Grosek J, Zavrtanik H, Tomažič A. Health-related quality of life after curative resection for gastric adenocarcinoma. World J Gastroenterol 2021; 27(16): 1816-1827 [PMID: 33967559 DOI: 10.3748/wjg.v27.i16.1816]
Corresponding Author of This Article
Aleš Tomažič, MD, PhD, Chief Doctor, Professor, Surgeon, Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloška cesta 7, Ljubljana 1000, Slovenia. ales.tomazic@kclj.si
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
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World J Gastroenterol. Apr 28, 2021; 27(16): 1816-1827 Published online Apr 28, 2021. doi: 10.3748/wjg.v27.i16.1816
Table 1 The time elapsed from surgery to completion of the questionnaires among different surgical procedures
Median (IQR), yr
Total gastrectomy
3 (2-4)
Subtotal distal gastrectomy
3 (2-4)
Billroth II reconstruction
3 (1-4)
Roux-en-Y reconstruction
2.5 (1-4)
Table 2 Baseline characteristics of patients eligible for inclusion (n = 234)
Respondents (n = 116)
Non-respondents (n = 118)
P value
Gender, n (%)
0.192
Male
63 (54.3)
74 (62.7)
Female
53 (45.7)
44 (37.3)
Age at surgery (yr, median, IQR)
66 (58-74)
72 (63-78)
0.016
Performed procedure, n (%)
0.299
Total gastrectomy
43 (37.1)
55 (46.6)
Distal-Billroth II
26 (22.4)
20 (16.9)
Distal-Roux-Y
47 (40.5)
43 (36.4)
Postoperative complications, n (%)
Yes
28 (24.1)
38 (32.2)
0.170
TNM stage, n (%)
0.001
0
3 (2.6)
4 (3.4)
I
52 (44.8)
25 (21.2)
II
32 (27.6)
36 (30.5)
III
29 (25.0)
53 (44.9)
Table 3 European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30) questionnaire scores by the type of resection (Mann-Whitney U test)
Subtotal gastrectomy (n = 73)
Total gastrectomy (n = 43)
P value
mean (SD)
Median (IQR)
mean (SD)
Median (IQR)
Functional scales
Physical functioning
79.9 (21.4)
87 (67-100)
80.3 (19.5)
87 (73-100)
0.954
Role functioning
80.2 (26.7)
100 (67-100)
77.9 (26.1)
83 (67-100)
0.509
Cognitive functioning
81.9 (21.6)
83 (67-100)
82.9 (19.7)
83 (67-100)
0.842
Emotional functioning
82.1 (20.5)
92 (75-100)
76.1 (21.5)
79 (58-96)
0.116
Social functioning
81.5 (22.5)
83 (67-100)
73.7 (26)
83 (50-100)
0.115
Symptoms
Dyspnoea
10.5 (22.1)
0 (0-0)
10.8 (21.5)
0 (0-0)
0.869
Insomnia
28.7 (29.1)
33 (0-33)
27.8 (28.1)
33 (0-33)
0.917
Appetite loss
10 (19.7)
0 (0-0)
12.3 (20.6)
0 (0-33)
0.489
Nausea/vomiting
10.7 (17.4)
0 (0-17)
4.7 (9.8)
0 (0-0)
0.079
Constipation
10.5 (22.1)
0 (0-0)
6.9 (13.6)
0 (0-0)
0.665
Diarrhoea
13.6 (22.7)
0 (0-33)
19.3 (24.4)
0 (0-33)
0.141
Fatigue
30.5 (23.3)
22 (17-33)
34.2 (23.4)
33 (22-50)
0.263
Pain
18.3 (22.4)
17 (0-33)
17.9 (21.6)
17 (0-33)
0.906
Financial problems
16.4 (26.7)
0 (0-33)
27.1 (32.8)
0 (0-67)
0.069
Global health status
66.6 (22.9)
67 (50-83)
67.4 (19.9)
67 (58-83)
0.846
Table 4 European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30) questionnaire scores by the type of reconstruction (Mann-Whitney U test)
Billroth II (n = 26)
Roux-Y (n = 47)
P value
mean (SD)
Median (IQR)
mean (SD)
Median (IQR)
Functional scales
Physical functioning
73.1 (23)
73.5 (53-93)
83.7 (19.6)
92 (73-100)
0.038
Role functioning
70.5 (31.4)
67 (50-100)
85.5 (22.4)
100 (67-100)
0.034
Cognitive functioning
76.9 (26.3)
83 (67-100)
84.7 (18.3)
83 (83-100)
0.301
Emotional functioning
74.9 (27.7)
83 (58-100)
86 (14)
92 (75-100)
0.220
Social functioning
79.5 (25.9)
83 (67-100)
82.6 (20.5)
83 (67-100)
0.792
Symptoms
Dyspnoea
16.7 (30.3)
0 (0-33)
7 (15.4)
0 (0-0)
0.285
Insomnia
37.1 (33.2)
33 (0-67)
24 (25.8)
33 (0-33)
0.102
Appetite loss
12.8 (25.1)
0 (0-33)
8.4 (16.2)
