Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2021; 13(5): 461-475
Published online May 27, 2021. doi: 10.4240/wjgs.v13.i5.461
Comparison of effects of six main gastrectomy procedures on patients’ quality of life assessed by Postgastrectomy Syndrome Assessment Scale-45
Koji Nakada, Yoshiyuki Kawashima, Shinichi Kinami, Ryoji Fukushima, Hiroshi Yabusaki, Akiyoshi Seshimo, Naoki Hiki, Keisuke Koeda, Mikihiro Kano, Yoshikazu Uenosono, Atsushi Oshio, Yasuhiro Kodera
Koji Nakada, Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Yoshiyuki Kawashima, Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama 362-0806, Japan
Shinichi Kinami, Department of Surgical Oncology, Kanazawa Medical University, Kahoku-gun 920-0293, Ishikawa, Japan
Ryoji Fukushima, Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan
Hiroshi Yabusaki, Department of Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
Akiyoshi Seshimo, Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
Naoki Hiki, Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
Keisuke Koeda, Department of Medical Safety Science, Iwate Medical University, Iwate 028-3695, Japan
Mikihiro Kano, Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima 731-0293, Japan
Yoshikazu Uenosono, Department of Digestive Surgery, Imamura General Hospital, Kagoshima 890-0064, Japan
Atsushi Oshio, Faculty of Letters, Arts and Sciences, Waseda University, Tokyo 162-8644, Japan
Yasuhiro Kodera, Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
Author contributions: Nakada K, Kinami S, Uenosono Y, Kodera Y designed the study, collected and managed the data; Kawashima Y, Fukushima R, Yabusaki H, Seshimo A, Hiki N, Koeda K, Kano M collected and managed the data; Oshio A contributed to statistical analysis; Nakada K wrote the paper; all authors have read and approved the final version to be published.
Supported by The Jikei University School of Medicine; and the Japanese Society for Gastro-surgical Pathophysiology.
Institutional review board statement: This study was approved by the local ethics committees of each participating institution and was in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1964 and later versions.
Informed consent statement: Written informed consent was obtained from all enrolled patients.
Conflict-of-interest statement: The authors declare no conflicts of interests related to the publication of this study.
Data sharing statement: No additional data was available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Koji Nakada, MD, PhD, Professor, Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan. nakada@jikei.ac.jp
Received: January 19, 2021
Peer-review started: January 19, 2021
First decision: February 14, 2021
Revised: February 21, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: May 27, 2021
Processing time: 121 Days and 16.7 Hours
ARTICLE HIGHLIGHTS
Research background

No study has simultaneously assessed the effects of the different gastrectomy procedures used to treat gastric cancer at various sites on the postgastrectomy quality of life (QOL).

Research motivation

It is important for surgeons to understand the general aspects of how the site and extent of gastrectomy affect patient’s postoperative QOL.

Research objectives

The aim of this study was to compare the effects of six main gastrectomy procedures on the postoperative QOL using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45).

Research methods

The 2368 patients who underwent either of the six main gastrectomy procedures [total gastrectomy with Roux-en-Y reconstruction (TGRY; n = 393), proximal gastrectomy (PG; n = 193), distal gastrectomy with Roux-en-Y reconstruction (DGRY; n = 475), distal gastrectomy with Billroth-I reconstruction (DGBI; n = 909), pylorus-preserving gastrectomy (PPG; n = 313), and local resection of the stomach (LR; n = 85)] were enrolled in this study. The severity and characteristics of postgastrectomy syndrome were compared among the six gastrectomy procedures by the main outcome measures of PGSAS-45.

Research results

Postoperative QOL was greatly impaired in TGRY and PG, and was excellent in LR. After distal gastrectomy, diarrhea and dumping were less frequent in PPG, and there was no difference between DGBI and DGRY. The most noticeable adverse effects with significant differences among the gastrectomy procedures were meal-related distress SS, dissatisfaction at the meal, and weight loss.

Research conclusions

Postoperative QOL greatly differed depending on the site and extent of gastrectomy.

Research perspectives

To improve postgastrectomy QOL, it is important for surgeons to understand these matters to select the appropriate procedure, to improve the surgical technique to compensate for the shortcomings of each procedure, and to enhance postoperative care by providing appropriate dietary guidance and detecting and addressing postgastrectomy syndromes at an early stage.