Defecation disorders are crucial sequelae that impairs the quality of life of patients after conventional gastrectomy

Table 1 Relationship of the domains and main outcome measures of the Postgastrectomy Syndrome Assessment Scale-45

Domain	Main outcome measures
Symptoms	Esophageal reflux SS
	Abdominal pain SS
	Meal-related distress SS
	Indigestion SS
	Diarrhea SS
	Constipation SS
	Dumping SS
	Total symptom score
Living status	Change in BW
	Ingestion amount of food per meal
	Necessity for additional meals
	Quality of ingestion SS
	Ability for working
QOL	Dissatisfaction with symptoms
	Dissatisfaction at the meal
	Dissatisfaction at working
	Dissatisfaction for daily life SS
	PCS of SF-8
	MCS of SF-8

Integrated subscales are italicized in the table. SS: Subscale; BW: Body weight; PCS: Physical component summary; MCS: Mental component summary.

Table 2 Patients' characteristics, n (%)

	TG (n = 393)	DG (n = 1384)	P value
Age (yr)1	63.4 ± 9.2	61.8 ± 9.1	0.0022
Gender:			0.0803
Male	276 (71.0)	912 (66.2)
Female	113 (29.0)	46 5(33.8)
Postoperative period (mo)1	35.0 ± 24.6	37.6 ± 27.4	0.0922
Preoperative BMI (kg/m2)1	23.0 ± 3.3	22.8 ± 3.0	0.1762
Surgical approach:			< 0.0013
Laparoscopic	97 (24.9)	567 (41.2)
Open	293 (75.1)	809 (58.8)
Celiac branch of vagus:			< 0.0013
Preserved	12 (3.1)	161 (11.9)
Divided	371 (96.9)	1196 (88.1)

¹Data are presented as mean ± SD.

²t-test.

³Chi-square test.

BMI: Body mass index.

Table 3 Comparison of the severity and ranking of postgastrectomy symptoms between total and distal gastrectomy

	TG (n = 393)		DG (n = 1384)
	Mean ± SD	Ranking	Mean ± SD	Ranking	P value	Cohen's d
Esophageal reflux SS	2.00 ± 1.03	6	1.64 ± 0.78	7	< 0.001	0.43
Abdominal pain SS	1.77 ± 0.79	7	1.68 ± 0.77	6	0.055	0.11
Meal-related distress SS	2.65 ± 1.11	1	2.07 ± 0.88	3	< 0.001	0.62
Indigestion SS	2.30 ± 0.91	3	2.01 ± 0.84	4	< 0.001	0.34
Diarrhea SS	2.28 ± 1.19	4	2.10 ± 1.11	2	0.007	0.16
Constipation SS	2.09 ± 0.93	5	2.19 ± 1.03	1	0.107	0.09
Dumping SS	2.30 ± 1.10	2	1.96 ± 1.01	5	< 0.001	0.32

Integrated subscales are italicized in the table. The interpretation of effect size, Cohen's d: Small, ≥ 0.2; medium, ≥ 0.5; large, ≥ 0.8. SS: Subscale.

Table 4 Correlation between each defecation disorder symptom and other postgastrectomy symptoms after total and distal gastrectomy

		TG (n = 393)			DG (n = 1384)
		r	P value	Ranking	r	P value	Ranking
Diarrhea SS	Esophageal reflux SS	0.273	< 0.001	6	0.260	< 0.001	5
	Abdominal pain SS	0.340	< 0.001	4	0.377	< 0.001	3
	Meal-related distress SS	0.305	< 0.001	5	0.358	< 0.001	4
	Indigestion SS	0.443	< 0.001	2	0.420	< 0.001	2
	Constipation SS	0.341	< 0.001	3	0.232	< 0.001	6
	Dumping SS	0.447	< 0.001	1	0.467	< 0.001	1
Constipation SS	Esophageal reflux SS	0.392	< 0.001	3	0.396	< 0.001	5
	Abdominal pain SS	0.436	< 0.001	1	0.444	< 0.001	3
	Meal-related distress SS	0.402	< 0.001	2	0.479	< 0.001	1
	Indigestion SS	0.365	< 0.001	4	0.469	< 0.001	2
	Diarrhea SS	0.341	< 0.001	6	0.232	< 0.001	6
	Dumping SS	0.350	< 0.001	5	0.415	< 0.001	4

Integrated subscales are italicized in the table. The interpretation of effect size, Pearson correlation coefficient (r): Small, ≥ 0.1; medium, ≥ 0.3; large, ≥ 0.5. SS: Subscale.