0 (0-0)
0.651
Nausea/vomiting
15.4 (22.1)
0 (0-33)
8.1 (13.8)
0 (0-17)
0.194
Constipation
19.2 (31.5)
0 (0-33)
5.6 (12.5)
0 (0-0)
0.054
Diarrhoea
14.1 (31.6)
0 (0-0)
13.3 (16.4)
0 (0-33)
0.200
Fatigue
41 (28.6)
33 (22-67)
24.6 (17.5)
22 (17-33)
0.028
Pain
28.9 (28.1)
17 (0-50)
12.4 (16.1)
0 (0-17)
0.010
Financial problems
19.2 (28.6)
0 (0-33)
14.8 (25.8)
0 (0-33)
0.510
Global health status
68.2 (24.7)
67 (50-83)
65.7 (22)
67 (50-83)
0.635
Table 5 Surgery type among different stages of the disease
Total gastrectomy, n (%)
Subtotal-Billroth II, n (%)
Subtotal-Roux-Y, n (%)
P value
Stage
0.002
0
4 (4.1)
3 (6.5)
0 (0)
I
25 (25.5)
14 (30.4)
38 (42.2)
II
26 (26.5)
10 (21.7)
32 (35.6)
III
43 (43.9)
19 (41.3)
20 (22.2)
Table 6 Association between surgery type and global health status scores adjusted for demographic and clinical characteristics
β (P value)
Male
-0.11 (0.229)
Age (yr)
-0.05 (0.625)
Total vs Billroth II
-0.001 (0.990)
Roux-Y vs Billroth II
-0.08 (0.492)
Postoperative complications-yes
-0.15 (0.116)
Stage II/III vs 0/I
-0.21 (0.029)
Table 7 Association between surgery type and scores on functional scales adjusted for demographic and clinical characteristics
Emotional
Social
Role
Physical
Cognitive
β
P value
β
P value
β
P value
β
P value
β
P value
Male
0.01
0.901
0.10
0.254
0.09
0.334
0.16
0.089
0.04
0.666
Age (yr)
0.09
0.343
0.05
0.557
0.08
0.379
-0.09
0.343
0.18
0.054
Total vs Billroth II
0.04
0.729
-0.11
0.343
0.15
0.199
0.15
0.201
0.16
0.194
Roux-Y vs Billroth II
0.24
0.041
0.04
0.763
0.24
0.034
0.23
0.048
0.17
0.154
Postoperative complications yes
-0.03
0.730
-0.13
0.150
-0.15
0.101
-0.10
0.292
0.01
0.915
Saage II/III vs 0/I
-0.17
0.062
-0.20
0.031
-0.27
0.003
-0.16
0.079
-0.09
0.324
Table 8 European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire gastric cancer-specific module (QLQ STO-22) questionnaire scores by the type of resection (Mann-Whitney U test)
Subtotal gastrectomy (n = 60)
Total gastrectomy (n = 51)
P value
mean (SD)
Median (IQR)
mean (SD)
Median (IQR)
Dysphagia
11.1 (15.8)
11 (0-11)
17.2 (17.1)
11 (0-33)
0.020
Pain
19.7 (17.9)
17 (8-33)
23.3 (20.9)
17 (8-33)
0.477
Reflux
16 (20.9)
11 (0-22)
22.7 (23.6)
11 (0-44)
0.089
Eating restrictions
14.7 (17.4)
8 (0-17)
21.6 (18.2)
17 (8-33)
0.017
Anxiety
33.1 (23.4)
33 (17-44)
31.4 (25.8)
22 (11-44)
0.591
Dry mouth
24.1 (28.5)
33 (0-33)
24.7 (28.3)
33 (0-33)
0.871
Taste
6.4 (18.1)
0 (0-0)
11.6 (21.7)
0 (0-33)
0.109
Body image
18.7 (29.9)
0 (0-33)
20.1 (27.4)
0 (0-33)
0.567
Hair loss
16.4 (27.9)
0 (0-33)
8.7 (20.9)
0 (0-0)
0.124
Table 9 European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire gastric cancer-specific module (QLQ STO-22) questionnaire scores by the type of reconstruction (Mann-Whitney U test)
Billroth II (n = 18)
Roux-Y (n = 42)
P value
mean (SD)
Median (IQR)
mean (SD)
Median (IQR)
Dysphagia
15.8 (22.3)
5.5 (0-22)
8.5 (10.2)
11 (0-11)
0.526
Pain
24.3 (23.9)
17 (8-33)
17.2 (13.3)
17 (8-25)
0.471
Reflux
28.5 (26.3)
22 (0-44)
9.1 (13)
0 (0-11)
0.001
Eating restrictions
22.3 (22.8)
17 (0-42)
10.4 (11.7)
8 (0-17)
0.069
Anxiety
36.6 (26.9)
33 (22-55)
31.2 (21.3)
33 (11-44)
0.541
Dry mouth
23 (26.3)
33 (0-33)
24.7 (29.9)
0 (0-33)
0.965
Taste
11.5 (26.6)
0 (0-0)
3.5 (10.3)
0 (0-0)
0.247
Body image
26.8 (36.5)
0 (0-33)
14.1 (24.8)
0 (0-33)
0.127
Hair loss
14.1 (27)
0 (0-33)
17.7 (28.6)
0 (0-33)
0.541
Citation: Grosek J, Zavrtanik H, Tomažič A. Health-related quality of life after curative resection for gastric adenocarcinoma. World J Gastroenterol 2021; 27(16): 1816-1827