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Christodoulidis G, Kouliou MN, Koumarelas KE, Giakoustidis D, Athanasiou T. Quality of Life in Patients Undergoing Surgery for Upper GI Malignancies. Life (Basel) 2023; 13:1910. [PMID: 37763313 PMCID: PMC10532582 DOI: 10.3390/life13091910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Upper gastrointestinal (GI) conditions vastly affect each individual's physical, social, and emotional status. The decision-making process by the medical personnel about these patients is currently based on a patient's life quality evaluation scale, HRQL scales. By utilizing HRQL scales, a better understanding of the various surgical and non-surgical treatment options, as well as their long-term consequences, can be achieved. In our study, an organ-based approach is used in an attempt to examine and characterized the effect of upper GI surgery on HRQL. Therefore, HRQL scales' function as a prognostic tool is useful, and the need for future research, the creation of valid training programs, and modern guidelines is highlighted.
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Affiliation(s)
- Grigorios Christodoulidis
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Marina-Nektaria Kouliou
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Konstantinos-Eleftherios Koumarelas
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Dimitris Giakoustidis
- Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece;
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Yi C, Wang X, Ye H, Lin J, Yang X. Patient-reported gastrointestinal symptoms in patients with peritoneal dialysis: the prevalence, influence factors and association with quality of life. BMC Nephrol 2022; 23:99. [PMID: 35264119 PMCID: PMC8905857 DOI: 10.1186/s12882-022-02723-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aims of this study were to investigate the prevalence and the influence factors of gastrointestinal symptoms, and its association with the quality of life (QOL) in peritoneal dialysis (PD) patients. Methods Continuous ambulatory PD patients (CAPD) who followed up in our PD center between March 2016 and December 2017 were enrolled in this cross-sectional study. Gastrointestinal symptom rating scale (GSRS) was used to evaluate gastrointestinal symptoms. The related clinical data were also collected. Multiple linear regression analysis was test for the influence factors associated with score of GSRS and QOL. Results This study included 471 CAPD patients. The mean age was 48.5±13.9 years, 53.9% were male and 15.1% with diabetic nephropathy. The median duration of PD was 37.3 (17.5~66.5) months. The median score of GSRS was 1.2(1.1~1.3) scores. Totally 82.2% (n=387) CAPD patients had at least one gastrointestinal symptom. Higher glycosylated hemoglobin, higher score of depression, lower diastolic blood pressure, urine output, score of instrumental activities of daily living scale and more amount of pills per day were independently associated with higher score of GSRS (all P<0.05). Score of dyspepsia and eating dysfunction were independently associated with worse score of QOL and physical health (all P<0.05). Conclusions Gastrointestinal symptoms were common but not serious in CAPD patients. Glycemic control, depression, blood pressure, urine output, activity of daily life and amount of pills were all associated with gastrointestinal symptoms. Moreover, gastrointestinal symptoms were correlated with QOL of PD patients.
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Affiliation(s)
- Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health, 58th, Zhongshan Road II, Guangzhou, 510080, Guangdong Province, China
| | - Xin Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health, 58th, Zhongshan Road II, Guangzhou, 510080, Guangdong Province, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health, 58th, Zhongshan Road II, Guangzhou, 510080, Guangdong Province, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health, 58th, Zhongshan Road II, Guangzhou, 510080, Guangdong Province, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health, 58th, Zhongshan Road II, Guangzhou, 510080, Guangdong Province, China.
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Choi YK, Kim DH, Gong EJ, Na HK, Ahn JY, Jung KW, Lee JH, Choi KD, Song HJ, Jung HY, Yook JH, Kim BS. Comparison Between Redo Endoscopic Treatment and Surgery in Patients with Locally Recurrent Gastric Neoplasms. J Gastrointest Surg 2020; 24:1489-1498. [PMID: 31313143 DOI: 10.1007/s11605-019-04303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/07/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of locally recurrent gastric neoplasms after endoscopic resection remains challenging. We investigated the efficacy and safety of treatment options for recurrent gastric neoplasms localized to the scar of previous endoscopic submucosal dissection (ESD). METHODS The clinicopathological characteristics and treatment outcomes of patients who underwent endoscopic treatment or surgery for recurrent gastric neoplasms between June 2010 and May 2017 were retrospectively reviewed. RESULTS Of the 92 patients included, 74 underwent endoscopic treatment (51 redo ESD, 23 argon plasma coagulation [APC] ablation) and 18 underwent surgery. The redo ESD procedure time was significantly longer than that of the primary ESD (31.0 versus 22.0 min, p = 0.018). Overall, adverse events occurred in 11 patients (12.0%), with the incidence being significantly higher in the surgery group (27.8% versus 8.1% in the endoscopic treatment group, p = 0.036). Local recurrence-free survival rates were 81.1% for the endoscopic treatment group (86.3% and 69.6% for redo ESD and APC groups, respectively) and 100% for the surgery group (log rank p = 0.033). Logistic regression analysis showed that tumor size > 12.5 mm (odds ratio [OR] 5.14, 95% confidence interval [CI] 1.25-26.9, p = 0.032) and tumors located in the upper two-thirds of the stomach (OR 4.43, 95% CI 1.27-16.8, p = 0.023) were associated with non-curative resection after redo ESD. CONCLUSIONS Endoscopic treatment could be an effective and safe alternative to surgery for selected patients with gastric neoplasms recurring at the scar of previous ESD. Especially, patients having small lesions located in the distal part of the stomach could be a good candidate for redo ESD.
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Affiliation(s)
- Young Kwon Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Eun Jeong Gong
- Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, South Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jeong Hwan Yook
- Department of Surgery Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung Sik Kim
- Department of Surgery Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Zuin M, Celotto F, Pucciarelli S, Urso EDL. Isoperistaltic Jejunal Loop Interposition after Total Gastrectomy for Gastric Cancer in Patients with Familial Adenomatous Polyposis. J Gastric Cancer 2020; 20:225-231. [PMID: 32596005 PMCID: PMC7311215 DOI: 10.5230/jgc.2020.20.e16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/12/2020] [Accepted: 04/02/2020] [Indexed: 01/09/2023] Open
Abstract
Gastric cancer is a rare condition affecting patients with familial adenomatous polyposis (FAP). The mainstay of treatment is total gastrectomy. Since duodenal cancer is the most common cause of death after total colectomy in FAP, endoscopic surveillance for duodenal cancer is mandatory. Here, we describe the use of an isoperistaltic jejunal loop interposition technique to reconstruct the digestive tract after total gastrectomy in 2 patients with FAP. There were no early or late complications. Both patients are still alive and in good clinical condition. They did not experience weight loss or symptoms of dumping syndrome. Duodenal endoscopic surveillance after this technique was easier than after the classical Roux-en-Y reconstruction. Hence, regular follow-up was possible for both patients.
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Affiliation(s)
- Matteo Zuin
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Clinica Chirurgica I, Azienda Ospedaliera di Padova, Università di Padova, Padova, Italy
| | - Francesco Celotto
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Clinica Chirurgica I, Azienda Ospedaliera di Padova, Università di Padova, Padova, Italy
| | - Salvatore Pucciarelli
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Clinica Chirurgica I, Azienda Ospedaliera di Padova, Università di Padova, Padova, Italy
| | - Emanuele Damiano Luca Urso
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Clinica Chirurgica I, Azienda Ospedaliera di Padova, Università di Padova, Padova, Italy
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Murawa D, Murawa P, Oszkinis G, Biczysko W. Long-Term Consequences of Total Gastrectomy: Quality of Life, Nutritional Status, Bacterial Overgrowth and Adaptive Changes in Esophagojejunostomic Mucosa. TUMORI JOURNAL 2018; 92:26-33. [PMID: 16683381 DOI: 10.1177/030089160609200106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate long-term quality of life and adaptive changes in the mucosa of the proximal section of the small intestine used for esophagojejunostomy reconstruction in stomach cancer patients after total gastrectomy. MATERIAL AND METHODS Thirty-one patients who had undergone stomach cancer-related total gastrectomy were included in the study, which spanned a period of 48 to 127 months (79.6 months on the average) after the surgery. The analysis included: a) evaluation of selected biochemical parameters; b) microbiological evaluation of esophagojejunostomic area; c) evaluation of adaptive changes in esophagojejunostomic mucosa using light and electron microscopy; d) quality of life evaluation with a Troidl questionnaire. RESULTS Quality of life was subjectively rated as good or very good by almost all subjects. The analyzed biochemical parameters were within the range of normal values in all the subjects with the exception of mild abnormalities in alkaline phosphatase and vitamin B12 levels in some patients. Microbiological examination of mucosal specimens from below the esophagojejunostomy revealed significant bacterial flora overgrowth in all the patients, with streptococci being the most abundant species. Light and electron microscopy examination of the epithelium confirmed it was normal and characteristic of a healthy small intestine. CONCLUSIONS Long-term quality of life in patients after complete stomach resection is considered good or very good, irrespective of the reconstruction method used, and the esophagojejunostomic mucosa of the reconstructed area is normal and typical for a healthy small intestine.
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Affiliation(s)
- Dawid Murawa
- 1st Clinic of Surgical Oncology, Great Poland Cancer Center, Wielkopolskie Centrum Onkologii, Poznaf, Poland.
