Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Effect of Four Main Gastrectomy Procedures for Proximal Gastric Cancer on Patient Quality of Life: A Nationwide Multi-Institutional Study

  • Koji Nakada (Department of Laboratory Medicine, The Jikei University School of Medicine) ;
  • Akitoshi Kimura (Division of Gastroenterological Surgery, Clinical Oncology Center, Aomori Prefectural Central Hospital) ;
  • Kazuhiro Yoshida (Department of Surgical Oncology, Gifu University) ;
  • Nobue Futawatari (Department of Surgery, Toho University Ohashi Medical Center) ;
  • Kazunari Misawa (Department of Gastroenterological Surgery, Aichi Cancer Center) ;
  • Kuniaki Aridome (Department of Surgery, Saiseikai Sendai Hospital) ;
  • Yoshiyuki Fujiwara (Division of Gastrointestinal and Pediatric Surgery, Tottori University Faculty of Medicine) ;
  • Kazuaki Tanabe (Department of Gastroenterological Surgery, Hiroshima University Hospital) ;
  • Hirofumi Kawakubo (Department of Surgery, Keio University School of Medicine) ;
  • Atsushi Oshio (Faculty of Letters, Arts, and Sciences, Waseda University) ;
  • Yasuhiro Kodera (Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine)
  • Received : 2022.09.21
  • Accepted : 2022.12.26
  • Published : 2023.04.30
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Abstract

Purpose: This study aimed to examine the effects of 4 main types of gastrectomy for proximal gastric cancer on postoperative symptoms, living status, and quality of life (QOL) using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45). Materials and Methods: We surveyed 1,685 patients with upper one-third gastric cancer who underwent total gastrectomy (TG; n=1,020), proximal gastrectomy (PG; n=518), TG with jejunal pouch reconstruction (TGJP; n=93), or small remnant distal gastrectomy (SRDG; n=54). The 19 main outcome measures (MOMs) of the PGSAS-45 were compared using the analysis of means (ANOM), and the general QOL score was calculated for each gastrectomy type. Results: Patients who underwent TG experienced the lowest postoperative QOL. ANOM showed that 10 MOMs were worse in patients with TG. Four MOMs improved in patients with PG, while 1 worsened. One MOM was improved in patients with TGJP versus 8 MOMs in patients with SRDG. The general QOL scores were as follows: SRDG (+39 points), TGJP (+6 points), PG (+3 points), and TG (-1 point). Conclusions: The TG group experienced the greatest decline in postoperative QOL. SRDG and PG, which preserve part of the stomach without compromising curability, and TGJP, which is used when TG is required, enhance the postoperative QOL of patients with proximal gastric cancer. When selecting the optimal gastrectomy method, it is essential to understand the characteristics of each and actively incorporate guidance to improve postoperative QOL.

Keywords

Acknowledgement

This study was supported by a grant from Jikei University and the Japanese Gastric Cancer Association.

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