Junya Fujita1, Masazumi Takahashi2, Takashi Urushihara3, Kazuaki Tanabe4, Yasuhiro Kodera5, Takeyoshi Yumiba6, Hideo Matsumoto7, Akinori Takagane8, Chikara Kunisaki9, Koji Nakada10. 1. Department of Surgery, NTT West Osaka Hospital, 2-6-40 Karasugatsuji Tennoji-ku, Osaka, 543-8922, Japan. j.fujita@mhc.west.ntt.co.jp. 2. Division of Gastroenterological Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan. 3. Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan. 4. Department of Gastroenterological and Transplant Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 5. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 6. Department of Surgery, Kenporen Osaka Central Hospital, Osaka, Japan. 7. Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan. 8. Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan. 9. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan. 10. Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: Pylorus-preserving gastrectomy (PPG) is increasingly being used to treat early gastric cancer in the middle third of the stomach, with the hope of ameliorating postoperative dysfunction and improving quality of life (QOL). We evaluated symptoms of postgastrectomy syndrome (PGS) and QOL by means of a newly developed integrated questionnaire, the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), and compared PPG with Billroth-I distal gastrectomy (DGBI). METHODS: The PGSAS-45 consists of 45 items, including items from the SF-8 and GSRS instruments, as well as 22 newly selected items. It was designed to assess the severity of PGS and the living status and QOL of gastrectomized patients. The nationwide PGSAS surveillance study enrolled 2,368 gastric cancer patients who underwent various types of gastrectomy. In this study we analyzed 313 PPG patients and 909 DGBI patients. RESULTS: Body weight loss was -6.9% in the PPG group and -7.9% in the DGBI group (P = 0.052). The PPG group scored better on the diarrhea subscale (PPG; 1.8 vs. DGBI; 2.1, P < 0.0001), dumping subscale (1.8 vs. 2.0, P = 0.003), and frequency of additional meals (1.8 vs. 1.9, P = 0.034). Multiple regression analysis revealed that age and the preservation of the celiac branch of the vagus nerve were independent factors predicting diarrhea and dumping. CONCLUSIONS: It has been suggested that PPG is superior to DGBI for ameliorating PGS. Preservation of the celiac branch of the vagus nerve is recommended to reduce postoperative disorders regardless of the reconstruction method used.
BACKGROUND: Pylorus-preserving gastrectomy (PPG) is increasingly being used to treat early gastric cancer in the middle third of the stomach, with the hope of ameliorating postoperative dysfunction and improving quality of life (QOL). We evaluated symptoms of postgastrectomy syndrome (PGS) and QOL by means of a newly developed integrated questionnaire, the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), and compared PPG with Billroth-I distal gastrectomy (DGBI). METHODS: The PGSAS-45 consists of 45 items, including items from the SF-8 and GSRS instruments, as well as 22 newly selected items. It was designed to assess the severity of PGS and the living status and QOL of gastrectomized patients. The nationwide PGSAS surveillance study enrolled 2,368 gastric cancerpatients who underwent various types of gastrectomy. In this study we analyzed 313 PPGpatients and 909 DGBIpatients. RESULTS: Body weight loss was -6.9% in the PPG group and -7.9% in the DGBI group (P = 0.052). The PPG group scored better on the diarrhea subscale (PPG; 1.8 vs. DGBI; 2.1, P < 0.0001), dumping subscale (1.8 vs. 2.0, P = 0.003), and frequency of additional meals (1.8 vs. 1.9, P = 0.034). Multiple regression analysis revealed that age and the preservation of the celiac branch of the vagus nerve were independent factors predicting diarrhea and dumping. CONCLUSIONS: It has been suggested that PPG is superior to DGBI for ameliorating PGS. Preservation of the celiac branch of the vagus nerve is recommended to reduce postoperative disorders regardless of the reconstruction method used.
Authors: T Imada; Y Rino; M Takahashi; M Suzuki; J Tanaka; M Shiozawa; K Kabara; S Hatori; H Ito; Y Yamamoto; T Amano Journal: Surgery Date: 1998-02 Impact factor: 3.982