Table 5 The effects of defecation disorder symptoms on the living status and quality of life after total and distal gastrectomy (multiple regression analysis)

		TG (n = 393)						DG (n = 1384)
		Diarrhea SS		Constipation SS				Diarrhea SS		Constipation SS
		β	P value	β	P value	R2	P value	β	P value	β	P value	R2	P value
Living status	Change in BW	-0.003	0.960	-0.052	0.359	0.003	0.613	-0.061	0.034	-0.039	0.170	0.006	0.017
	Ingested amount of food per meal	0.087	0.113	-0.182	0.001	0.030	0.004	-0.150	< 0.001	-0.183	< 0.001	0.069	< 0.001
	Necessity for additional meals	-0.060	0.270	0.147	0.008	0.019	0.027	0.111	< 0.001	0.182	< 0.001	0.055	< 0.001
	Quality of ingestion SS	0.058	0.292	-0.177	0.001	0.028	0.006	-0.080	0.004	-0.138	< 0.001	0.030	< 0.001
	Ability for working	-0.071	0.189	0.275	< 0.001	0.068	< 0.001	0.122	< 0.001	0.260	< 0.001	0.097	< 0.001
QOL	Dissatisfaction with symptoms	0.100	0.055	0.276	< 0.001	0.105	< 0.001	0.257	< 0.001	0.244	< 0.001	0.155	< 0.001
	Dissatisfaction at the meal	0.012	0.813	0.275	< 0.001	0.078	< 0.001	0.266	< 0.001	0.269	< 0.001	0.176	< 0.001
	Dissatisfaction at working	0.066	0.205	0.292	< 0.001	0.102	< 0.001	0.234	< 0.001	0.237	< 0.001	0.137	< 0.001
	Dissatisfaction for daily life SS	0.067	0.189	0.338	< 0.001	0.134	< 0.001	0.297	< 0.001	0.294	< 0.001	0.216	< 0.001
	PCS of SF-8	-0.058	0.258	-0.323	< 0.001	0.120	< 0.001	-0.140	< 0.001	-0.242	< 0.001	0.094	< 0.001
	MCS of SF-8	-0.147	0.005	-0.227	< 0.001	0.096	< 0.001	-0.214	< 0.001	-0.244	< 0.001	0.130	< 0.001

Integrated subscales are italicized in the table. The interpretation of effect size, standardization coefficient of regression (β): Small, ≥ 0.1; medium, ≥ 0.3; large, ≥ 0.5. The interpretation of effect size, coefficient of determination (R²): Small, ≥ 0.02; medium, ≥ 0.13; large, ≥ 0.26. QOL: Quality of life. SS: Subscale; BW: Body weight; PCS: Physical component summary; MCS: Mental component summary.

Table 6 The effects of various clinical factors on defecation disorder symptoms after gastrectomy (multiple regression analysis)

	Objective variables
	Diarrhea SS		Constipation SS
Explanatory variables	β	P value	β	P value
Type of gastrectomy	0.061	0.013	-0.032	0.198
Postoperative period (mo)	-0.038	0.123	-0.010	0.697
Age (yr)	-0.102	< 0.0001	0.031	0.213
Gender (Male)	0.062	0.010	-0.073	0.003
Approach (laparoscopic)	-0.027	0.288	-0.002	0.947
Celiac branch of vagus (preserved)	-0.070	0.004	0.007	0.790
R2	0.023	< 0.0001	0.007	0.068

Integrated subscales are italicized in the table. SS: Subscale