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Fundectomy-Evoked Osteopenia in Pigs Is Mediated by the Gastric-Hypothalamic-Pituitary Axis. Exp Biol Med (Maywood) 2016; 232:1449-57. [DOI: 10.3181/0608-rm-196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to determine the effects of gastric impairment in pigs on the axial and peripheral skeletal system properties and to test the hypothesis that fundectomy-evoked osteopenia is related to disturbed gastric-hypothalamic-pituitary axis function. Forty-day-old male piglets were subjected to experimental fundectomy (FX group, n = 6) to induce osteopenia, while sham operation was performed in the controls (SHO group, n = 6). At the age of 8 months, serum samples were collected, and the animals were sacrificed to obtain lumbar vertebrae (L1–L6) and right humerus for analysis. Using quantitative computed tomography (QCT) and dual-energy x-ray absorptiometry (DEXA) methods, bone mineral density and bone mineral content of the vertebrae and humerus were measured. The compression and three-point bending tests were applied to determine mechanical properties of lumbar vertebrae and humerus, respectively. Furthermore, geometric properties of humerus were assessed. Serum concentrations of ghrelin, growth hormone (GH), insulin-like growth factor-1 (IGF-1), and selected macro- and microelements were also determined. Performed fundectomy decreased body weight in pigs by 66% compared with pair-fed sham operated pigs ( P < 0.0001). Bone weight, bone mineral density, and bone mineral content of the lumbar vertebrae and humerus were significantly decreased in the fundectomized pigs ( P < 0.01). Mechanical parameters of the lumbar spine and humerus were decreased after the fundectomy, as well. Serum concentrations of ghrelin, GH, and IGF-1 were lowered by 74.4%, 90.6%, and 54.6% in the fundectomized pigs, respectively (all P < 0.001). Moreover, the serum concentrations of calcium, magnesium, iron and copper in the fundectomized animals were significantly decreased by 15.5%, 45.3%, 26.7%, and 26.2%, respectively ( P ≤ 0.05). In conclusion, the results obtained showed that both the disturbed gastric-hypothalamic-pituitary axis function and impaired mineral metabolism are associated with development of postfundectomy osteopenia of axial and peripheral skeleton in pigs.
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Long-term Quality of Life After Distal Subtotal and Total Gastrectomy: Symptom- and Behavior-oriented Consequences. Ann Surg 2016; 263:738-44. [PMID: 26501699 DOI: 10.1097/sla.0000000000001481] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study assessed long-term quality of life (QoL) after subtotal gastrectomy (STG) and total gastrectomy (TG) by comparing groups matched by a set of patient factors at and beyond postoperative 5 years. The cause of QoL gaps based on symptomatic and behavioral consequences of surgery were investigated. BACKGROUND Survivors after STG and TG were matched by a set of patient factors (age, sex, stage, chemotherapy, and postoperative period). QoL data were obtained from 53 and 36 pairs of survivors at and beyond postoperative 5 years, respectively. METHODS The European Organization for Research and Treatment of Cancer QoL Questionnaire (QLQ)-C30 and QLQ-STO22 were used to assess QoL. QoL comparisons between STG and TG groups were made for 5-year survivors and long-term survivors. RESULTS Five-year survivors after TG showed significantly worse QoL in social functioning, nausea and vomiting, eating restrictions, and taste. For long-term survivors, QoL inferiority of the TG group was observed only in eating restrictions. Among 4 items constituting eating restrictions, the TG group tended to exhibit worse QoL in 2 items (enjoyable meals and social meals). CONCLUSIONS Although 5-year survivors after TG still suffer from QoL inferiority from symptomatic and behavioral consequences of surgery, inferiority from behavioral consequences will persist even after symptomatic inferiority to STG survivors is no longer valid. Efforts to ameliorate persistent QoL inferiority in TG survivors should be directed toward restoring dietary behaviors, where TG survivors are prevented from enjoyable meals and social meals.
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Tomaszewska E, Dobrowolski P, Prost Ł, Hułas-Stasiak M, Muszyński S, Blicharski T. The effect of supplementation of a glutamine precursor on the growth plate, articular cartilage and cancellous bone in fundectomy-induced osteopenic bone. J Vet Med Sci 2015; 78:563-71. [PMID: 26725871 PMCID: PMC4873845 DOI: 10.1292/jvms.15-0385] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The aim of the study was to investigate the effect of 2-oxoglutaric acid (2-Ox)
supplementation (a precursor of glutamine and hydroxyproline, the most abundant amino acid
of collagen) on cartilage and bone in pigs after fundectomy. Pigs at the age of forty days
were subjected to fundectomy and divided into two groups depending on 2-Ox supplementation
(at the daily dosage of 0.4 g/kg of body weight). Other pigs were sham operated. Pigs were
euthanized at the age of eight months. An analysis of the morphometry of trabeculae,
growth plate and articular cartilage in fundectomy-induced osteopenic bone was performed.
Moreover, the levels of expression of osteocalcin, osteopontin and osteoprotegerin in
trabecular bone and osteocalcin in articular cartilage were evaluated. Articular cartilage
was thinnest in fundectomized pigs and thickest in 2-Ox-supplemented animals after
fundectomy. Moreover, 2-Ox supplementation after fundectomy enhanced the total thickness
of the growth plate and trabeculae in fundectomized pigs. The most evident signal for
osteocalcin and osteoprotegerin in trabecular bone was in sham-operated and
2-Ox-supplemented pigs; a low reaction was observed in the fundectomized group.
Additionally, as a long-term postoperative consequence, a change was observed in the
expression of osteocalcin in articular cartilage. It seems that 2-Ox is suitable for use
in preventing the negative effects of fundectomy on cancellous bone and cartilage.
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Affiliation(s)
- Ewa Tomaszewska
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, Akademicka 12, 20-950 Lublin, Poland
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Saito H, Nomura K, Abe S, Motegi T, Ishii T, Hattori K, Kusunoki Y, Gemma A, Kida K. Long-term effects of gastrectomy in patients with spirometry-defined COPD and patients at risk of COPD: a case-control study. Int J Chron Obstruct Pulmon Dis 2015; 10:2311-8. [PMID: 26604730 PMCID: PMC4631414 DOI: 10.2147/copd.s87135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Comorbidities are characteristic of COPD. However, little is known about the secondary manifestations of COPD in the gastrointestinal tract. Therefore, we aimed to explore the long-term effects of gastrectomy in patients with spirometry-defined COPD or those at risk of COPD. PARTICIPANTS Subjects included 87 patients either with COPD or at risk of COPD (symptomatic) who underwent gastrectomy between December 2003 and October 2013 (group A), and 174 patients either with COPD or at risk of COPD, matched by age (±5 years), sex, and forced expiratory volume in 1 second (FEV1) as percentage of predicted (FEV1% predicted) (±5%) (group B). METHODS All patients underwent routine blood chemistry and pulmonary function tests, arterial blood gas analysis, 6-minute walk test (6MWT), high-resolution chest computed tomography scans, and nutritional assessments. RESULTS The mean duration postgastrectomy was 18.3±15.4 years. The mean FEV1 and FEV1% predicted were 2.07±0.76 L and 74.6±24.5%, respectively. Univariate analysis indicated that group A patients had significantly lower body mass index, fat-free mass index, and serum hemoglobin and albumin concentration (all P=0.00), and walked a significantly shorter distance in the 6MWT (P<0.05). Multivariate linear regression analysis for the distance in the 6MWT indicated that increased residual volume (RV) to total lung capacity (TLC) as percentage of predicted (%RV/TLC) alone was an independent and significant predictor of reduced distances in the 6MWT. CONCLUSION We concluded that nutritional insufficiency in patients with COPD (or those at risk of COPD) who previously underwent gastrectomy might lead to hyperinflation and consequently, decreased exercise capacity.
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Affiliation(s)
- Hitoshi Saito
- Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
| | - Koichiro Nomura
- Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
| | - Shinji Abe
- Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
| | - Takashi Motegi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Takeo Ishii
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Kumiko Hattori
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Yuji Kusunoki
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
| | - Kozui Kida
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
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Straatman J, van der Wielen N, Joosten PJ, Terwee CB, Cuesta MA, Jansma EP, van der Peet DL. Assessment of patient-reported outcome measures in the surgical treatment of patients with gastric cancer. Surg Endosc 2015; 30:1920-9. [PMID: 26310527 PMCID: PMC4848335 DOI: 10.1007/s00464-015-4415-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]
Abstract
Background Gastric cancer is responsible for 10 % of all cancer-related deaths worldwide. With improved operative techniques and neo-adjuvant therapy, survival rates are increasing. Outcomes of interest are shifting to quality of life (QOL), with many different tools available. The aim of this study was to assess which patient-reported outcome measures (PROMs) are used to measure QOL after a gastrectomy for cancer. Methods A comprehensive search was conducted for original articles investigating QOL after gastrectomy. Two authors independently selected relevant articles, conducted clinical appraisal and extracted data (P.J. and J.S.). Results Out of 3414 articles, 26 studies were included, including a total of 4690 patients. These studies included ten different PROMs, which could be divided into generic, symptom-specific and disease-specific questionnaires. The EORTC and the FACT questionnaires use an oncological overall QOL module and an organ-specific module. Only one validation study regarding the use of the EORTC after surgery for gastric cancer was available, demonstrating good psychometric properties and clinical validity. Conclusions A great variety of PROMs are being used in the measurement of QOL after surgery for gastric cancer. A questionnaire with a general module along with a disease-specific module for the assessment of QOL seems most desirable, such as the EORTC and the FACT with their specific modules. Both are developed in different treatment modalities, such as in surgical patients. EORTC is the most widely used questionnaire and therefore allows for comparison of new studies to existing data. Future studies are needed to assess content validity in surgical gastric cancer patients.
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Affiliation(s)
- Jennifer Straatman
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands.
| | - Nicole van der Wielen
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Pieter J Joosten
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Miguel A Cuesta
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Elise P Jansma
- Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
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Jeon BH, Choi M, Lee J, Noh SH. Relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in patients with gastric cancer after gastrectomy. Nurs Health Sci 2015; 18:23-9. [PMID: 26284952 DOI: 10.1111/nhs.12219] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 12/14/2022]
Abstract
This study examines relationships between gastrointestinal symptoms, uncertainty, and perceived recovery in gastric cancer patients after gastrectomy. Data were collected from 146 patients at an outpatient clinic of a university hospital in Seoul, Korea from October to November 2012. The Gastrointestinal Symptoms Rating Scale, the Mishel Uncertainty in Illness Scale, and questions on perceived recovery of physical, psychological, and social functions were analyzed. High gastrointestinal symptom scores were reported in women younger patients (F = 5.55, P = 0.005), and in patients without a family history of gastric cancer. The uncertainty score was higher in patients with low economic (F = 3.84, P = 0.024) and educational status and no family history. Regression analysis revealed uncertainty was the strongest factor associated with recovery. Nurses can assist patients and families to predict and deal with health problems by offering education on progress from diagnosis to postoperative management, promoting all aspects of recovery after gastrectomy.
