Long-term outcomes of postgastrectomy syndrome after total laparoscopic distal gastrectomy using the augmented rectangle technique

Table 1 Postgastrectomy Syndrome Assessment Scale-37 evaluation items

	Item		Subscales
Symptom	1	Abdominal pains	Esophageal reflux subscale (items 2, 3, 5, 16)
	2	Heartburn	Abdominal pain subscale (items 1, 4, 20)
	3	Acid regurgitation	Meal-related distress subscale (items 17-19)
	4	Sucking sensations in the epigastrium	Indigestion subscale (items 6-9)
	5	Nausea and vomiting	Diarrhea subscale (items 11, 12, 14)
	6	Borborygmus	Constipation subscale (items 10, 13, 15)
	7	Abdominal distension	Dumping subscale (items 22, 23, 25)
	8	Eructation
	9	Increased flatus	Total symptom score (more than seven subscale)
	10	Decreased passage of stools
	11	Increased passage of stools
	12	Loose stools
	13	Hard stools
	14	Urgent need for defecation
	15	Feeling of incomplete evacuation
	16	Bile regurgitation
	17	Sense of foods sticking
	18	Postprandial fullness
	19	Early satiation
	20	Lower abdominal pains
	21	Number and type of early dumping symptoms
	22	Early dumping, general symptoms
	23	Early dumping, abdominal symptoms
	24	Number and type of late dumping symptoms
	25	Late dumping symptoms
Living status	26	Ingested amount of food per meal1
	27	Ingested amount of food per day1
	28	Frequency of main meals
	29	Frequency of additional meals
	30	Appetite1	Quality of ingestion subscale (items 30-32)1
	31	Hunger feeling1
	32	Satiety feeling1
	33	Necessity for additional meals
	34	Ability for working
Quality of life	35	Dissatisfaction with symptoms	Dissatisfaction with daily life subscale (items 35-37)
	36	Dissatisfaction at the meal
	37	Dissatisfaction with working

¹Higher scores indicate a better condition. In items or subscale without ¹, higher scores indicate a worse condition. Each subscale and total symptom score is calculated as the average of its composite items or subscale score.

Table 2 Main outcomes consisting of three categories

Category	Main outcome measure
Symptoms
Subscale	Esophageal reflux subscale
	Abdominal pain subscale
	Meal-related distress subscale
	Indigestion subscale
	Diarrhea subscale
	Constipation subscale
	Dumping subscale
Total	Total symptom score
Living status
Body weight	Change in body weight (%)1
Meals (amount)	Amount of food ingested per meal (%)1
	Necessity of additional meals
Meals (quality)	Quality of ingestion subscale1
Work	Ability for working
Quality of life	Dissatisfaction with symptom
Dissatisfaction	Dissatisfaction at the meal
	Dissatisfaction at working
	Dissatisfaction with daily life subscale

¹Higher scores indicate a better condition. In items or subscale without ¹, higher scores indicate a worse condition.

Table 3 Patients’ clinicopathological characteristics

	ART group	PGSAS group	P value
Number of patients	94	909
Postoperative period in mo	27.1 ± 12.2	40.7 ± 30.7	< 0.001
Age in yr	70.0 ± 11.0	61.6 ± 9.1	< 0.001
Sex			0.333
Male	57	594
Female	37	311
Preoperative BMI in kg/m2	22.7 ± 3.4	22.7 ± 3.0	1.000
Stage			< 0.001
I	70	909
II	16	0
III	8	0
IV	0	0
Approach			< 0.001
Open	0	489
Laparoscopic	94	415
Extent of lymph node dissection (D1 >/D1/D2)			0.135
D1 >	0	4
D1	70	586
D2	24	319
Combined resection (absence/presence)			0.001
Absence	89	743
Presence	5	166

ART: Augmented rectangle technique; BMI: Body mass index; PGSAS: Postgastrectomy Syndrome Assessment Scale.

Table 4 Perioperative outcomes

	ART, n = 94
Operation time in min	285 ± 84
Intraoperative blood loss in mL	21.1 ± 16.4
Conversion to open surgery	0 (0%)
Postoperative complication CD ≥ 3	3 (3.1%)
Anastomotic-related complication
Anastomotic leakage	1 (1.0%)
Anastomotic bleeding	2 (2.1%)
Anastomotic stenosis	0 (0%)
Delayed gastric emptying	0 (0%)
Non-anastomotic-related complication
Pancreatic fistula	4 (4.2%)
Surgical site infection	4 (4.2%)
Pneumoniae	1 (1.0%)
Postoperative hospital stay in day	14.5 ± 14.9
Adjuvant chemotherapy	17 (18.1%)
Adjuvant radiation therapy	0 (0%)

ART: Augmented rectangle technique; CD: Clavien-Dindo.

Table 5 Main outcomes in symptoms categories

		ART group, n = 94		PGSAS group, n = 909		Cohen’s d	P value
		mean	SD	mean	SD
Symptom	Esophageal reflux subscale	1.4	0.6	1.7	0.8	0.30	< 0.001
	Abdominal pain subscale	1.5	0.5	1.7	0.7	0.26	0.003
	Meal-related distress subscale	1.7	0.7	2.1	0.9	0.35	< 0.001
	Indigestion subscale	1.6	0.6	2.0	0.8	0.43	< 0.001
	Diarrhea subscale	1.8	0.7	2.1	1.1	0.27	0.001
	Constipation subscale	1.9	0.7	2.2	1.0	0.32	< 0.001
	Dumping subscale	1.5	0.7	2.0	1.0	0.41	< 0.001
	Total symptoms score	1.6	0.4	2.0	0.7	0.45	< 0.001

ART: Augmented rectangle technique; PGSAS: Postgastrectomy Syndrome Assessment Scale; SD: Standard deviation.

Table 6 Main outcomes in living status and quality of life categories

		ART group, n = 94	PGSAS group, n = 909
		mean	SD	mean	SD	Cohen’s d	P value
Living status	Change in body weight (%)1	-9.3	6.4	-7.9	8.1	0.17	0.054
	Amount of food ingested per meal (%)1	6.3	1.9	7.1	2.0	0.41	< 0.001
	Necessity of additional meals	1.8	0.7	1.9	0.8	0.00	0.977
	Quality of ingestion subscale1	3.3	1.0	3.8	0.9	0.52	< 0.001
	Ability for working	1.8	0.9	1.8	0.9	0.13	0.261
Quality of life	Dissatisfaction with symptoms	1.6	0.7	1.8	0.9	0.21	0.022
	Dissatisfaction during meals	1.8	0.9	2.2	1.1	0.29	0.004
	Dissatisfaction during work	1.6	0.7	1.7	0.9	0.03	0.774
	Dissatisfaction with daily life subscale	1.7	0.6	1.9	0.8	0.21	0.016

¹Higher scores indicate a better condition. In items or subscale without ¹, higher scores indicate a worse condition. ART: Augmented rectangle technique; PGSAS: Postgastrectomy Syndrome Assessment Scale; SD: Standard deviation.