Effect of Four Main Gastrectomy Procedures for Proximal Gastric Cancer on Patient Quality of Life: A Nationwide Multi-Institutional Study.

IF 3.2 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Gastric Cancer Pub Date : 2023-04-01 DOI:10.5230/jgc.2023.23.e14

Koji Nakada, Akitoshi Kimura, Kazuhiro Yoshida, Nobue Futawatari, Kazunari Misawa, Kuniaki Aridome, Yoshiyuki Fujiwara, Kazuaki Tanabe, Hirofumi Kawakubo, Atsushi Oshio, Yasuhiro Kodera

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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.

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四种主要胃切除术对近端胃癌患者生活质量的影响:一项全国性多机构研究。

目的:本研究采用胃切除术后综合征评定量表-45 (PGSAS-45)，探讨4种主要胃切除术方式对近端胃癌患者术后症状、生活状态和生活质量的影响。材料和方法:我们调查了1,685例接受全胃切除术(TG;n= 1020)，近端胃切除术(PG;n=518)， TG伴空肠袋重建(TGJP;n=93)，或小残余远端胃切除术(SRDG;n = 54)。采用均数分析(ANOM)对PGSAS-45的19项主要结局指标(mom)进行比较，并计算各胃切除术类型的总体生活质量评分。结果:TG组患者术后生活质量最低。ANOM结果显示，TG患者的10个mom更差。PG患者中4例mom改善，1例恶化。TGJP患者有1例MOM得到改善，而SRDG患者有8例MOM得到改善。总体生活质量评分如下:SRDG(+39分)、TGJP(+6分)、PG(+3分)、TG(-1分)。结论:TG组术后生活质量下降幅度最大。SRDG和PG保留部分胃而不影响治愈率，TGJP在需要TG时使用，可提高近端胃癌患者的术后生活质量。在选择最佳胃切除术方法时，了解每种方法的特点，并积极纳入指导，以提高术后生活质量。

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来源期刊

Journal of Gastric Cancer Biochemistry, Genetics and Molecular Biology-Cancer Research

CiteScore

4.30

自引率

12.00%

发文量

期刊介绍： The Journal of Gastric Cancer (J Gastric Cancer) is an international peer-reviewed journal. Each issue carries high quality clinical and translational researches on gastric neoplasms. Editorial Board of J Gastric Cancer publishes original articles on pathophysiology, molecular oncology, diagnosis, treatment, and prevention of gastric cancer as well as articles on dietary control and improving the quality of life for gastric cancer patients. J Gastric Cancer includes case reports, review articles, how I do it articles, editorials, and letters to the editor.