Published online Jul 14, 2017. doi: 10.3748/wjg.v23.i26.4823
Peer-review started: February 14, 2017
First decision: March 16, 2017
Revised: April 3, 2017
Accepted: May 4, 2017
Article in press: May 4, 2017
Published online: July 14, 2017
Processing time: 150 Days and 17.7 Hours
To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life (QOL).
We applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45, which consists of 45 items including those from the Short Form-8 and Gastrointestinal Symptom Rating Scale instruments, in addition to 22 newly selected items. Between July 2009 and December 2010, completed questionnaires were received from 2520 patients with curative resection at 1 year or more after having undergone one of six types of gastrectomy for Stage I gastric cancer at one of 52 participating institutions. Of those, we analyzed 1777 eligible questionnaires from patients who underwent total gastrectomy with Roux-en-Y procedure (TGRY) or distal gastrectomy with Billroth-I (DGBI) or Roux-en-Y (DGRY) procedures.
A total of 393, 475 and 909 patients underwent TGRY, DGRY, and DGBI, respectively. The mean age of patients was 62.1 ± 9.2 years. The mean time interval between surgery and retrieval of the questionnaires was 37.0 ± 26.8 mo. On multiple regression analysis, higher preoperative body mass index, total gastrectomy, and female sex, in that order, were independent predictors of greater body weight loss after gastrectomy. There was a significant difference in the degree of weight loss (P < 0.001) among groups stratified according to preoperative body mass index (< 18.5, 18.5-25 and > 25 kg/m2). Multiple linear regression analysis identified lower postoperative body mass index, rather than greater body weight loss postoperatively, as a certain factor for worse QOL (P < 0.0001) after gastrectomy, but the influence of both such factors on QOL was relatively small (R2, 0.028-0.080).
While it is certainly important to maintain adequate body weight after gastrectomy, the impact of body weight loss on QOL is unexpectedly small.
Core tip: Our study of almost 1800 gastrectomy patients revealed that higher preoperative body mass index, total gastrectomy, and female sex were independent predictors of greater body weight loss after gastrectomy. Moreover, we determined lower postoperative body mass index, rather than greater postoperative weight loss, as a certain factor of worse quality of life (QOL), although the effect was not substantial. We believe that this contribution is theoretically and practically relevant in the current context of gastric cancer treatment and recovery because early diagnosis and improved treatments have led to increased long-term survival postgastrectomy, highlighting the need for better QOL.