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Affiliation(s)
- Byeong Hee Jeon
- Department of Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Mona Choi
- College of Nursing, Yonsei University, Seoul, Korea
| | - JuHee Lee
- College of Nursing, Yonsei University, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, College of Medicine, Yonsei University, Seoul, Korea
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Nergaard BJ, Leifsson BG, Hedenbro J, Gislason H. Gastric bypass with long alimentary limb or long pancreato-biliary limb--long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg 2015; 24:1595-602. [PMID: 24744188 PMCID: PMC4153949 DOI: 10.1007/s11695-014-1245-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Several studies indicate that increasing the alimentary limb length in gastric bypass surgery produces only a minor improvement of excess BMI loss. Few studies have addressed the efficacy of increasing the length of the pancreatico-biliary limb. Methods Here, we present a prospective randomized study of 187 consecutive laparoscopic Roux-Y gastric bypass operations operated over 2 years (2004–2005) in Iceland. The patients were operated with a gastric bypass with either a 2-m biliopancreatic (BP)-limb and a 60-cm alimentary (A)-limb (n = 93) or with a 150-cm A-limb and a 60-cm BP-limb (n = 94). Results Preoperative median BMI was 44.1 (38–70), median age 35.5 (17–74) years, and 85 % of the patients were female. Follow-up rate after 5 years was 85 %. Eighteen months following surgery, the weight loss was significantly higher in the BP-limb group (p < 0.001), and this difference remained 7 years after surgery. Weight regain occurred in both groups, and 7 years after surgery, excess BMI loss (EBMIL) was 78.4 % in the BP-limb group compared to 67.1 % in the A-limb group (p < 0.001). Most patients (78 %) needed supplementation adjustment (iron, vitamin D and calcium) during the study period, significantly more often in the BP-limb group compared to the A-limb group (p < 0.001). Patients in the BP-limb group had more frequent stools than patients in the A-limb group; otherwise, gastro-intestinal symptoms rating scoring were comparable. Complication rate was similar. Conclusions Gastric bypass with a 2-m BP-limb gives better weight loss than gastric bypass with a 60-cm BP-limb and a 150-cm A-limb. Metabolic follow-up is of utmost importance, as most patients needed repeated adjustments of their supplementation.
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Affiliation(s)
- Bent Johnny Nergaard
- Department of Surgery, Aleris Hospital, Fredrik Stangs Gate 11-13, 0264 Oslo, Norway
- Aleris Obesity Skane, Kristianstad, Sweden
| | - Björn Geir Leifsson
- Department of Surgery, Landspitali University Hospital, Reykjavik, Iceland
- Department of Surgery, Aleris Hospital, Fredrik Stangs Gate 11-13, 0264 Oslo, Norway
- Aleris Obesity Skane, Kristianstad, Sweden
| | - Jan Hedenbro
- Department of Surgery, Aleris Hospital, Fredrik Stangs Gate 11-13, 0264 Oslo, Norway
- Aleris Obesity Skane, Kristianstad, Sweden
| | - Hjörtur Gislason
- Department of Surgery, Landspitali University Hospital, Reykjavik, Iceland
- Department of Surgery, Aleris Hospital, Fredrik Stangs Gate 11-13, 0264 Oslo, Norway
- Aleris Obesity Skane, Kristianstad, Sweden
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Tatara MR, Krupski W, Szpetnar M, Dąbrowski A, Bury P, Szabelska A, Charuta A, Boguszewska-Czubara A, Maciejewski R, Wallner G. Effects of total gastrectomy on plasma silicon and amino acid concentrations in men. Exp Biol Med (Maywood) 2015; 240:1557-63. [PMID: 26041388 DOI: 10.1177/1535370215588925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/01/2015] [Indexed: 12/18/2022] Open
Abstract
The aim of the study was to determine one-year effects of total gastrectomy on plasma silicon and free amino acid concentrations in patients and evaluate changes of volumetric bone mineral density (vBMD) in lumbar spine. Eight patients were enrolled to the control (CTR) group. Six patients subjected to total gastrectomy (GX group) were included to the experimental group. vBMD in trabecular and cortical bone was measured in lumbar vertebrae at baseline (before surgery) and one year later using quantitative computed tomography. Plasma concentrations of silicon and free amino acids were determined at baseline and one year later using photometric method and ion-exchange chromatography. Body weights within CTR and GX groups were not different after one-year follow-up when compared to the baseline values (P > 0.05). An average annual decrease of vBMD in the trabecular bone in the gastrectomized patients reached 15.0% in lumbar spine and was significantly different in comparison to the percentage changes observed in CTR group (P = 0.02). One-year percentage change of vBMD in the cortical bone in L1 and L2 has shown significantly decreased values by 10.5 and 9.1% in the GX group when compared to the percentage change observed in the controls (P < 0.05). Plasma concentration of adipic acid was significantly higher by 101.6% one year after total gastrectomy procedure in the patients when compared to the baseline value (P = 0.01). Plasma concentration of silicon was significantly lowered by 26.7% one year after the total gastrectomy when compared to the baseline value (P = 0.009). Total gastrectomy in patients has induced severe osteoporotic changes in lumbar spine within one-year period. The observed osteoporotic changes were associated with decreased plasma concentration of silicon indicating importance of exocrine and endocrine functions of stomach for silicon homeostasis maintenance. Gastrectomy-induced bone loss was not related to decreased amino acid concentration in plasma obtained from overnight fasted patients.
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Affiliation(s)
- Marcin R Tatara
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland II Department of Radiology, Medical University of Lublin, 20-081 Lublin, Poland
| | - Witold Krupski
- II Department of Radiology, Medical University of Lublin, 20-081 Lublin, Poland
| | - Maria Szpetnar
- Department of Medical Chemistry, Medical University in Lublin, 20-093 Lublin, Poland
| | - Andrzej Dąbrowski
- II Department of General and Gastroenterological Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, 20-081 Lublin, Poland
| | - Paweł Bury
- II Department of General and Gastroenterological Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, 20-081 Lublin, Poland
| | - Anna Szabelska
- Department of Prosthetic Dentistry, Medical University in Lublin, 20-081 Lublin, Poland
| | - Anna Charuta
- Vertebrates Morphology Department, Department of Zoology, Institute of Biology, Siedlce University of Natural Sciences and Humanities, 08-110 Siedlce, Poland
| | | | - Ryszard Maciejewski
- Human Anatomy Department, Medical University in Lublin, 20-090 Lublin, Poland
| | - Grzegorz Wallner
- II Department of General and Gastroenterological Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, 20-081 Lublin, Poland
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Ding X, Yan F, Liang H, Xue Q, Zhang K, Li H, Ren X, Hao X. Functional jejunal interposition, a reconstruction procedure, promotes functional outcomes after total gastrectomy. BMC Surg 2015; 15:43. [PMID: 25886854 PMCID: PMC4404078 DOI: 10.1186/s12893-015-0032-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/02/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Functional jejunal interposition (FJI) has been applied as a reconstruction procedure to maintain the jejunal continuity and duodenal food passage after total gastrectomy in patients with gastric cancer. The purpose of this study was to evaluate clinical efficacy of the FJI procedure by comparing the functional outcomes of FJI to Roux-en-Y after total gastrectomy in gastric cancer patients, and investigate physiologic mechanisms by which FJI exerts beneficial outcomes in beagles. METHODS Patients with stage I-IV gastric cancer without metastasis and recurrence one year after surgery were enrolled in this retrospective study. Seventy one patients received FJI and seventy nine patients received Roux-en-Y after total gastrectomy. We evaluated the nutritional status at three and twelve months and incidence of complications up to twelve months after surgery. Beagles receiving sham operation, FJI, or Roux-en-Y after total gastrectomy were sacrificed forty eight hours postoperatively. Beagles were gavaged with active carbon for evaluating the intestinal transit rate. Intestinal tissues from the duodenojejunal anastomosis were collected for examining interstitial cells of Cajal (ICC), inflammation, and apoptosis. RESULTS Compared to the bodyweight before surgery, the bodyweight loss at three and twelve months after surgery in patients receiving FJI was significant less than that in patients with Roux-en-Y. Patients with the FJI procedure showed significant increase of blood hemoglobin and total protein, compared to those at one month after surgery, and the prognostic nutrition index scores at three and twelve months after surgery. The incidence rates of post-operative complications, including reflux esophagitis, dumping syndrome, and Roux-en-Y syndrome were decreased in patients with FJI. Compared to beagles receiving Roux-en-Y, more ICC in the intestinal submuocsa, less intestinal epithelial cell apoptosis, and decreased inflammation in serosal side of the intestine were found in the FJI group. The intestinal transit rate in FJI group was lower than that in Roux-en Y group, indicating that FJI benefits food storage. CONCLUSION The FJI procedure promotes nutritional recovery and decreases post-operative complications in gastric cancer patients after total gastrectomy, which may be through ameliorating intestinal inflammation and damage and reducing ICC loss to preserve food reservoir function and intestinal motility.
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Affiliation(s)
- Xuewei Ding
- Department of Gastrointestinal Oncology, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, P.R. China
| | - Fang Yan
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Immunology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, P.R. China
| | - Han Liang
- Department of Gastrointestinal Oncology, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, P.R. China
| | - Qiang Xue
- Department of Gastrointestinal Oncology, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, P.R. China
| | - Kuo Zhang
- Department of Laboratory Animal Science, Peking University Health Science Center, Beijing, P.R. China
| | - Hui Li
- Department of Immunology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, P.R. China
| | - Xiubao Ren
- Department of Immunology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, P.R. China
| | - Xishan Hao
- Department of Gastrointestinal Oncology, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, P.R. China.
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Dong R, Guo ZY, Ding JR, Zhou YY, Wu H. Gastrointestinal symptoms: A comparison between patients undergoing peritoneal dialysis and hemodialysis. World J Gastroenterol 2014; 20:11370-11375. [PMID: 25170224 PMCID: PMC4145778 DOI: 10.3748/wjg.v20.i32.11370] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/28/2014] [Accepted: 07/11/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the prevalence and diversity of gastrointestinal (GI) symptoms in patients undergoing peritoneal dialysis (PD) and hemodialysis (HD).
