given for every 5%, if the QOL is worse less than 5% compared to the overall mean, -1 point is given for every 5%.

In italicized items or subscales, higher score indicates better condition. In non-italicized items or subscales, higher score indicates worse condition.

TGRY: Total gastrectomy with Roux-en-Y reconstruction; PG: Proximal gastrectomy; DGRY: Distal gastrectomy with Roux-en-Y reconstruction; DGBI: Distal gastrectomy with Billroth I reconstruction; PPG: Pylorus preserving gastrectomy; LR: Local resection of the stomach; QOL: Quality of life; SF-8: 8-item short-form generic health-related QOL questionnaire; SS: Subscale.