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Yoshida S, Nishigori T, Maekawa H, Hoshino N, Hisamori S, Tsunoda S, Kobayashi A, Nobori Y, Shide K, Inagaki N, Obama K. Total gastrectomy as a risk factor for postoperative loss of skeletal muscle in minimally invasive surgery for patients with gastric cancer. Asian J Endosc Surg 2023; 16:715-723. [PMID: 37524325 DOI: 10.1111/ases.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/06/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Loss of skeletal muscle mass after gastrectomy for gastric cancer leads to decreased quality of life and poor postoperative survival. However, few studies have examined the postoperative loss of skeletal muscle mass following minimally invasive gastrectomy. This study investigated the impact of minimally invasive total gastrectomy (MI-TG) on changes in skeletal muscle mass during the early postoperative period. METHODS Patients who underwent MI-TG or minimally invasive distal or proximal gastrectomy (MI-nonTG) for cStage I-III gastric cancer were retrospectively analyzed (n = 58 vs. 182). Their body composition was measured before surgery and 2 months after surgery. Multivariable linear regression analysis was performed to clarify the impact of the surgical procedure on skeletal muscle index changes using clinically relevant covariates. RESULTS Skeletal muscle mass decreased more in the MI-TG group than in the MI-nonTG group (median [interquartile range]; -5.9% [-10.6, -3.7] vs -4.5% [-7.3, -1.9], P = 0.004). In multivariable linear regression analysis using clinically relevant covariates, MI-TG was an independent risk factor for postoperative loss of skeletal muscle mass (coefficient - 2.6%, 95% CI -4.5 to -0.68, P = 0.008). CONCLUSIONS Total gastrectomy was a risk factor for loss of skeletal muscle mass during the early postoperative period. If oncologically feasible, proximal or distal gastrectomy with a small remnant stomach should be considered.
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Affiliation(s)
- Shinya Yoshida
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Tatsuto Nishigori
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
- Department of Patient Safety, Kyoto University Hospital, Kyoto, Japan
| | | | - Nobuaki Hoshino
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Shigeo Hisamori
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Ami Kobayashi
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Yukiko Nobori
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Kenichiro Shide
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
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Lee SS, Chung HY, Kwon OK. Impact on quality of life with affirmative feedback on weight loss after gastrectomy. Sci Rep 2023; 13:15454. [PMID: 37723236 PMCID: PMC10507081 DOI: 10.1038/s41598-023-42695-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
This study investigated the feasibility of improving post-gastrectomy satisfaction/quality of life (QoL) of gastric cancer survivors by readjusting their expectations through patient interviews. Weight loss after gastric cancer surgery is common, and a change in the departmental policy helped in providing cancer survivors with an alternative interpretation of lost weight. Under the new policy, a group of patients who were preoperatively overweight or obese were provided with affirmative feedback, despite their postoperative weight loss. The European Organization for Research and Treatment of Cancer QoL Questionnaire-C30 and -STO22 were used to assess the QoL. The postoperative 1-year QoL was compared before (control) and after policy changes (affirmative-feedback group) in preoperatively overweight (or obese) patients who lost weight. Despite the weight loss, the affirmative-feedback group exhibited a higher percentage of "less worried" responses (90.4%) on low body weight concerns as compared to the control group (76.5%; P = 0.037). Significant QoL advantages were also observed in the affirmative-feedback group on multiple scales (global health status/QoL, nausea/vomiting, diarrhea, dysphagia, dry mouth, and body image). Patient interviews with affirmative feedback on weight loss improved weight satisfaction and QoL in gastric cancer survivors who lost weight.
