Chikara Kunisaki1, Kazuhiro Yoshida2, Masashi Yoshida3, Sohei Matsumoto4, Takaaki Arigami5, Yoichi Sugiyama6, Yasuyuski Seto7, Yuji Akiyama8, Atsushi Oshio9, Koji Nakada10. 1. Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan. s0714@med.yokohama-cu.ac.jp. 2. Department of Surgical Oncology, Gifu University, Gifu, Japan. 3. Department of Surgery, International University of Health and Welfare, Otawara, Japan. 4. Department of Surgery, Nara Medical University, Kashihara, Japan. 5. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima, Japan. 6. Department of Surgery, JA General Hospital, Hiroshima, Japan. 7. Gastrointestinal Surgery/Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 8. Department of Surgery, Iwate Medical University, Morioka, Japan. 9. Faculty of Letters, Arts, and Sciences, Waseda University, Tokyo, Japan. 10. Department of Laboratory Medicine, Jikei University, Tokyo, Japan.
Abstract
BACKGROUND: It is important to determine the effect of clinical factors on several domains (symptoms, living status, and quality of life [QOL]) after gastrectomy to establish individualized therapeutic strategies. This study was designed to determine the factors-particularly surgical method-that influence certain domains after gastrectomy for proximal gastric cancer by using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire. METHODS: We conducted a nationwide study of PGSAS-45 questionnaire responses retrieved from 1950 (82.5%) patients from 70 institutions who had undergone gastrectomy for gastric cancer. Of these, 1,538 responses for proximal gastric cancer (1020 total gastrectomies and 518 proximal gastrectomies [PGs]) were examined. RESULTS: PG significantly and favorably affected four main outcome measures (MOMs): elderly affected 10 MOMs, male sex affected 4 MOMs, longer postoperative period affected 8 MOMs, preservation of the vagus nerve affected 1 MOM, adjuvant chemotherapy affected 1 MOM, clinical stage affected 2 MOMs, and more extensive lymph node dissection affected 2 MOMs. However, the laparoscopic approach had an adverse effect on MOMs and combined resection of other organs had no favorable effect on any MOMs. CONCLUSIONS: This PGSAS NEXT study showed that it is better to perform PG for proximal gastric cancer, even for patients with advanced cancer, to obtain favorable postoperative QOL if oncological safety is guaranteed. Because the MOMs of PGSAS-45 are positively and negatively influenced by various background factors, it also is necessary to provide personalized care for each patient to prevent deterioration and further improve symptoms, living status, and QOL postoperatively.
BACKGROUND: It is important to determine the effect of clinical factors on several domains (symptoms, living status, and quality of life [QOL]) after gastrectomy to establish individualized therapeutic strategies. This study was designed to determine the factors-particularly surgical method-that influence certain domains after gastrectomy for proximal gastric cancer by using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire. METHODS: We conducted a nationwide study of PGSAS-45 questionnaire responses retrieved from 1950 (82.5%) patients from 70 institutions who had undergone gastrectomy for gastric cancer. Of these, 1,538 responses for proximal gastric cancer (1020 total gastrectomies and 518 proximal gastrectomies [PGs]) were examined. RESULTS: PG significantly and favorably affected four main outcome measures (MOMs): elderly affected 10 MOMs, male sex affected 4 MOMs, longer postoperative period affected 8 MOMs, preservation of the vagus nerve affected 1 MOM, adjuvant chemotherapy affected 1 MOM, clinical stage affected 2 MOMs, and more extensive lymph node dissection affected 2 MOMs. However, the laparoscopic approach had an adverse effect on MOMs and combined resection of other organs had no favorable effect on any MOMs. CONCLUSIONS: This PGSAS NEXT study showed that it is better to perform PG for proximal gastric cancer, even for patients with advanced cancer, to obtain favorable postoperative QOL if oncological safety is guaranteed. Because the MOMs of PGSAS-45 are positively and negatively influenced by various background factors, it also is necessary to provide personalized care for each patient to prevent deterioration and further improve symptoms, living status, and QOL postoperatively.
Authors: Masaya Nakauchi; Elvira Vos; Yelena Y Janjigian; Geoffrey Y Ku; Mark A Schattner; Makoto Nishimura; Mithat Gonen; Daniel G Coit; Vivian E Strong Journal: Ann Surg Oncol Date: 2021-03-11 Impact factor: 4.339
Authors: Sang Il Youn; Sang Yong Son; Kanghaeng Lee; Yongjoon Won; Sahong Min; Young Suk Park; Sang-Hoon Ahn; Hyung-Ho Kim Journal: Gastric Cancer Date: 2021-01-03 Impact factor: 7.370