METHODS: Two hundred and ninety-four end-stage renal disease patients participated in the study, including 182 HD and 112 PD patients. Dimension scores were calculated from a modified gastrointestinal symptom rating scale (GSRS) 18-item questionnaire, including items concerning eating dysfunction, and were used for measuring GI symptoms. Information on patient age, condition contributing to end-stage renal disease and the most recent dialysis adequacy assessment (serum Kt/V urea value) was obtained from the follow-up database and by interviewing patients and/or reviewing the medical records. Differences between the HD and PD groups were evaluated using Student’s t, Pearson’s χ2 or Fisher’s exact tests.
RESULTS: The overall prevalence of GI symptoms, defined by a GSRS > 1, in end-stage renal disease patients was 70.7% (208/294), which differed between HD and PD patients (76.4% vs 61.6%, P < 0.01). HD patients had a higher prevalence of constipation, abdominal pain and diarrhea compared to PD patients (36.3% vs 17.9%, 32.4% vs 5.4%, 17.6% vs 4.5%, respectively, P < 0.05). PD patients had a higher prevalence of reflux compared to HD patients (32.1% vs 24.2%, P < 0.05). Additionally, reflux and eating dysfunction were more severe in PD patients (GSRS: 1.71 ± 1.15 vs 1.30 ± 0.67, 1.57 ± 0.84 vs 1.39 ± 0.61, respectively, P < 0.05), whereas HD patients had greater abdominal pain, diarrhea and constipation (GSRS: 1.22 ± 0.39 vs 1.04 ± 0.19, 1.19 ± 0.53 vs 1.07 ± 0.35, 1.51 ± 0.83 vs 1.23 ± 0.58, respectively, P < 0.05). Finally, 14.8% (27/182) of HD patients presented with more than three GI symptoms, compared to 7.2% (8/112) of PD patients (P < 0.01).
CONCLUSION: HD and PD patients differ in prevalence, severity and diversity of GI symptoms.
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Lee SS, Chung HY, Kwon OK, Yu W. Quality of life in cancer survivors 5 years or more after total gastrectomy: a case-control study. Int J Surg 2014; 12:700-5. [PMID: 24866069 DOI: 10.1016/j.ijsu.2014.05.067] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 05/12/2014] [Accepted: 05/20/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study investigated how total gastrectomy (TG), along with memories of cancer, affect the subjective wellness of survivors long after surgery. Rational approaches for effectively improving the quality of life (QoL) of these survivors were suggested. METHODS Between 2008 and 2013, QoL data of gastric cancer patients who underwent a curative TG, were obtained at 5-year postoperative follow-up visits (5-year survivors) and at visits beyond 5 years (long-term survivors). The control groups for these survivor groups were constructed from volunteers who visited our health-examination center for annual medical checkups. The Korean versions of the European Organization for Research and Treatment (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and the gastric cancer specific module, the EORTC QLQ-STO22, were used to assess QoL. RESULTS Five-year survivors showed worse QoL compared to the control group in role functioning, social functioning, nausea/vomiting, appetite loss, financial difficulties, reflux, eating restrictions, taste, and body image, and better QoL in the emotional and cognitive functioning scales. In long-term survivors, deterioration in QoL were still apparent in financial difficulties, reflux, and eating restrictions, while QoL differences in the remaining scales had diminished. DISCUSSION Surviving 5 years after TG does not result in living in a carefree state in terms of QoL. After 5 postoperative years, survivors still need extended care for deteriorated QoL indicators due to symptomatic, behavioral, and financial consequences of surgery. CONCLUSION While relevant clinical and institutional approaches are required for corresponding declines in QoL, such efforts must extend beyond 5 postoperative years.
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Affiliation(s)
- Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 700-721, Republic of Korea
| | - Ho Young Chung
- Department of Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 700-721, Republic of Korea.
| | - Oh Kyoung Kwon
- Gastric Cancer Center, Kyungpook National University Medical Center, 807 Hoguk-ro, Buk-gu, Daegu 702-210, Republic of Korea
| | - Wansik Yu
- Gastric Cancer Center, Kyungpook National University Medical Center, 807 Hoguk-ro, Buk-gu, Daegu 702-210, Republic of Korea
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Kalaitzakis E, Josefsson A, Castedal M, Henfridsson P, Bengtsson M, Andersson B, Björnsson E. Gastrointestinal symptoms in patients with cirrhosis: a longitudinal study before and after liver transplantation. Scand J Gastroenterol 2013; 48:1308-16. [PMID: 24063547 DOI: 10.3109/00365521.2013.836755] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Gastrointestinal (GI) symptoms are common in cirrhosis and have an impact on quality of life. Their pathophysiology and their relation to energy intake have not been fully elucidated and the effect of liver transplantation on GI symptoms has not been studied. We aimed to prospectively evaluate GI symptoms and their determinants before and after transplantation and their potential relation with energy intake in cirrhosis. METHODS A total of 108 cirrhotic liver transplant candidates completed the Gastrointestinal Symptom Rating Scale (GSRS) and the hospital anxiety and depression scale. Fasting serum glucose and insulin were measured in all patients. Serum thyrotropin, free T3/T4, cortisol, free testosterone, estradiol, dehydroepiandrosterone sulfate, interleukin-6 and tumor necrosis factor-α were measured in a subgroup of 80 patients. Transplant recipients were followed for 1 year. A separate cohort of 40 cirrhotic patients underwent a high-caloric satiation drinking test (SDT). RESULTS GI symptoms were more severe in cirrhotics compared to controls from the general population. In regression analysis, the total GSRS score was independently related to lactulose, anxiety and low free testosterone (p < 0.05 for all). Four out of six GSRS domain scores improved significantly 1 year post-transplant (p < 0.05) but the total GSRS score remained higher compared to controls. GI symptoms predicted ingestion of fewer calories at SDT compared to other patients and controls (p < 0.05). CONCLUSIONS Psychological distress, lactulose treatment and low testosterone are predictors of GI symptoms which are common among cirrhotic transplant candidates. They are also associated with decreased energy intake as measured by a SDT. GI symptoms remain of concern post-transplant.
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Affiliation(s)
- Evangelos Kalaitzakis
- Institute of Internal Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
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Changes of quality of life in gastric cancer patients after curative resection: a longitudinal cohort study in Korea. Ann Surg 2013; 256:1008-13. [PMID: 23154395 DOI: 10.1097/sla.0b013e31827661c9] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Little is known about how quality of life (QOL) changes over time after gastrectomy. We prospectively examined changes of QOL in Korean patients with gastric cancer after curative resection. BACKGROUND As early detection and improved treatment have led to higher survival rates and an increasing number of long-term survivors, the importance of QOL has increased. METHODS Patients newly diagnosed with gastric cancer, who were expected to undergo curative resection, were studied. QOL was assessed, using the European Organization for Research and Treatment of Cancer QLQ-C30 and its gastric module QLQ-STO22, before and after 3 and 12 months of gastrectomy. RESULTS In total, 465 patients were included in the study, and 377 and 88 patients underwent subtotal gastrectomy and total gastrectomy, respectively. For most of the functional or symptom scales, the mean score deteriorated at 3 months and generally improved during follow-up period. Patients with total gastrectomy had more functional and symptomatic problems related to QOL than those with subtotal gastrectomy during the follow-up. For both groups, there were temporal, unrecovered, improved, and unchanged problems in QOL. Fatigue; digestive symptoms such as diarrhea, dysphagia, and eating restrictions; body image disturbance; and cognitive functioning were the representative unrecovered problems, which persisted at 12 months after surgery. CONCLUSIONS Our findings show that there are various functional and symptomatic problems, which health care providers need to manage during the postsurgical period. We need to continuously address fatigue, diarrhea, dysphagia, eating restrictions, body image disturbance, and cognitive functioning. In addition, it would be necessary to inform patients about possible QOL outcomes while they are receiving information about surgery and signing informed consent for surgery.
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Dikken JL, Stiekema J, van de Velde CJH, Verheij M, Cats A, Wouters MWJM, van Sandick JW. Quality of care indicators for the surgical treatment of gastric cancer: a systematic review. Ann Surg Oncol 2012; 20:381-98. [PMID: 23054104 DOI: 10.1245/s10434-012-2574-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Quality assurance is increasingly acknowledged as a crucial factor for the (surgical) treatment of gastric cancer. The purpose of the current study was to define a minimum set of evidence-based quality of care indicators for the surgical treatment of locally advanced gastric cancer. METHODS A systematic review of the literature published between January 1990 and May 2011 was performed, using search terms on gastric cancer, treatment, and quality of care. Studies were selected based on predefined selection criteria. Potential quality of care indicators were assessed based on their level of evidence and were grouped into structure, process, and outcome indicators. RESULTS A total of 173 articles were included in the current study. For structural measures, evidence was found for the inverse relationship between hospital volume and postoperative mortality as well as overall survival. Regarding process measures, the most common indicators concerned surgical technique, perioperative care, and multimodality treatment. The only outcome indicator with supporting evidence was a microscopically radical resection. CONCLUSIONS Although specific literature on quality of care indicators for the surgical treatment of locally advanced gastric cancer is limited, several quality of care indicators could be identified. These indicators can be used in clinical audits and other quality assurance programs.
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Affiliation(s)
- Johan L Dikken
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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20
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Dikic S, Randjelovic T, Dragojevic S, Gacic D, Bilanovic D, Vulovic V, Jovanovic I, Andjelic S. Nutritional Insight into Preduodenal Pouch Reconstruction One Year after Total Gastrectomy. J Surg Res 2012; 176:34-41. [DOI: 10.1016/j.jss.2011.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 05/29/2011] [Accepted: 06/07/2011] [Indexed: 12/28/2022]
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Abstract
BACKGROUND Attention has recently focused on decreased quality of life (QOL) that occurs in postgastrectomy patients. We verified how gastric emptying function affected QOL. METHODS Subjects were 72 consecutive patients after gastrectomy for cancer, including 25 after distal gastrectomy (DG), 18 after proximal gastrectomy (PG), 16 after pylorus-preserving gastrectomy (PpG), and 13 after total gastrectomy (TG). Using the (13)C breath test method, (13)CO(2) levels in breath were measured over 2 h, and T (max) was determined. Questionnaires (Japanese versions of the Short-Form 36 [SF-36] and Gastrointestinal Symptom Rating Scale [GSRS]) were used to analyze QOL and correlations between questionnaire results and T (max). RESULTS Mean T (max) (min) for each procedure was 15.4 for DG, 21.1 for PG, 41.3 for PpG, and 10.4 for TG. T (max) differed between procedures, but not between survey periods. SF-36 was not correlated with T (max), whereas GSRS showed a difference in diarrhea and total score between procedures, but not between survey periods. In addition, GSRS correlated with T (max) for abdominal pain, indigestion, and total score. The total scores showed a significant symptom aggregation in patients with T (max) less than 21 min. CONCLUSIONS Gastrointestinal symptoms in postgastrectomy patients were associated with the function of the remaining stomach. The (13)C breath test is useful for objectively assessing such symptoms.