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Affiliation(s)
- Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721, Republic of Korea
| | - Ho Young Chung
- Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 700-721, Republic of Korea.
| | - Oh Kyoung Kwon
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Nakazono M, Aoyama T, Komori K, Watanabe H, Kano K, Nagasawa S, Segami K, Tamagawa H, Yukawa N, Rino Y, Ogata T, Oshima T. The Comparison of the Dietary Intake Loss Between Elderly and Non-Elderly Patients After Gastrectomy for Gastric Cancer. J Gastrointest Cancer 2023; 54:35-43. [PMID: 34978046 PMCID: PMC10182928 DOI: 10.1007/s12029-021-00776-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIM The present study quantified the changes in the dietary and nutritional intake after gastrectomy between elderly and non-elderly patients. PATIENTS AND METHODS This prospective observational study enrolled patients who underwent curative gastrectomy for gastric cancer. RESULTS Twenty-three patients ≥ 75 years old were classified into the elderly group, and 127 patients < 75 years old were classified into the non-elderly group. The respective median % dietary intake losses at 1 and 3 months postoperatively were -12.4% and -5.3% in the elderly group and -8.3% and -2.8% in the non-elderly group (p = 0.075 and 0.080). On comparing the intake loss of three major nutrients, the respective median % lipid intake losses at 1 and 3 months postoperatively were -13.5% and -5.8% in the elderly group and -7.3% and 0% in the non-elderly group (p = 0.029 and 0.045). CONCLUSION Our results suggested that elderly patients experienced more serious lipid intake loss after gastrectomy than non-elderly patients.
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Affiliation(s)
- Masato Nakazono
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Toru Aoyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
- Department of Surgery, Yokohama City University, Yokohama, Japan.
| | - Keisuke Komori
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Hayato Watanabe
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Kazuki Kano
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | | | - Kenki Segami
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
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Jung HK, Tae CH, Lee HA, Lee KE, Moon CM, Kim SE, Seoh JY, Lee JH. Association Between Gut Regulatory Hormones and Post-operative Weight Loss Following Gastrectomy in Patients With Gastric Cancer. J Neurogastroenterol Motil 2022; 28:409-417. [PMID: 35799234 PMCID: PMC9274481 DOI: 10.5056/jnm21145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/31/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hye-Kyung Jung
- Departments of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chung Hyun Tae
- Departments of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye Ah Lee
- Clinical Trial Center, Mokdong Hospital, Ewha Womans University, Seoul, Korea
| | - Ko Eun Lee
- Departments of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chang Mo Moon
- Departments of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Seong Eun Kim
- Departments of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ju Young Seoh
- Departments of Microbiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Joo-Ho Lee
- Departments of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
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Nakazono M, Aoyama T, Hayashi T, Hara K, Segami K, Shimoda Y, Nagasawa S, Kumazu Y, Yamada T, Tamagawa H, Shiozawa M, Morinaga S, Rino Y, Masuda M, Ogata T, Oshima T. Comparison of the Dietary Intake Loss Between Total and Distal Gastrectomy for Gastric Cancer. In Vivo 2021; 35:2369-2377. [PMID: 34182520 DOI: 10.21873/invivo.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The changes of dietary intake (DI) after gastrectomy have not been objectively reported. It has not been clear how much DI loss is experienced after total gastrectomy (TG) in comparison to after distal gastrectomy (DG). This study quantified the changes of DI after gastrectomy, and clarified how much DI loss is experienced after TG. PATIENTS AND METHODS This was a prospective observational study. Patients who underwent gastrectomy for gastric cancer were enrolled. The DI loss was evaluated at 1 and 3 months postoperatively. RESULTS Thirty-three patients underwent TG, and 117 patients underwent DG. The median %DI loss of the overall study population at 1 and 3 months after surgery was -9.3% and -3.6%. The median %DI loss at 1 and 3 months postoperatively was -15.6% and -5.3% in TG group, -8.9% and -3.3% in DG group (p=0.10 and 0.49, respectively). CONCLUSION The patients experienced DI loss of approximately 10% at 1 month after gastrectomy. Patients who received TG tended to show a greater %DI loss at 1 month postoperatively.
