BACKGROUND Following a total gastrectomy,patients suffer the most severe form of postgastrectomy syndrome.This is a significant clinical problem as it reduces quality of life(QOL).Roux-en-Y reconstruction,which is reg...BACKGROUND Following a total gastrectomy,patients suffer the most severe form of postgastrectomy syndrome.This is a significant clinical problem as it reduces quality of life(QOL).Roux-en-Y reconstruction,which is regarded as the gold standard for post-total gastrectomy reconstruction,can be performed using various techniques.Although the technique used could affect postoperative QOL,there are no previous reports regarding the same.AIM To investigate the effect of different techniques on postoperative QOL.The data was collected from the registry of the postgastrectomy syndrome assessment study(PGSAS).METHODS In the present study,we analyzed 393 total gastrectomy patients from those enrolled in PGSAS.Patients were divided into groups depending on whether antecolic or retrocolic jejunal elevation was performed,whether the Roux limb was“40 cm”,“shorter”(≤39 cm),or“longer”(≥41 cm),and whether the device used for esophageal and jejunal anastomosis was a circular or linear stapler.Subsequently,we comparatively investigated postoperative QOL of the patients.RESULTS Reconstruction route:Esophageal reflux subscale(SS)occurred significantly less frequently in patients who underwent antecolic reconstruction.Roux limb length:“Shorter”Roux limb did not facilitate esophageal reflux SS and somewhat attenuated indigestion SS and abdominal pain SS.Anastomosis technique:In terms of esophagojejunostomy techniques,no differences were observed.CONCLUSION The techniques used for total gastrectomy with Roux-en-Y reconstruction significantly affected postoperative symptoms.Our results suggest that elevating the Roux limb,which is not overly long,through an antecolic route may improve patients’QOL.展开更多
To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life(QOL).METHODSWe applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45,wh...To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life(QOL).METHODSWe applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45,which consists of 45 items including those from the Short Form-8 and Gastrointestinal Symptom Rating Scale instruments,in addition to 22 newly selected items.Between July 2009 and December 2010,completed questionnaires were received from 2520 patients with curative resection at 1 year or more after having undergone one of six types of gastrectomy for Stage I gastric cancer at one of 52 participating institutions.Of those,we analyzed 1777 eligible questionnaires from patients who underwent total gastrectomy with Roux-en-Y procedure(TGRY)or distal gastrectomy with Billroth-I(DGBI)or Roux-en-Y(DGRY)procedures.RESULTSA total of 393,475 and 909 patients underwent TGRY,DGRY,and DGBI,respectively.The mean age of patients was 62.1±9.2 years.The mean time interval between surgery and retrieval of the questionnaires was 37.0±26.8 mo.On multiple regression analysis,higher preoperative body mass index,total gastrectomy,and female sex,in that order,were independent predictors of greater body weight loss after gastrectomy.There was a significant difference in the degree of weight loss(P<0.001)among groups stratified according to preoperative body mass index(<18.5,18.5-25 and>25 kg/m<sup>2</sup>).Multiple linear regression analysis identified lower postoperative body mass index,rather than greater body weight loss postoperatively,as a certain factor for worse QOL(P<0.0001)after gastrectomy,but the influence of both such factors on QOL was relatively small(R<sup>2</sup>,0.028-0.080).CONCLUSIONWhile it is certainly important to maintain adequate body weight after gastrectomy,the impact of body weight loss on QOL is unexpectedly small.展开更多
BACKGROUND Postgastrectomy syndromes(PGS) after curative gastrectomy for gastric cancer are influenced by not only gastrectomy type but also by background factors. Recently, a nationwide PGS study was performed using ...BACKGROUND Postgastrectomy syndromes(PGS) after curative gastrectomy for gastric cancer are influenced by not only gastrectomy type but also by background factors. Recently, a nationwide PGS study was performed using the Postgastrectomy Syndrome Assessment Scale-45(PGSAS-45) questionnaire.AIM To determine the influence of each background factor on PGS for each gastrectomy type using PGS assessment study(PGSAS) data as an additional analysis. METHODS The data of 2368 patients were obtained from the PGSAS. This included patients undergoing distal gastrectomy(DG) with Billroth I reconstruction, DG with Roux-en-Y reconstruction, total gastrectomy with Roux-en-Y, proximal gastrectomy, pylorus-preserving gastrectomy(PPG), and local resection. Multiple regression analysis was performed to explore the independent effects of each background factor on the main outcome measures(MOMs) of PGSAS-45 for each gastrectomy type. The background factors included postoperative period, age, sex, surgical approach(laparoscopic or open), and the status of the celiac branch of the vagal nerve.RESULTS The MOMs of DG and PPG were highly affected by background factors, whereas those of total gastrectomy with Roux-en-Y, proximal gastrectomy, and local resection were not. Worse PGS were found in females, whereas a longer postoperative period alleviated some of the MOMs. For DG and PPG, a laparoscopic approach and preservation of the celiac branch improved several MOMs.CONCLUSION Various background factors affected PGS, and their influence varied with the type of gastrectomy performed. Laparoscopic surgery and celiac branch preservation can improve PGS in patients undergoing DG and PPG.展开更多