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Abstract
The first postgastrectomy syndrome was noted not long after the first gastrectomy was performed. The indications for gastric resection have changed dramatically over the past 4 decades, and the overall incidence of gastric resection has decreased. This article focuses on the small proportion of patients with severe, debilitating symptoms; these symptoms can challenge the acumen of the surgeon who is providing the patient's long-term follow-up and care. The article does not deal with the sequelae of bariatric surgery.
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Affiliation(s)
- John S Bolton
- Department of Surgery Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
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Ring Jacobsson L, Friedrichsen M, Göransson A, Hallert C. Does a Coeliac School increase psychological well-being in women suffering from coeliac disease, living on a gluten-free diet? J Clin Nurs 2011; 21:766-75. [PMID: 22039932 DOI: 10.1111/j.1365-2702.2011.03953.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM AND OBJECTIVE To assess the effects of an active method of patient education on the psychological well-being of women with coeliac disease in remission. BACKGROUND Despite remission with a gluten-free diet, adults with coeliac disease and especially women experience a subjective poor health. Self-management education seems to be promising tool to help patients suffering from coeliac disease to cope with their disorder. DESIGN A randomised controlled trial. METHODS A total of 106 women, ≥ 20 years, with confirmed coeliac disease, who had been on a gluten-free diet for a minimum of five years. The intervention group (n = 54) underwent a 10-session educational programme, 'Coeliac School', based on problem-based learning. The controls (n = 52) received information regarding coeliac disease sent home on a regular basis. The primary outcomes were psychological general well-being measured with a validated questionnaire. RESULTS Participants in the Coeliac School reported a significant improvement in psychological well-being at 10 weeks, whereas the controls given usual care reported a worsening in psychological well-being. After six months, a significant improvement remained for the index of vitality. CONCLUSIONS Patient education increased psychological well-being in women with coeliac disease. There is a need to refine the methods of patient education to make the effects of well-being more pronounced over time. RELEVANCE TO CLINICAL PRACTICE Patient education using problem-based learning promotes self-management in coeliac disease by improving the well-being of patients who have been struggling with the gluten-free diet for years.
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Affiliation(s)
- Lisa Ring Jacobsson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
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Tsujimoto H, Sakamoto N, Ichikura T, Hiraki S, Yaguchi Y, Kumano I, Matsumoto Y, Yoshida K, Ono S, Yamamoto J, Hase K. Optimal size of jejunal pouch as a reservoir after total gastrectomy: a single-center prospective randomized study. J Gastrointest Surg 2011; 15:1777-82. [PMID: 21785918 DOI: 10.1007/s11605-011-1641-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 07/13/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND In order to improve a patient's quality of life after total gastrectomy, jejunal pouch reconstruction has been employed. However, little information exists regarding the optimal size of the jejunal pouch after total gastrectomy. METHODS The study was designed as a single-center randomized trial in which the results of double-tract reconstruction with pouches of two different sizes were compared, i.e., short and long pouch double tract (SPDT and LPDT, respectively). We conducted a clinical assessment with standard questionnaire after surgery. The amount of residual food in the jejunal pouch was determined by endoscopy. RESULTS No demographic differences were noted between the two groups. The eating capacity per meal was higher in the SPDT group than in the LPDT group. The postoperative weight loss 24 months after surgery was lower in SPDT group than that in the LPDT group. Although the incidence of early dumping symptoms was higher in the SPDT group, no difference was noted in the other postprandial abdominal symptoms between the two groups. CONCLUSIONS We conclude that the optimal pouch should be relatively short, as a short pouch improves the eating capacity per meal and the weight loss ratio to the preoperative value.
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Affiliation(s)
- Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
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Dorcaratto D, Grande L, Ramón JM, Pera M. [Quality of life of patients with cancer of the oesophagus and stomach]. Cir Esp 2011; 89:635-44. [PMID: 21907976 DOI: 10.1016/j.ciresp.2011.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 06/27/2011] [Indexed: 12/17/2022]
Abstract
The study of the health related quality of life in patients with digestive tract cancer, and particularly in those with tumours of the oesophagus and stomach, provides useful information for selecting the most suitable therapeutic option. It may also be used to predict the impact of the disease and its possible treatments on the physical, emotional and social condition of the patient. Various sensitive and reliable tools have been developed over the past decades that are capable of measuring the quality of life of patients; the use of questionnaires has made it easier to exchange information between the patient and the doctor. The pre- and post-operative variations in the quality of life in patients with oesophageal-gastric cancer are of prognostic value on the outcome of the disease. For all these reasons, the health related quality of life is currently considered, along with disease free survival and absence of recurrences, one of the most important parameters in order to assess the impact on the patients of a particular oncological treatment. The aim of this article is to review the role of the health related quality of life assessment, as well as the various tools which are available to measure it in patients with oesophageal-gastric cancer.
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Affiliation(s)
- Dimitri Dorcaratto
- Sección de Cirugía Gastrointestinal, Servicio de Cirugía General y Digestiva, Hospital Universitario del Mar, Institut de Recerca IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Distal pouch reconstruction with transverse jejunoplasty after experimental gastrectomy. Langenbecks Arch Surg 2011; 397:63-7. [PMID: 21755432 DOI: 10.1007/s00423-011-0826-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 06/29/2011] [Indexed: 01/20/2023]
Abstract
PURPOSE Various reconstruction methods with or without reservoir formation after total gastrectomy have been established. Transverse intestinoplasty has benefits as a functional peristalsis modification in rectal resections. In this study, we evaluate a distal pouch combined with a transverse jejunoplasty compared to standard Roux-en-Y reconstruction. METHODS Total gastrectomy was performed on 23 pigs randomly assigned to 3 reconstruction groups-group 1 (n = 7): esophagojejunostomy without a pouch, group 2 (n = 8): esophagojejunostomy with a distal pouch, and group 3 (n = 8): distal pouch with a transverse jejunoplasty. Seven days postoperatively, weight was measured, and X-ray examinations were conducted for 1 h after oral contrast medium application. Blood glucose levels after oral glucose intake and the volume of the pouch loop were evaluated. RESULTS Upper jejunal passage was delayed and the mean volume of the jejunal loop increased by pouch formation compared to controls (p < 0.05). Body weight was the best for the pouch group with jejunoplasty (-1.9 ± 0.8% vs. pouch alone -3.3 ± 2.4% vs. no pouch -7.5 ± 2.1%, p < 0.05). CONCLUSIONS The distal jejunal pouch after total gastrectomy offers advantages with respect to bowel passage and postoperative nutrition status compared to standard Roux-en-Y reconstruction. The combination of a distal pouch and transverse jejunoplasty may provide additional functional benefits.
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Abstract
Gastric resection, whether partial or total gastrectomy, often results in nutrition-related complications including weight loss, diet intolerances, and micronutrient deficiencies. The physiology of normal and postgastrectomy digestion is the basis for most of the current diet recommendations after gastric surgery. A careful review reveals that there is not sufficient literature to support a standard postgastrectomy diet. Rather, individualized diet manipulation for symptom relief is recommended. This review highlights the physiology behind common postgastrectomy complications, provides guidelines for the medical and nutrition management of these complications, and presents a basic approach to postgastrectomy gastrointestinal symptoms.
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Affiliation(s)
- Christie Rogers
- Nutrition Support Services, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Abstract
The aim of this study was to describe and explore participants' experiences of their recovery from upper gastrointestinal surgery and being recovered or not 12 months following their operations. A hermeneutic approach was used to understand participants' experiences and situations. Fifteen participants were interviewed at 12 months postoperatively. According to participants, the year that had passed was experienced as being "pale and gray." Themes that were identified included feelings of doubtfulness, others' concern, and disappointment; never feeling quite well and having to adapt to new circumstances; feelings of being changed; and feelings of becoming free from illness and regaining strength. Being trapped in suffering meant that participants' lives had lost meaningful values. They felt disappointed because of physical discomforts and thoughts about disease and death. Recovery was felt when their physical discomforts decreased, and they felt free from doubts and "difficult" thoughts about illness and death. The recovery process can be understood as a movement between darkness and light.
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Karanicolas PJ, Bickenbach K, Jayaraman S, Pusic AL, Coit DG, Guyatt GH, Brennan MF. Measurement and interpretation of patient-reported outcomes in surgery: an opportunity for improvement. J Gastrointest Surg 2011; 15:682-9. [PMID: 21246410 DOI: 10.1007/s11605-011-1421-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 01/05/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgery may have a profound effect on patients' health-related quality of life (QOL). To be optimally useful, trials that seek to guide clinical decision making should measure outcomes that are important to patients and report the results in a clinically meaningful way. We sought to explore how researchers currently measure and interpret QOL in surgical trials, using gastric cancer as a case study. METHOD We performed a systematic review of randomized controlled trials (RCTs) of gastric cancer surgery published between 1966 and 2009 that included at least one patient-reported outcome (PRO). Investigators assessed trial eligibility and extracted data in duplicate using standardized forms, then resolved disagreements by consensus. RESULTS Our search identified 87 RCTs of gastric cancer surgery, of which 11 (13%) included at least one PRO. Ten RCTs measured one or more validated PROs, although six also included ad hoc measures. All manuscripts presented the results as raw scores and nine of the 11 trials identified a statistical difference between groups. All 11 manuscripts prominently reported the PRO results in the abstracts and conclusions, but only one discussed the clinical significance of the differences between groups. CONCLUSIONS Most RCTs of gastric cancer surgery do not include measures of QOL and those that do suffer from important limitations. RCTs would be more useful to surgeons and patients if authors measured PROs and utilized existing approaches to present the results of PROs in ways that provide an intuitive sense of the magnitude of effects.