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Affiliation(s)
- Masato Nakazono
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Toru Aoyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan; .,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tsutomu Hayashi
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kentaro Hara
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kenki Segami
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yota Shimoda
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Shinsuke Nagasawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yuta Kumazu
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Soichiro Morinaga
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
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Ileocolic Interposition as a Gastric Substitute in Patients with Total Gastrectomy; Case Series and Literature Review. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.107505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The standard method for reconstruction after total gastrectomy is Roux-en-Y reconstruction, which has several negative points such as malabsorption. The most important reasons for weight loss in these patients are reserval insufficiency and reduction of food-digestive juice blending. We suggest that the creation of a food reserve with a natural conduit by ileocolic interposition may help the patient to have more normal diet habits and prevent severe weight loss. Methods: The study enrolled 8 patients with proximal gastric cancer, who underwent total gastrectomy with omentectomy and D2 lymphadenectomy. Then, the ileocolic segment with its vasculature was prepared and the anastomosis was done like right colon interposition between esophagus and duodenum. Intraoperative and postoperative events and also nutritional conditions were recorded. Results: Among 8 patients enrolled in the study, not an intraoperative bad event nor anastomotic site leakage, abscess formation, or other significant post-operative complication were seen. Except for the first two patients, the rest did not suffer from dysphagia. None of the patients suffered from delayed, chronic, or uncontrolled vomiting. All patients experienced weight loss postoperatively but after 2 months, they gained weight. Barium examination and also upper endoscopy revealed that the patients had normal reserval volume, no evidence of erosion or ulceration, no evidence of biliary esophagitis or reflux, and absence of tumor relapse. Conclusions: Because of the nutritional benefits of ileocolic interposition after total gastrectomy in gastric cancer treatment, it can be used as an acceptable alternative method of reconstruction in a subgroup of selected patients.
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Miyasaka M, Ebihara Y, Tanaka K, Nakanishi Y, Asano T, Noji T, Kurashima Y, Nakamura T, Murakami S, Tsuchikawa T, Okamura K, Shichinohe T, Murakami Y, Murakawa K, Nakamura F, Morita T, Okushiba S, Hirano S. The effect of the body mass index on the short-term surgical outcomes of laparoscopic total gastrectomy: A propensity score-matched study. J Minim Access Surg 2020; 16:376-380. [PMID: 32978353 PMCID: PMC7597878 DOI: 10.4103/jmas.jmas_212_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose This study aimed to evaluate the relationship between the body mass index (BMI) and the short-term outcomes of laparoscopic total gastrectomy (LTG). Subjects and Methods Data of patients who underwent LTG for gastric cancer at six institutions between 2004 and 2018 were retrospectively collected. The patients were classified into three groups: low BMI (<18.5 kg/m2), normal BMI (≥18.5 and <25 kg/m2) and high BMI (≥25 kg/m2). In these patients, clinicopathological variables were analysed using propensity score matching for age, sex, the American Society of Anaesthesiologists physical state, clinical stage, surgical method, D2 lymph node dissection, combined resection of other organs, anastomosis method and jejunal pouch reconstruction. The surgical results and post-operative outcomes were compared among the three groups. Results A total of 82 patients were matched in the analysis of the low BMI and normal BMI groups. There were no differences in operative time (P = 0.693), blood loss (P = 0.150), post-operative complication (P = 0.762) and post-operative hospital stay (P = 0.448). In the analysis of the normal BMI and high BMI groups, 208 patients were matched. There were also no differences in blood loss (P = 0.377), post-operative complication (P = 0.249) and post-operative hospital stay (P = 0.676). However, the operative time was significantly longer in the high BMI group (P = 0.023). Conclusions Despite the association with a longer operative time in the high BMI group, BMI had no significant effect on the surgical outcomes of LTG. LTG could be performed safely regardless of BMI.
