Assessing optimal Roux-en-Y reconstruction technique after total gastrectomy using the Postgastrectomy Syndrome Assessment Scale-45

Table 1 Structure of postgastrectomy syndrome assessment scale 45 (domains/subdomains/items/subscales)

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

In items or subscales with *; higher score indicating better condition. In items or subscales without *; higher score indicating worse condition. Each subscale is calculated as the mean of composed items or subscales except PCS and MCS of SF-8. Item 29 and 32 don't have score. Then, they were analyzed separately. Citation: Nakada K, Ikeda M, Takahashi M, Kinami S, Yoshida M, Uenosono Y, Kawashima Y, Oshio A, Suzukamo Y, Terashima M, Kodera Y. Characteristics and clinical relevance of postgastrectomy syndrome assessment scale (PGSAS)-45: newly developed integrated questionnaires for assessment of living status and quality of life in postgastrectomy patients. Gastric Cancer 2015; 18: 147-158. QOL: Quality of life.

Table 2 Patients' characteristics (393 cases are listed)

Characteristics	Values
Number of patients	393
Postoperative period (mo), mean ± SD	35.0 ± 24.6
Preoperative BMI, mean ± SD	23.0 ± 3.3
Postoperative BMI, mean ± SD	19.8 ± 2.5
Age, mean ± SD	63.4 ± 9.2
Gender (male/female)	276/113
Approach (laparoscopic/open)	97/293
Extent of lymph node dissection1
D2	164
D1b	192
D1a	28
D1	4
D1>	0
None	0
Celiac branch of the vagal nerve (preserved/divided)	12/371
Combined resection
Gallbladder	83
Spleen	52
Miscellaneous	2
None	246

¹According to the Japanese gastric cancer treatment guideline. BMI: Body mass index.

Table 3 The effect of the reconstruction route (antecolic or retrocolic) of Roux–limb on postoperative quality of life after total gastrectomy

Reconstruction route of Roux limb	Retro-colica (n = 206)		Ante-colica (n = 179)		P value	Cohens d
	mean	SD	mean	SD
Esophageal reflux SS	2.1	1.1	1.8	0.9	0.028	0.229
Abdominal pain SS	1.8	0.8	1.7	0.8	NS
Meal-related distress SS	2.7	1.1	2.6	1.1	NS
Indigestion SS	2.3	0.98	2.3	0.9	NS
Diarrhea SS	2.4	1.3	2.2	1.1	NS
Constipation SS	2.1	1.0	2.0	0.8	NS
Dumping SS	2.4	1.1	2.3	1.1	NS
Total symptom score	2.2	0.8	2.1	0.7	NS
Change in Body weight	-13.6%	7.8%	-14.0%	8.1%	NS
Ingested amount of food per meal	6.5	1.9	6.4	1.8	NS
Necessity for additional meals	2.3	0.8	2.4	0.7	NS
Quality of ingestion SS	3.7	1.0	3.8	0.9	NS
Ability to work	2.1	0.9	2.0	0.8	NS
Dissatisfaction with symptoms	2.1	1.0	2.0	1.0	NS
Dissatisfaction at the meal	2.8	1.1	2.8	1.1	NS
Dissatisfaction at working	2.1	1.1	2.2	1.0	NS
Dissatisfaction for daily life SS	2.4	0.9	2.3	0.9	NS
Physical component summary	49.2	5.8	50.1	5.4	NS
Mental component summary	49.1	6.1	49.2	5.9	NS

SS: Subscale; NS: Not significant.

Table 4 The effect of the length of Roux-limb (shorter, 40 cm, longer) on postoperative quality of life after total gastrectomy

Length of Roux limb	Shorter (n = 16)		40 cm (n = 238)		Longer (n = 119)		ANOVA	Multiple comparisons	P value	Cohens d
	mean	SD	mean	SD	mean	SD	P value
Esophageal reflux SS	1.8	0.9	2.0	1.1	2.0	1.0	NS
Abdominal pain SS	1.4	0.4	1.8	0.8	1.7	0.7	0.081	Shorter vs 40 cm	0.053	0.52
Meal-related distress SS	2.2	0.9	2.7	1.2	2.7	1.0	NS
Indigestion SS	1.7	0.7	2.3	0.9	2.3	0.9	0.026	Shorter vs 40 cm	0.020	0.69
								Shorter vs longer	0.030	0.68
Diarrhea SS	2.0	1.2	2.3	1.2	2.3	1.2	NS
Constipation SS	2.3	0.9	2.1	0.9	2.1	0.9	NS
Dumping SS	1.8	0.9	2.4	1.1	2.3	1.1	NS
Total symptom score	1.9	0.6	2.2	0.8	2.2	0.7	NS
Change in Body weight	-14.1%	8.6%	-13.8%	8.2%	-13.5%	7.5%	NS
Ingested amount of food per meal	5.5	2.6	6.4	1.9	6.5	1.7	NS
Necessity for additional meals	2.4	0.8	2.4	0.8	2.3	0.7	NS
Quality of ingestion SS	3.3	1.2	3.8	0.9	3.8	1.0	NS
Ability to work	2.4	1.2	2.0	0.9	2.1	0.9	NS
Dissatisfaction with symptoms	1.8	1.0	2.0	1.1	2.2	1.0	NS
Dissatisfaction at the meal	3.3	1.2	2.8	1.2	2.8	1.0	NS
Dissatisfaction at working	2.5	1.3	2.2	1.1	2.1	1.0	NS
Dissatisfaction for daily life SS	2.5	1.0	2.3	0.9	2.4	0.8	NS
Physical component summary	49.2	6.7	49.4	5.7	50.1	5.5	NS
Mental component summary	48.1	5.9	48.7	6.3	49.9	5.5	NS

SS: Subscale; NS: Not significant.

Table 5 The effect of anastomotic procedure for esophagojejunostomy (circular stapler, linear stapler) on postoperative quality of life after total gastrectomy

Anastomotic method	Circular stapler(n = 348)		Liner stapler (n = 40)		P value
	mean	SD	mean	SD
Esophageal reflux SS	2.0	1.0	1.9	0.8	NS
Abdominal pain SS	1.8	0.8	1.7	0.8	NS
Meal-related distress SS	2.6	1.1	2.8	1.2	NS
Indigestion SS	2.3	0.9	2.2	0.8	NS
Diarrhea SS	2.3	1.2	2.2	1.3	NS
Constipation SS	2.1	0.9	2.1	1.0	NS
Dumping SS	2.3	1.1	2.4	1.1	NS
Total symptom score	2.2	0.7	2.1	0.7	NS
Change in Body weight	-13.9%	7.9%	-12.8%	7.9%	NS
Ingested amount of food per meal	6.5	1.9	6.2	1.8	NS
Necessity for additional meals	2.3	0.8	2.4	0.8	NS
Quality of ingestion SS	3.8	1.0	3.8	0.9	NS
Ability to work	2.0	0.9	2.1	0.9	NS
Dissatisfaction with symptoms	2.1	1.0	2.1	0.9	NS
Dissatisfaction at the meal	2.8	1.1	3.0	1.0	NS
Dissatisfaction at working	2.1	1.1	2.2	1.0	NS
Dissatisfaction for daily life SS	2.3	0.9	2.5	0.8	NS
Physical component summary	49.6	5.7	50.2	4.9	NS
Mental component summary	49.2	6.0	49.2	5.9	NS

SS: Subscale; NS: Not significant.