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Affiliation(s)
- Paul J Karanicolas
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA.
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Śliwa E. ORIGINAL ARTICLE: 2-Oxoglutaric acid administration diminishes fundectomy-induced osteopenia in pigs. J Anim Physiol Anim Nutr (Berl) 2010; 94:e86-95. [DOI: 10.1111/j.1439-0396.2009.00985.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dong R, Guo ZY. Gastrointestinal symptoms in patients undergoing peritoneal dialysis: Multivariate analysis of correlated factors. World J Gastroenterol 2010; 16:2812-7. [PMID: 20533603 PMCID: PMC2883139 DOI: 10.3748/wjg.v16.i22.2812] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate gastrointestinal (GI) symptoms in peritoneal dialysis (PD) patients and to explore related factors contributing to GI symptoms.
METHODS: One hundred and twelve patients undergoing PD participated in the study. The gastrointestinal symptom rating scale was used for measuring GI symptoms. Information on age, height, weight, body mass index, disease leading to chronic renal failure, history of corticosteroid therapy, presence of predialytic GI symptoms, daily dosage of pills, and duration, type and daily dialysate volume of PD was obtained by interviewing patients and/or reviewing the medical records. Hemoglobin, albumin and Kt/V data were obtained from follow-up database. We used multiple regression analysis with stepwise backward variable selection to test for factors predicting GSRS scores with significance level of selection entry at 0.05 and selection of stay at 0.10.
RESULTS: The prevalence of eating dysfunction, reflux and indigestion in the PD patients was 44.2%, 32.7%, 32.7%, respectively. A history of corticosteroid therapy (b = 8.93, P < 0.001) and all pills daily intake (b = 0.16, P = 0.007) were positively correlated to GI symptoms, while residual renal Kt/V (b = -3.47, P = 0.009) was negatively correlated to GI symptoms. Other factors were proven to be not associated with GI symptoms, with P > 0.05.
CONCLUSION: Eating dysfunction, reflux and indigestion were common in PD patients. Daily dosage of pills and corticosteroid history predicted GI symptoms, while residual renal function prevented them.
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Rêgo ACM, Neto AV, Azevedo ÍM, Araújo-Filho I, Egito EST, Medeiros AC. Biodistribution of Technetium-99m Pertechnetate after Total Gastrectomy and Roux-en-Y Jejunal Pouch. J INVEST SURG 2010; 23:94-100. [DOI: 10.3109/08941930903469409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Laurenius A, Taha O, Maleckas A, Lönroth H, Olbers T. Laparoscopic biliopancreatic diversion/duodenal switch or laparoscopic Roux-en-Y gastric bypass for super-obesity-weight loss versus side effects. Surg Obes Relat Dis 2010; 6:408-14. [PMID: 20655023 DOI: 10.1016/j.soard.2010.03.293] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 02/27/2010] [Accepted: 03/25/2010] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic biliopancreatic diversion/duodenal switch (LDS) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the main surgical options for super-obese patients (body mass index >50 kg/m(2)). METHODS We performed a medium long-term evaluation of 13 super-obese patients who had undergone LDS compared with a control group of 19 patients who had undergone LRYGB. The patients were assessed 31 months (range 17-38) and 34 months (range 26-62) after LDS and LRYGB, respectively, for body mass index changes, relief of co-morbidities, nutrition, quality of life, postoperative bowel function, and accumulated healthcare consumption. RESULTS The mean body mass index decreased from 54.9 to 30.0 kg/m(2) in the LDS group and 57.8 to 39.8 kg/m(2) in the LRYGB group (P = .005). The hemoglobin A1c level was lower in the LDS group than in the LRYGB group (3.8 +/- .31% versus 4.3 +/- .43%, respectively; P = .01). The LDS patients reported greater energy intake than the LRYGB patients (3132 +/- 1392 kcal versus 2014 +/- 656 kcal, respectively; P = .021). The number of stools daily was 4.1 +/- 3.3 in the LDS group and 1.9 +/- 1.1 in the LRYGB group, P = .0482). Of the 12 patients in the LDS group, 6 reported fecal incontinence or soiling compared with 2 of 16 in the LRYGB group (P = .034). The number of outpatient visits was 5.6 +/- 4.6 for the LDS group and 2.0 +/- 1.9 for the LRYGB group (P = .016), and the number of telephone consultations was 5.0 +/- 5.6 and 1.4 +/- 1.6 for the LDS and LRYGB groups, respectively (P = .043). CONCLUSION LDS resulted in greater weight loss than LRYGB in super-obese patients. However, the LDS patients in our series had more frequent gastrointestinal side effects, required greater doses of calcium and vitamin supplementation, and required more postoperative monitoring. Patient satisfaction was high in both groups.
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Affiliation(s)
- Anna Laurenius
- Department of Clinical Nutrition, Sahlgrenska University Hospital, Gastrosurgical Research, Sahlgrenska Academy, Gothenburg, Sweden.
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Abstract
OBJECTIVES Whether reconstruction after total gastrectomy for gastric malignancies should be done with or without a pouch is a controversial issue in clinical research. There is still no consensus on the reconstruction technique of choice. The aim of this report was to assess the value of pouch formation as a gastric substitute after total gastrectomy compared with reconstruction techniques without a pouch. METHODS A systematic literature search of the Medline database and the Cochrane Library was carried out and a meta-analysis executed according to the Quality of Reporting Meta-Analyses (QUOROM) statement. Only randomized controlled trials (RCTs) comparing reconstruction techniques with and without a pouch were eligible for inclusion. All trials were independently assessed by two authors. Data on perioperative parameters, postgastrectomy symptoms, eating capability, body weight, and quality of life were extracted from the RCTs for meta-analysis using random-effects models for the calculation of pooled estimates of treatment effects. RESULTS Nine RCTs comparing Roux-en-Y reconstructions with and without pouch and four RCTs comparing jejunal interpositions with and without a pouch were included. The results of the meta-analyses show that additional pouch formation does not significantly increase morbidity or mortality and does not considerably extend the operating time or the hospital stay. Patients with a pouch complained significantly less of dumping and heartburn and showed a significantly better food intake postoperatively. Quality of life was significantly improved in patients with a pouch compared with patients without a pouch. This difference even increased over time from 6 to 12 and 24 months postoperatively. CONCLUSIONS This meta-analysis highlights some clinical advantages of pouch reconstruction after total gastrectomy.
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Zhang H, Sun Z, Xu HM, Shan JX, Wang SB, Chen JQ. Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction. World J Gastroenterol 2009; 15:3183-90. [PMID: 19575501 PMCID: PMC2705744 DOI: 10.3748/wjg.15.3183] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare postoperative quality of life (QOL) in patients with gastric cancer treated by esophagogastrostomy reconstruction after proximal gastrectomy.
METHODS: QOL assessments that included functional outcomes (a 24-item survey about treatment-specific symptoms) and health perception (Spitzer QOL Index) were performed in 149 patients with gastric cancer in the upper third of the stomach, who had received proximal gastrectomy with additional esophagogastrostomy.
RESULTS: Fifty-four patients underwent reconstruction by esophagogastric anterior wall end-to-side anastomosis combined with pyloroplasty (EA group); 45 patients had reconstruction by esophagogastric posterior wall end-to-side anastomosis (EP group); and 50 patients had reconstruction by esophagogastric end-to-end anastomosis (EE group). The EA group showed the best postoperative QOL, such as recovery of body weight, less discomfort after meals, and less heart burn or belching at 6 and 24 mo postoperatively. However, the survival rates, surgical results and Spitzer QOL index were similar among the three groups.
CONCLUSION: Postoperative QOL was better in the EA than EP or EE group. To improve QOL after proximal gastrectomy for upper third gastric cancer, the EA procedure using a stapler is safe and feasible for esophagogastrostomy.
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Strid H, Fjell A, Simrén M, Björnsson ES. Impact of dialysis on gastroesophageal reflux, dyspepsia, and proton pump inhibitor treatment in patients with chronic renal failure. Eur J Gastroenterol Hepatol 2009; 21:137-42. [PMID: 19212202 DOI: 10.1097/meg.0b013e3283200047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Gastrointestinal (GI) symptoms are common in patients with chronic renal failure. Patients with chronic renal failure on dialysis have a high consumption of proton pump inhibitors (PPIs) and long-term treatment is very common. The aim of the study was to investigate the prevalence of gastroesophageal reflux symptoms (GORS), dyspeptic symptoms, and PPI treatment in patients with chronic renal failure on dialysis and to compare the impact of the different types of dialysis on these upper GI symptoms and PPI treatment. METHODS One hundred and twelve peritoneal dialysis (PD) patients and 157 hemodialysis (HD) patients participated in the study. The patients were asked to complete two questionnaires: Gastrointestinal Symptom Rating Scale measuring GI symptoms in general and a GI symptom questionnaire evaluating upper GI tract symptoms specifically. Information about the use of and indication for PPI treatment and onset of GI symptoms was obtained by interviewing the patients and/or reviewing the medical records. RESULTS Dyspepsia was more common among PD patients compared with HD patients (55 vs. 38%, P=0.003). The start of dialysis tended to have a greater impact on dyspepsia (P=0.09) and GORS (P=0.09) in PD patients than in HD patients. The proportion of patients who started PPI treatment after onset of dialysis was high but did not differ between PD and HD patients (51 vs. 44%, P=0.43). A higher proportion of women with chronic renal failure started PPI treatment after the onset of dialysis than men with chronic renal failure (P=0.002). CONCLUSION Dyspepsia and GORS leading to PPI treatment are common in CRF patients on dialysis. Dialysis in general and the type of dialysis seem to affect the presence of upper GI symptoms.