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Affiliation(s)
- Mamoru Miyasaka
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
| | | | - Katsuhiko Murakawa
- Department of Surgery, Obihiro-Kosei General Hospital, Obihiro, Hokkaido, Japan
| | | | - Takayuki Morita
- Department of Surgery, Hokkaido Gastroenterology Hospital, Sapporo, Hokkaido, Japan
| | | | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Asahikawa, Japan
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8
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Sakin A, Sahin S, Sakin A, Aldemir MN, Bayram I, Kotan C. The Effect of Obesity on Response to Neoadjuvant Therapy in Locally Advanced Gastric Cancer. Asian Pac J Cancer Prev 2020; 21:2723-2731. [PMID: 32986374 PMCID: PMC7779463 DOI: 10.31557/apjcp.2020.21.9.2723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: The effect of obesity on response to neoadjuvant chemotherapy (NACT) remains unknown. We aimed to investigate the effect of obesity on response to NACT and survival in locally-advanced gastric cancer (GC). Methods: From 2010 to 2019, 142 GC patients with clinical stage III disease who underwent curative surgery after NACT were enrolled. Patients were divided into 3 groups according to body mass index (BMI) as follows; BMI < 25 kg/m2, BMI = 25-30 kg/m2, and BMI > 30 kg/m2. The Mandard tumor regression grading system was used for tumor regression grade (TRG). Results: Of the 142 GC patients, 45(31.7%) were female. The median age was 58 years. BMI was < 25 kg/m2 in 60 (42.3%) patients, 25-30 kg/m2 in 44 (31%) patients, and > 30kg/m2 in 38 (26.8%) patients. The numbers of patients with TRGI-II, TRGIII, and TRGIV-V were 35 (24.6%), 44 (31%), and 63 (44.4%), respectively. There was no statistically significant difference among BMI groups in terms of disease-free survival (DFS) and overall survival (OS) (p = 0.919 and p = 0.398, respectively). According to TRG groups; mDFS was 46 months in TRG I-II, 28 months in TRG III, and 18 months in TRG IV-V (p<0.001). In multivariate analysis, presence of perineural invasion and lymphovascular invasion were the factors affecting TRG. Conclusion: In our study, we found that pre-treatment obesity did not affect the TRG in clinical stage III GC patients. However, a better TRG status was associated with improved survival.
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Affiliation(s)
- Aysegul Sakin
- Department of Internal medicine, University of Health Sciences, Van Research and Training Hospital, Van, Turkey
| | - Suleyman Sahin
- Department of Medical Oncology, University of Health Sciences, Van Research and Training Hospital, Van, Turkey
| | - Abdullah Sakin
- Department of Medical Oncology, Yuzuncu Yil University Medical School, 65030, Van, Turkey
| | - Mehmet Naci Aldemir
- Department of Medical Oncology, Yuzuncu Yil University Medical School, 65030, Van, Turkey
| | - Irfan Bayram
- Department of Pathology, Yuzuncu Yil University Medical School, 65030, Van, Turkey
| | - Cetin Kotan
- Department of General surgery, Yuzuncu Yil University Medical School, 65030, Van, Turkey
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Achamrah N, Grigioni S, Coëffier M, Ainseba N, Déchelotte P. Gastric Necrosis After Binge Eating in Bulimia: Recovery From Eating Disorder After Total Gastrectomy. Front Psychiatry 2020; 11:741. [PMID: 32903630 PMCID: PMC7438759 DOI: 10.3389/fpsyt.2020.00741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gastric necrosis following acute gastric dilatation is rare but more common in females with eating disorders, such as anorexia nervosa or bulimia, during which patients often alternate restriction and binge eating behaviors. CASE PRESENTATION A 37-year old female patient with a history of 15 years of bulimia nervosa was admitted to the emergency department 24 h after binge eating. Abdominal Computed Tomography imaging showed major gastric distension reaching the pelvis and compressing the digestive organs. Total gastrectomy was required because of gastric necrosis. The patient reported significant reduction in bulimic symptoms after gastrectomy. CONCLUSION We discuss here the possible mechanisms underlying this recovery, including changes in gut-derived factors that could mediate eating behavior changes.