基金Supported by The Jikei University School of Medicineand Japanese Society for Gastro-surgical Pathophysiology
文摘BACKGROUND Following a total gastrectomy,patients suffer the most severe form of postgastrectomy syndrome.This is a significant clinical problem as it reduces quality of life(QOL).Roux-en-Y reconstruction,which is regarded as the gold standard for post-total gastrectomy reconstruction,can be performed using various techniques.Although the technique used could affect postoperative QOL,there are no previous reports regarding the same.AIM To investigate the effect of different techniques on postoperative QOL.The data was collected from the registry of the postgastrectomy syndrome assessment study(PGSAS).METHODS In the present study,we analyzed 393 total gastrectomy patients from those enrolled in PGSAS.Patients were divided into groups depending on whether antecolic or retrocolic jejunal elevation was performed,whether the Roux limb was“40 cm”,“shorter”(≤39 cm),or“longer”(≥41 cm),and whether the device used for esophageal and jejunal anastomosis was a circular or linear stapler.Subsequently,we comparatively investigated postoperative QOL of the patients.RESULTS Reconstruction route:Esophageal reflux subscale(SS)occurred significantly less frequently in patients who underwent antecolic reconstruction.Roux limb length:“Shorter”Roux limb did not facilitate esophageal reflux SS and somewhat attenuated indigestion SS and abdominal pain SS.Anastomosis technique:In terms of esophagojejunostomy techniques,no differences were observed.CONCLUSION The techniques used for total gastrectomy with Roux-en-Y reconstruction significantly affected postoperative symptoms.Our results suggest that elevating the Roux limb,which is not overly long,through an antecolic route may improve patients’QOL.
基金Supported by Jikei University School of Medicine and the Japanese Society for Gastro-surgical PathophysiologyJPGSWP and registered to UMIN-CTR#000002116 entitled
文摘To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life(QOL).METHODSWe applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45,which consists of 45 items including those from the Short Form-8 and Gastrointestinal Symptom Rating Scale instruments,in addition to 22 newly selected items.Between July 2009 and December 2010,completed questionnaires were received from 2520 patients with curative resection at 1 year or more after having undergone one of six types of gastrectomy for Stage I gastric cancer at one of 52 participating institutions.Of those,we analyzed 1777 eligible questionnaires from patients who underwent total gastrectomy with Roux-en-Y procedure(TGRY)or distal gastrectomy with Billroth-I(DGBI)or Roux-en-Y(DGRY)procedures.RESULTSA total of 393,475 and 909 patients underwent TGRY,DGRY,and DGBI,respectively.The mean age of patients was 62.1±9.2 years.The mean time interval between surgery and retrieval of the questionnaires was 37.0±26.8 mo.On multiple regression analysis,higher preoperative body mass index,total gastrectomy,and female sex,in that order,were independent predictors of greater body weight loss after gastrectomy.There was a significant difference in the degree of weight loss(P<0.001)among groups stratified according to preoperative body mass index(<18.5,18.5-25 and>25 kg/m<sup>2</sup>).Multiple linear regression analysis identified lower postoperative body mass index,rather than greater body weight loss postoperatively,as a certain factor for worse QOL(P<0.0001)after gastrectomy,but the influence of both such factors on QOL was relatively small(R<sup>2</sup>,0.028-0.080).CONCLUSIONWhile it is certainly important to maintain adequate body weight after gastrectomy,the impact of body weight loss on QOL is unexpectedly small.
基金Supported by a grant from the Jikei University School of Medicine and Japanese Society for Gastro-surgical Pathophysiology
文摘BACKGROUND Postgastrectomy syndromes(PGS) after curative gastrectomy for gastric cancer are influenced by not only gastrectomy type but also by background factors. Recently, a nationwide PGS study was performed using the Postgastrectomy Syndrome Assessment Scale-45(PGSAS-45) questionnaire.AIM To determine the influence of each background factor on PGS for each gastrectomy type using PGS assessment study(PGSAS) data as an additional analysis. METHODS The data of 2368 patients were obtained from the PGSAS. This included patients undergoing distal gastrectomy(DG) with Billroth I reconstruction, DG with Roux-en-Y reconstruction, total gastrectomy with Roux-en-Y, proximal gastrectomy, pylorus-preserving gastrectomy(PPG), and local resection. Multiple regression analysis was performed to explore the independent effects of each background factor on the main outcome measures(MOMs) of PGSAS-45 for each gastrectomy type. The background factors included postoperative period, age, sex, surgical approach(laparoscopic or open), and the status of the celiac branch of the vagal nerve.RESULTS The MOMs of DG and PPG were highly affected by background factors, whereas those of total gastrectomy with Roux-en-Y, proximal gastrectomy, and local resection were not. Worse PGS were found in females, whereas a longer postoperative period alleviated some of the MOMs. For DG and PPG, a laparoscopic approach and preservation of the celiac branch improved several MOMs.CONCLUSION Various background factors affected PGS, and their influence varied with the type of gastrectomy performed. Laparoscopic surgery and celiac branch preservation can improve PGS in patients undergoing DG and PPG.