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Affiliation(s)
- Hans Strid
- Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
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The Effect of Appropriate Eating Habits, Depressive State, and Social Support on Postoperative Symptom Experience Among Japanese Postgastrectomy Patients. Gastroenterol Nurs 2008; 31:423-9. [DOI: 10.1097/sga.0b013e31818ff081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kalaitzakis E, Carlsson E, Josefsson A, Bosaeus I. Quality of life in short-bowel syndrome: impact of fatigue and gastrointestinal symptoms. Scand J Gastroenterol 2008; 43:1057-65. [PMID: 18609190 DOI: 10.1080/00365520802078325] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Patients with short-bowel syndrome (SBS) have impaired health-related quality of life (QoL). However, comparisons of QoL data with the data on other chronic gastrointestinal diseases are not available. The aim of this study was to assess QoL in SBS patients compared with that in the general population and with patients with inflammatory bowel disease (IBD). The potential relation between fatigue and gastrointestinal symptoms and impaired QoL in these patients was also investigated. MATERIAL AND METHODS Four validated questionnaires were used to measure aspects of QoL (SF-36), psychological distress (hospital anxiety and depression scale, HAD), fatigue (fatigue impact scale, FIS), and gastrointestinal symptoms (gastrointestinal symptom rating scale, GSRS) in 26/28 patients (93%) attending a SBS clinic (median age 62 years, 15 F/11 M) at a tertiary referral center. Persons from the general population (n=286) as well as patients with IBD (n=41) of similar age and gender distribution as the SBS group acted as controls. RESULTS SBS patients had significantly lower SF-36 physical and mental component summaries than those in the general population as well as significantly lower SF-36 physical (p<0.05) but not mental (p>0.05) component summaries compared with those of IBD patients. Fatigue and gastrointestinal symptoms were more severe in SBS patients than in IBD patients (p>0.05). The SF-36 physical component summary was independently related to the physical FIS dimension (beta=-0.4, p=0.004), the GSRS eating dysfunction dimension (beta=-0.31, p=0.025), and opiate use (beta=-0.28, p=0.031), regardless of diagnosis (SBS or IBD). CONCLUSIONS Patients with SBS show poor QoL compared with that in the general population and also impairment of mainly physical health compared with that in patients with IBD. Fatigue and gastrointestinal symptoms are more severe in patients with SBS, which has an impact on QoL.
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Affiliation(s)
- Evangelos Kalaitzakis
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Pape L, Ahlenstiel T, Kreuzer M, Ehrich JHH. Improved gastrointestinal symptom burden after conversion from mycophenolate mofetil to enteric-coated mycophenolate sodium in kidney transplanted children. Pediatr Transplant 2008; 12:640-2. [PMID: 18798359 DOI: 10.1111/j.1399-3046.2007.00831.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It has been shown in adult kidney transplant recipients that a conversion from MMF to EC-MPS significantly reduced the GI related symptom burden. No such study exists on children with GI problems while receiving MMF therapy. Ten paediatric kidney transplant recipients (mean age 14.5 yr, s.d. 4.5) receiving triple immunosuppression (Cyclosporin A or Tacrolimus + MMF + Prednisolone) with severe GI symptoms were converted to an equimolar dose of EC-MPS. The GSRS was completed before and at four wk after the switch, and GFR was determined for a mean period of six months. Values were compared by the paired t-test. Mean GSRS improved significantly after the switch to EC-MPS in all but one patient, from 2.1 (s.d. 0.9) to 1.1 (s.d. 0.6). The differences could be found in all four subscales. Graft function did not change after conversion to EC-MPS. In children with moderate or severe GI symptoms while receiving MMF, conversion to EC-MPS led to significantly reduced GI symptoms.
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Affiliation(s)
- Lars Pape
- Department of Pediatric Nephrology, Medical School of Hannover, Germany.
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MURAWA D, POŁOM K. Pathophysiological disorders, quality of life evaluation and recommendations after total resection of the stomach. Rep Pract Oncol Radiother 2008. [DOI: 10.1016/s1507-1367(10)60093-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
BACKGROUND Gastric pouches have the potential to improve nutrition following total gastrectomy, compared with standard reconstruction. However, a consensus view of clinical benefit is not available, at least partly due to a lack of standardization of pouch design or size. This study was undertaken to identify optimal conditions for pouch design. METHODS A mathematical model was established and a porcine model constructed to evaluate the pressure/volume dynamics of the pouch. A "J" pouch was constructed at anastomotic lengths of 5, 10, 15, and 20 cm. Each pouch was distended with saline and the pressure/volume relationship established. RESULTS Mathematically, increasing the anastomotic length of the pouch to 15 cm increases the volume significantly; thereafter, there is minimal benefit of increasing the pouch length further. For smaller pouches (5 and 10 cm) a 350-to 400-ml volume (approximate meal volume in the elderly) is never achieved until higher pressures (45 cmH(2)O) are applied. However, in the larger pouches (15 and 20 cm) a 350-to 400-ml volume is readily achieved at basal pressures of 15 cmH(2)O. CONCLUSION Smaller pouches never achieve adequate volumes at basal pressures; accordingly, it is unlikely that they will lead to any clinical benefit. Further in-vivo studies should therefore be based upon 15-cm pouch designs.
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Fein M, Fuchs KH, Thalheimer A, Freys SM, Heimbucher J, Thiede A. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg 2008; 247:759-65. [PMID: 18438112 DOI: 10.1097/sla.0b013e318167748c] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Roux-en-Y reconstruction with and without jejunal pouch was compared in a randomized controlled trial to identify the optimal reconstruction procedure in terms of quality of life. BACKGROUND DATA Randomized trials comparing techniques of reconstruction after total gastrectomy have shown controversial results. METHODS One hundred and thirty-eight patients with gastric cancer were intraoperatively randomized for Roux-en-Y reconstruction with pouch (n = 71) or without pouch (n = 67) after gastrectomy and stratified into curative or palliative resection. Intra- and postoperative complications were recorded. Body weight and quality of life were determined every 6 months with a follow-up of up to 12 years. RESULTS Both groups were comparable for age, sex, incidence of concomitant disease, and staging. There were no differences in operative time, postoperative complications, and mortality. Short- and long-term weight loss was similar in both groups. In the first postoperative year, there were no benefits of pouch reconstruction in terms of quality of life, independent of the resection status. In the third, fourth, and fifth year after surgery quality of life was significantly improved for patients with a pouch. CONCLUSIONS Roux-en-Y pouch reconstruction after gastrectomy is simple to perform and safe. Long-term survivors benefit from pouch reconstruction. Therefore, a pouch is recommended for patients with a good prognosis.
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Affiliation(s)
- Martin Fein
- Department of Surgery, University of Wuerzburg, Germany
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Abstract
OBJECTIVES Patients with liver cirrhosis have a high prevalence of gastrointestinal symptoms. The use of antiacid therapy (AAT) in these patients is unexplored. We aimed to assess the use of AAT in cirrhotic patients. METHODS A total of 128 consecutive cirrhotic patients were evaluated for the use of and indications for acid-suppressive agents. Upper endoscopy findings and concomitant medications were registered. A validated questionnaire was used to measure the gastrointestinal symptom burden. Adequate indications for AAT were those strongly supported by the medical literature. RESULTS Forty percent (n=51) of patients with cirrhosis were on AAT. Thirty-seven percent (n=19) of these had adequate and 63% (n=32) inadequate indications for AAT. The major inadequate indication was previous variceal bleeding (34%). Patients with inadequate indications for AAT had increased severity of symptoms of indigestion compared with patients without AAT (P<0.05). Multivariate analysis revealed that inadequate use of AAT was independently related only to previous variceal bleeding and the number of concomitant medications. CONCLUSION AAT is used by a large proportion of patients with cirrhosis. In the majority, therapy is based on inadequate indications, mainly continuous long-term therapy after previous variceal bleeding. Patients with an inadequate indication for acid-suppressive medications have increased severity of symptoms of indigestion, indicating that gastrointestinal symptoms might be a factor contributing to proton-pump inhibitor consumption in these patients.
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Tatara MR, Sliwa E, Krupski W, Worzakowska M. 3-Hydroxy-3-methylbutyrate administration diminishes fundectomy-induced osteopenia of the lumbar spine in pigs. Nutrition 2008; 24:753-60. [PMID: 18490141 DOI: 10.1016/j.nut.2008.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Revised: 12/11/2007] [Accepted: 03/12/2008] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of the study was to test the hypothesis that oral administration with 3-hydroxy-3-methylbutyrate (HMB) positively influences bone metabolism and diminishes fundectomy-induced osteopenia of the axial skeleton in pigs. The pig model was chosen because of its recognized physiologic and anatomic similarities of the gastrointestinal tract and skeletal system to those of humans. METHODS Eighteen male pigs were divided into three weight-matched groups at 40 d of life. Animals from the first and second groups were subjected to experimental fundectomy and the third group was sham operated. Starting the day after the fundectomy, the first and second groups received placebo and HMB, respectively. Animals were sacrificed at the age of 8 mo to obtain L(5) and L(6) vertebrae for analysis. The effects of HMB administration on plasma amino acids concentrations, bone mineral density, morphology, and mechanical properties of the lumbar vertebrae were determined. RESULTS The HMB treatment increased the weight of the vertebrae, bone mineral density, bone mineral content, total bone volume, trabecular bone mineral density, mean volumetric bone mineral density, calcium hydroxyapatite density in the trabecular and cortical bones, and plasma amino acid concentrations in the fundectomized pigs (P < 0.05). Mechanical strength of the spine, expressed by the values of ultimate force, Young's modulus, ultimate stress, stiffness, and work to the ultimate force point was increased in HMB-treated pigs (P < 0.05). CONCLUSION HMB administration to fundectomized pigs improved plasma amino acids concentrations and diminished development of fundectomy-induced osteopenia of the axial skeleton.
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Affiliation(s)
- Marcin R Tatara
- Department of Animal Physiology, Faculty of Veterinary Medicine, The Agricultural University of Lublin, Lublin, Poland.
