Yamauchi S, Orita H, Chen J, Egawa H, Yoshimoto Y, Kubota A, Matsui R, Yube Y, Kaji S, Oka S, Brock MV, Fukunaga T. Long-term outcomes of postgastrectomy syndrome after total laparoscopic distal gastrectomy using the augmented rectangle technique. World J Gastrointest Surg 2022; 14(2): 120-131 [PMID: 35317549 DOI: 10.4240/wjgs.v14.i2.120]
Corresponding Author of This Article
Suguru Yamauchi, MD, Doctor, Surgeon, Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan. s.yamauchi.gk@juntendo.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Suguru Yamauchi, Hajime Orita, Jun Chen, Hiroki Egawa, Yutaro Yoshimoto, Akira Kubota, Ryota Matsui, Yukinori Yube, Sanae Kaji, Shinichi Oka, Tetsu Fukunaga, Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo 113-8431, Japan
Malcolm V Brock, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21205-2196, United States
Author contributions: Yamauchi S, Orita H Matusi R, Yube Y, Kaji S, Orita H, Brock MV and Fukunaga T contributed to writing of the manuscript; Yamauchi S, Orita H, Jun C, Egawa H, Yoshimoto Y, Yube Y, Kaji S and Oka S contributed to performing the procedures and analyzing the data; Yamauchi S and Yoshimoto Y contributed to statistical review; Orita H, Fukunaga T and Brock MV contributed to the conception and design of this work.
Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Juntendo University Hospital (Approval No. 20-192).
Informed consent statement: The study design was retrospective and a noninterventional study. Patients were not required to give informed consent to the study because the analysis used anonymized clinical data that were obtained after each patient agreed to treatment by written consent. We also applied an opt-out method to obtain consent for this study. The opt-out approach was used with website disclosure (URL: https://www.gcprec.juntendo.ac.jp/kenkyu/files/6379827945f9a62a8f32ec.pdf).
Conflict-of-interest statement: The authors declare having no conflicts of interest.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. The data is not publicly available due to patient privacy and the General Data Protection Regulation.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Suguru Yamauchi, MD, Doctor, Surgeon, Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan. s.yamauchi.gk@juntendo.ac.jp
Received: October 7, 2021 Peer-review started: October 7, 2021 First decision: December 4, 2021 Revised: December 15, 2021 Accepted: February 10, 2022 Article in press: February 10, 2022 Published online: February 27, 2022 Processing time: 138 Days and 13.6 Hours
Abstract
BACKGROUND
For total laparoscopic distal gastrectomies for gastric cancer, the reconstruction method is critical to the clinical outcome of the procedure. However, which reconstruction technique is optimal remains controversial. We originally reported the augmented rectangle technique (ART) as a reconstruction option for total laparoscopic Billroth I reconstructions. Still, little is known about its effect on long-term outcomes, specifically the incidence of postgastrectomy syndrome and its impact on quality of life.
AIM
To analyze postgastrectomy syndrome and quality of life after ART using the Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaire.
METHODS
At Juntendo University, a total of 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 and March 2020 completed the PGSAS-37 questionnaire. Multidimensional analysis was performed, comparing those 94 ART cases from our institution (ART group) to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS-37 as part of a larger national database (PGSAS group).
RESULTS
Patients in the ART group had significantly better total symptom scores in all the symptom subscales (i.e., esophageal reflux, abdominal pain, meal-related distress, indigestion, diarrhea, constipation, and dumping). The loss of body weight was marginally greater for those in the ART group than in the PGSAS group (-9.3% vs -7.9%, P = 0.054). The ART group scored significantly lower in their dissatisfaction of ongoing symptoms, during meals, and with daily life.
CONCLUSION
ART for Billroth I reconstruction provided beneficial long-term results for postgastrectomy syndrome and quality of life in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.
Core Tip: Reducing the prevalence of postgastrectomy syndrome (PGS) and improving the quality of life (QOL) after gastrectomy for gastric cancer patients has become an important technical challenge for surgeons. We developed the augmented rectangle technique (ART) for Billroth I reconstruction after total laparoscopic distal gastrectomy. Our patient outcome results have been good in the short-term. Long-term patient outcomes have not been studied. Here, we evaluated PGS and QOL after gastrectomy with ART using the Postgastrectomy Syndrome Assessment Scale-37. Application of ART produced beneficial long-term PGS and QOL results in patients undergoing total laparoscopic distal gastrectomies.