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Affiliation(s)
- Najate Achamrah
- Nutrition Department, Rouen University Hospital Center, Rouen, France.,Normandie Univ, UNIROUEN, INSERM UMR 1073, Nutrition, Inflammation et dysfonction de l'axe Intestin-Cerveau, IRIB, Rouen, France.,Clinical Investigation Centre CIC 1404, INSERM and Rouen University Hospital, Rouen, France
| | - Sébastien Grigioni
- Nutrition Department, Rouen University Hospital Center, Rouen, France.,Normandie Univ, UNIROUEN, INSERM UMR 1073, Nutrition, Inflammation et dysfonction de l'axe Intestin-Cerveau, IRIB, Rouen, France
| | - Moïse Coëffier
- Nutrition Department, Rouen University Hospital Center, Rouen, France.,Normandie Univ, UNIROUEN, INSERM UMR 1073, Nutrition, Inflammation et dysfonction de l'axe Intestin-Cerveau, IRIB, Rouen, France.,Clinical Investigation Centre CIC 1404, INSERM and Rouen University Hospital, Rouen, France
| | - Nadjib Ainseba
- Digestive Surgery, Beauvais Hospital Center, Beauvais, France
| | - Pierre Déchelotte
- Nutrition Department, Rouen University Hospital Center, Rouen, France.,Normandie Univ, UNIROUEN, INSERM UMR 1073, Nutrition, Inflammation et dysfonction de l'axe Intestin-Cerveau, IRIB, Rouen, France.,Clinical Investigation Centre CIC 1404, INSERM and Rouen University Hospital, Rouen, France
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10
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Pouch Versus No Pouch Following Total Gastrectomy: Meta-analysis of Randomized and Non-randomized Studies. Ann Surg 2019; 269:1041-1053. [DOI: 10.1097/sla.0000000000003082] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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11
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Feng F, Zheng G, Guo X, Liu Z, Xu G, Wang F, Wang Q, Guo M, Lian X, Zhang H. Impact of body mass index on surgical outcomes of gastric cancer. BMC Cancer 2018; 18:151. [PMID: 29409475 PMCID: PMC5801809 DOI: 10.1186/s12885-018-4063-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/29/2018] [Indexed: 12/14/2022] Open
Abstract
Background The association between body mass index (BMI) and clinical outcomes of gastric cancer were still under debate. The aim of the present study was to investigate the impact of BMI on intraoperative conditions, postoperative complications and prognosis of gastric cancer. Methods From October 2008 to March 2015, 1210 gastric cancer patients treated with D2 gastrectomy were enrolled in the present study. Patients were divided into three groups: low BMI group (BMI < 18.5 Kg/m2), normal BMI group (18.5 Kg/m2 ≤ BMI < 25.0 Kg/m2) and high BMI group (BMI ≥ 25.0 Kg/m2). Clinicopathological characteristics and prognosis of patients were recorded and analyzed. Propensity score matching was used to match patients in the three groups. Results There were 107 patients in low BMI group (8.9%), 862 patients in normal BMI group (71.2%) and 241 patients in high BMI group (19.95%). Before matching, BMI was inversely associated with tumor size, tumor depth, lymph node metastasis (LNM) and tumor stage (all P < 0.05). After matching, the clinicopathological features were all comparable among the three groups (all P > 0.05). High BMI was associated with increased blood loss and operation time, and deceased number of retrieved lymph nodes (all P < 0.05). For postoperative complications, low BMI was associated with decreased rate of postoperative fever (P = 0.025). Age, BMI, tumor size, Borrmann type, pathological type, type of gastrectomy, tumor depth, LNM and tumor stage were risk factors for the prognosis of gastric cancer. Multivariate analysis showed that only BMI, tumor size, tumor depth and LNM were independent prognostic factors. The overall survival of patients with low BMI was significantly worse than patients with normal (P < 0.05) or high BMI (P < 0.05). However, the overall survival was comparable between patients with normal and high BMI (P > 0.05). Conclusions BMI was inversely associated with tumor size, tumor depth, LNM and tumor stage. High BMI was associated with increased blood loss and operation time, and deceased number of retrieved lymph nodes. Low BMI was associated with decreased rate of postoperative fever and decreased survival.