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Persiani R, Antonacci V, Biondi A, Rausei S, La Greca A, Zoccali M, Ciccoritti L, D'Ugo D. Determinants of surgical morbidity in gastric cancer treatment. J Am Coll Surg 2008; 207:13-9. [PMID: 18589356 DOI: 10.1016/j.jamcollsurg.2007.12.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 12/18/2007] [Accepted: 12/19/2007] [Indexed: 12/19/2022]
Abstract
BACKGROUND The occurrence of early surgical complications after gastrectomy as a treatment for gastric cancer has been reported to have a negative impact on longterm survival. The aim of this study was to identify treatment-related factors that can predict morbidity and mortality in patients undergoing operations for gastric cancer. STUDY DESIGN The charts of 388 patients who underwent different operations for gastric cancer at A Gemelli General Hospital, Catholic University of Rome, Italy, between January 1992 and April 2007, were reviewed. Patients were grouped according to the type of surgical treatment performed. The study end points were postoperative morbidity, mortality, and the length of hospital stay after surgery. RESULTS Overall morbidity and mortality rates were 16.2% (63 patients) and 2.3% (9 patients), respectively. Overall morbidity rates were higher in patients more than 64 years of age, when a gastric tumor was resected along with the spleen, and when an extended lymphadenectomy was performed. Patients older than 64 years had longer postoperative hospital stays, and Roux-en-Y gastrojejunostomy was predictive of a shorter stay. Mortality was not influenced by any surgically related factors. CONCLUSIONS Age, splenectomy, and extended lymphadenectomy were independently associated with the development of complications after gastric cancer operations. After subtotal gastrectomy, Roux-en-Y gastrojejunostomy was associated with a shorter postoperative length of stay than conventional Billroth I and Billroth II reconstructions.
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Affiliation(s)
- Roberto Persiani
- Department of Surgery, 1st General Surgery Unit, Catholic University of Rome, Rome, Italy
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Tyrväinen T, Sand J, Sintonen H, Nordback I. Quality of life in the long-term survivors after total gastrectomy for gastric carcinoma. J Surg Oncol 2008; 97:121-4. [PMID: 18181160 DOI: 10.1002/jso.20925] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Several studies report the health-related quality of life (HRQoL) after total gastrectomy in short term but long-term results have been less published. METHODS One hundred and seventy two patients underwent total gastrectomy between years 1987-1999 for gastric carcinoma. In 2005, 30% of them were still alive. The final study population consisted of 25 patients less than 80 years of age, for whom validated control population data were available. The SF-36 and 15D questionnaires were used as QoL instruments. The median follow-up time from surgery was 9. RESULTS The study group did not differ significantly in any of the SF-36 sub scores from the normal population controls. There was no significant difference in the total score in 15D but the patients did statistically significantly worse than the normal population controls in sleeping, elimination and distress. There was significant weight loss during the follow up, but this was not associated with any of HRQoL changes. CONCLUSIONS This study shows that patients who survived for long-term after total gastrectomy for gastric carcinoma do generally as well as the normal population controls, but depending on the QoL instrument used, may have lower QoL in some sub dimensions.
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Affiliation(s)
- Tuula Tyrväinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
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Abstract
Quality of life (QOL) was studied in gastric cancer patients treated on a randomised, controlled trial comparing D1 (level 1) with D3 (levels 1, 2 and 3) lymphadenectomy. A total of 221 patients were randomly assigned to D1 (n=110) and D3 (n=111) surgery. Quality-of-life assessments included functional outcomes (a 14-item survey about treatment-specific symptoms) and health perception (Spitzer QOL Index) was performed before and after surgery at disease-free status. Patients suffered from irrelative events such as loss of partners was excluded thereafter. Main analyses were done by intention-to-treat. Thus, 214 D1 (106/110=96.4%) and D3 (108/111=97.3%) R0 patients were assessed. Longitudinal analysis showed that functional outcomes decreased at 6 months after surgery and increased over time thereafter, while health perceptions increased over time in general. On the basis of linear mixed model analyses, patients having total gastrectomy, advanced cancer and hemipancreaticosplenectomy, but not complications had poorer QOL than those without. D1 and D3 patients showed no significant difference in QOL. The results suggest that changes of QOL were largely due to scope of gastric resection, disease status and distal pancreaticosplenectomy, rather than the extent of lymph node dissection. This indicates that nodal dissection can be performed for a potentially curable gastric cancer.
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Foukakis T, Lundell L, Gubanski M, Lind PA. Advances in the treatment of patients with gastric adenocarcinoma. Acta Oncol 2007; 46:277-85. [PMID: 17450463 DOI: 10.1080/02841860701218634] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite a decline in its incidence in the Western world, gastric cancer (GC) remains the fourth most frequent cancer diagnosis worldwide and is, after lung cancer, the second leading cause of death from a malignant disease globally. Based on the published literature, treatment guidelines and reports from international meetings, we here review the current treatment options for GC and discuss insights and perspectives from the latest clinical studies. The management of GC in the early stages of the disease is based on an optimal surgical resection of the primary tumor and the regional lymph nodes. However, less than one third of patients have a resectable disease at diagnosis and among those operated, more than half are not cured by surgery alone, due to a high rate of relapse. Thus, for the majority of patients, systemic cytotoxic therapy, and sometimes radiotherapy, is a treatment option both as an adjunct to surgery and in the palliative setting. Adjuvant chemotherapy offers only a marginal benefit and has not become a standard of care in the West. In North America, adjuvant chemoradiation is broadly used, shown to significantly improve overall survival, albeit with the cost of high toxicity. Furthermore, a recently reported study from the United Kingdom demonstrated a significant disease-free and survival benefit by the use of perioperative combination chemotherapy. Several chemotherapeutic agents have been tested as a palliative therapy in advanced GC including 5- fluorouracil (5-FU), oral pyrimidines, platinum derivatives, anthracyclines, taxanes and camptothecans. It is now accepted that chemotherapy is better than best supportive care only and that 5-FU based combinations are more effective than monotherapy. However, the response rates have generally been moderate and there is no consensus on the optimal combination of cytotoxic agents and the potential role of more recently developed "targeted therapies".
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Affiliation(s)
- Theodoros Foukakis
- Department of Oncology, Karolinska University Hospital-Södersjukhuset, Stockholm, Sweden.
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Dinis-Ribeiro M, da Costa-Pereira A, Lopes C, Moreira-Dias L. Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia. J Gastroenterol Hepatol 2007; 22:1594-604. [PMID: 17845687 DOI: 10.1111/j.1440-1746.2007.04863.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia may lead to early diagnosis of gastric cancer. However, to-date no cost-effective model has been proposed. Improved endoscopic examination using magnification chromoendoscopy together with non-invasive functional assessment with pepsinogen serum levels are accurate in the diagnosis of intestinal metaplasia (extension) and minute dysplastic lesions. The aim of this study was to assess the feasibility and cost-effectiveness of a follow-up model for patients with atrophic chronic gastritis and intestinal metaplasia based on gastric mucosal status using magnification chromoendoscopy and pepsinogen. METHODS A cohort of patients with lesions as severe as atrophic chronic gastritis were followed-up according to a standardized protocol using magnification chromoendoscopy with methylene blue and measurement of serum pepsinogen I and II levels. A single node decision tree and Markov chain modeling were used to define cost-effectiveness of this follow-up model versus its absence. Transition rates were considered time-independent and calculated using primary data following cohort data analysis. Costs, quality of life and survival were estimated based on published data and extensive sensitivity analysis was performed. RESULTS A total of 100 patients were successfully followed-up over 3 years. Seven cases of dysplasia were diagnosed during follow-up, all among patients with incomplete intestinal metaplasia at baseline, six of whom had extensive (pepsinogen I to II ratio <3) incomplete intestinal metaplasia. For those individuals with atrophic chronic gastritis or complete intestinal metaplasia, a yearly measurement of pepsinogen levels or an endoscopic examination on a 3-yearly basis would cost 455 euros per quality-adjusted life year (QALY) gain. Endoscopic examination and pepsinogen serum level measurement on a yearly basis would cost 1868 euros per QALY for patients with extensive intestinal metaplasia. CONCLUSIONS The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia is both feasible and cost-effective if improved accurate endoscopic examination of gastric mucosa together with non-invasive assessment of gastric mucosal status are used to identify individuals at high-risk for development of gastric cancer.
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Affiliation(s)
- Mário Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal.
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Pan Y, Li Q, Wang DC, Wang JC, Liang H, Liu JZ, Cui QH, Sun T, Zhang RP, Kong DL, Hao XS. Beneficial effects of jejunal continuity and duodenal food passage after total gastrectomy: a retrospective study of 704 patients. Eur J Surg Oncol 2007; 34:17-22. [PMID: 17884327 DOI: 10.1016/j.ejso.2007.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2006] [Accepted: 08/06/2007] [Indexed: 12/20/2022] Open
Abstract
AIM To evaluate effects of reconstruction procedures on post-operative outcomes and nutritional status after total gastrectomy. METHODS The study group comprised 704 consecutive patients with gastric cancer who underwent total gastrectomy between December 1985 and December 2003. Six alimentary reconstruction procedures were performed, including jejunal continuity [Braun, modified Braun I and II and functional jejunal interposition (FJI)] and jejunum transection ["P" Roux-en-Y and "P" jejunal interposition (PJI)]. The duodenal food passage was maintained only by FJI and PJI. We evaluated the time interval to restore food intake after surgery and the incidence of complications and nutritional status for 12 months. RESULTS Patients who received jejunum transection required 7.8+/-2.5 days and 11.9+/-4.9 days to restore liquid and semi-liquid food intake, respectively, which reduced to 3.9+/-2.1 days for liquid and 7.9+/-3.9 days for semi-liquid food intake by jejunum continuity. The incidence rates of reflux esophagitis and Roux-en-Y syndrome in patients receiving jejunum transection were 23.5% and 42.4%, respectively, which were decreased to 9.35% and 14.7%, respectively, by jejunal continuity. Furthermore, prognostic nutrition index score of patients receiving the procedures maintaining duodenal food passage (52.9+/-10.9) was higher than that of patients without the duodenal food passage (46.7+/-8.2). CONCLUSION Jejunal continuity and duodenal food passage showed beneficial effects on clinical outcomes after surgery. Among these six procedures, FJI was the only procedure to combine the benefits of jejunal continuity and maintaining the duodenal food passage, indicating that FJI has potential clinical application to improve the quality of patient's life after total gastrectomy.
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Affiliation(s)
- Y Pan
- Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Hospital and Institute, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin 300060, PR China
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