Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1111
Peer-review started: September 24, 2018
First decision: October 17, 2018
Revised: October 27, 2018
Accepted: November 14, 2018
Article in press: November 15, 2018
Published online: December 26, 2018
Processing time: 91 Days and 15.4 Hours
Postgastrectomy syndromes (PGS) are serious drawbacks after curative gastrectomy for gastric cancer. The main causes of PGS are gastrectomy and lymph node dissection. Nevertheless, a variety of other background factors are thought to be involved, such as age, sex, and postoperative period.
Although various background factors were considered to be involved in PGS, there have been no well-validated reports on this issue. In addition, there are two types of background factors: interventional and non-interventional. The non-interventional factors are age, sex, and postoperative period. The interventional factors are the laparoscopic approach and preservation of the celiac branch of the vagus. It is crucial to examine the effect of these interventional factors on PGS according to the type of gastrectomy in order to alleviate symptoms and improve quality of life (QoL).
We determined the influence of each background factor on PGS. However, as the invasiveness differs for each type of gastrectomy, the influence of background factors on PGS is likely to be different depending on the specific procedure. Therefore, we examined the influences of each background factor on PGS according to the type of gastrectomy.
We conducted this retrospective study by using the dataset obtained from the PGS assessment study (PGSAS). The PGSAS was a nationwide, large-scale, retrospective observational study that investigated the symptoms, living status, and QoL of patients who underwent gastrectomy and completed the Postgastrectomy Syndrome Assessment Scale-45 questionnaire (PGSAS-45). A dataset comprising 2368 patients was analyzed. Multiple regression analysis was performed to explore the independent effects of each background factor on main outcome measures (MOMs) of PGSAS-45 for each gastrectomy type. The MOMs were classified into three domains, the symptom domain, the living status domain, and the QoL domain. The background factors included postoperative period, age, sex, surgical approach (laparoscopic or open), and the status of the celiac branch of the vagal nerve.
Regarding the postoperative period, several MOMs were alleviated because of the length of the postoperative period. These MOMs were mainly in the living status or the QoL domains. Regarding the gastrectomy procedure, several MOMs improved with the passage of time after DGRY; in contrast, no MOM improved with the passage of time after TGRY or PG. Age and sex also affected several MOMs of the PGSAS. For older patients, several MOMs belonging to the symptom domain were alleviated; in contrast, many MOMs belonging to the living status or QoL domain had worsened. There were many MOMs that were worse for women after DGBI and DGRY, but not after TG and LR. A few MOMs were attained after laparoscopic distal gastrectomy and laparoscopic PPG compared to conventional open surgery, which included MOMs in the living status or QoL domain, but not the symptom domain. Preservation of the celiac branch of the vagus positively affected the MOMs of the symptom domain for DGBI patients and the MOMs of the living status or QoL domain for PG and PPG patients.
Various background factors affected the PGS. The degree of the effect varied according to the type of gastrectomy. The influence patterns of each background factor on the PGSAS MOMs were different. Many MOMs were alleviated over time yet worsened among women. Older age reduced the MOMs of the symptom domain, yet worsened the MOMs in the living status or QoL domains. Furthermore, surgical interventions, such as laparoscopic surgery and preservation of the celiac branch of the vagus, can alleviate some of the negative outcomes in patients undergoing DG and PPG.
We confirmed that various background factors affected many MOMs of the PGSAS-45. The influence of background factors on MOMs was different for each factor. Arranging these factors in descending order of influence yields the following: sex, age, postoperative period, celiac branch saving, and the laparoscopic approach. The preservation of the celiac branch of the vagus can reduce some PGS for the procedures that retains physiological food passage. Laparoscopic DG or PPG may be recommended to alleviate some negative outcomes relating to living status and QoL.