Hiroshi Kawahira1, Yasuhiro Kodera2, Naoki Hiki3, Masazumi Takahashi4, Seiji Itoh5, Norio Mitsumori6, Yoshiyuki Kawashima7, Tsutomu Namikawa8, Takao Inada9, Koji Nakada6. 1. Department of Frontier Surgery, Center for Frontier Medical Engineering, Chiba University, Graduate School of Medicine, 1-33, Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan. hk@faculty.chiba-u.jp. 2. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 3. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 4. Division of Gastroenterological Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan. 5. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. 6. Department of Surgery, Jikei University School of Medicine, Tokyo, Japan. 7. Division of Gastroenterological Surgery, Saitama Cancer Center, Ina, Japan. 8. Department of Surgery, Kochi Medical School, Kochi, Japan. 9. Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
Abstract
PURPOSE: The optimal surgical procedure for distal gastrectomy with Roux-en-Y reconstruction (DGRY) remains to be determined. Recently, a self-report assessment instrument, the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), was compiled to evaluate symptoms, the living status and the quality of life of patients who have undergone gastrectomy. We used this scale to evaluate procedures used for DGRY. METHODS: The subjects included 475 patients who underwent DGRY for stage IA/IB gastric cancer. We evaluated whether the size of the remnant stomach, length of the Roux limb, reconstruction route and anastomotic procedure affected the patients' symptoms, living status and quality of life assessed using the PGSAS-45. RESULTS: Patients with a residual stomach of more than half had significantly worse esophageal reflux scores than the patients with a smaller residual stomach (P = 0.0462); a residual stomach of one-third or one-fourth was favorable. A shorter length of the Roux limb was shown to be preferable to a longer Roux limb based on the results of the PGSAS-45. In addition, antecolic reconstruction and the anastomotic procedure using a linear stapler were found to be more favorable. CONCLUSIONS: The size of the remnant stomach and the length and route of the Roux limb significantly influence the patient-reported DGRY outcomes.
PURPOSE: The optimal surgical procedure for distal gastrectomy with Roux-en-Y reconstruction (DGRY) remains to be determined. Recently, a self-report assessment instrument, the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), was compiled to evaluate symptoms, the living status and the quality of life of patients who have undergone gastrectomy. We used this scale to evaluate procedures used for DGRY. METHODS: The subjects included 475 patients who underwent DGRY for stage IA/IB gastric cancer. We evaluated whether the size of the remnant stomach, length of the Roux limb, reconstruction route and anastomotic procedure affected the patients' symptoms, living status and quality of life assessed using the PGSAS-45. RESULTS:Patients with a residual stomach of more than half had significantly worse esophageal reflux scores than the patients with a smaller residual stomach (P = 0.0462); a residual stomach of one-third or one-fourth was favorable. A shorter length of the Roux limb was shown to be preferable to a longer Roux limb based on the results of the PGSAS-45. In addition, antecolic reconstruction and the anastomotic procedure using a linear stapler were found to be more favorable. CONCLUSIONS: The size of the remnant stomach and the length and route of the Roux limb significantly influence the patient-reported DGRY outcomes.