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Affiliation(s)
- Fan Feng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Gaozan Zheng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Xiaohua Guo
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Zhen Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Guanghui Xu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Fei Wang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China.,Department of General Surgery, No. 534 Hospital of PLA, West Lichun Road, Luoyang, Henan, 471000, China
| | - Qiao Wang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China.,Department of General Surgery, No. 91 Hospital of PLA, 239 Gongye Road, Jiaozuo, Henan, 454000, China
| | - Man Guo
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Xiao Lian
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Hongwei Zhang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China.
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Tomita R. Lower oesophageal sphincter-preserving Roux-en-Y esophagojejunostomy with a jejunal J-pouch reconstruction-added His angle formation after total gastrectomy in patients with gastric cancer. SURGICAL PRACTICE 2018. [DOI: 10.1111/1744-1633.12297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ryouichi Tomita
- Department of Surgery; Nippon Dental University School of Life Dentistry; Tokyo Japan
- First Department of Surgery; Nihon University School of Medicine; Tokyo Japan
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Park KB, Park JY, Lee SS, Kwon OK, Chung HY, Yu W. Impact of Body Mass Index on the Quality of Life after Total Gastrectomy for Gastric Cancer. Cancer Res Treat 2017; 50:852-860. [PMID: 28903552 PMCID: PMC6056960 DOI: 10.4143/crt.2017.080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/04/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose We evaluated the impact of postoperative body mass index (BMI) shifts on the quality of life (QoL) following total gastrectomy in patients with gastric cancer. Materials and Methods QoL data collected from the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and QLQ-STO22 questionnaires were obtained from 417 patients preoperatively and 1 year after surgery. Patients were divided into two groups based on changes in BMI: group 1 comprised patientswhose BMIrange category dropped, and group 2 included patients who maintained or rose to a higher category compared to their preoperative BMI category. Results There were 276 patients in group 1 and 141 in group 2. QoLs with respect to the global health status and functional scales were not significantly different between the groups 1 year after surgery. However, there were significantly greater decreases in QoL in group 1 due to gastrointestinal symptoms, such as nausea and vomiting (p=0.008), appetite loss (p=0.001), and constipation (p=0.038). Of the QLQ-STO22 parameters, dysphagia (p=0.013), pain (p=0.012), reflux symptoms (p=0.017), eating restrictions (p=0.007), taste (p=0.009), and body image (p=0.009) were associated with significantly worse QoL in group 1 than in group 2 1 year after surgery. Conclusion Patients have significantly different QoLs depending on the BMI shift after total gastrectomy. Efforts to reduce the gap in QoL should include intensive nutritional support and restoration of dietary behaviors. Appropriate clinical and institutional approaches, plus active medical interventions, are required for maintaining patients' BMIs after surgery.
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Affiliation(s)
- Ki Bum Park
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Ji Yeon Park
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Oh Kyoung Kwon
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Ho Young Chung
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Wansik Yu
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
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Jun DH, Kim BJ, Park JH, Kim JG, Chi KC, Park JM, Kim MK, Kang H. Preoperative Body Mass Index May Determine the Prognosis of Advanced Gastric Cancer. Nutr Cancer 2016; 68:1295-1300. [DOI: 10.1080/01635581.2016.1224363] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Taguchi M, Dezaki K, Koizumi M, Kurashina K, Hosoya Y, Lefor AK, Sata N, Yada T. Total gastrectomy-induced reductions in food intake and weight are counteracted by rikkunshito by attenuating glucagon-like peptide-1 elevation in rats. Surgery 2016; 159:1342-50. [PMID: 26775072 DOI: 10.1016/j.surg.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/16/2015] [Accepted: 12/06/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Decrease in appetite and weight after total gastrectomy in patients with gastric cancer leads to a decrease in quality of life, increased mortality, and may necessitate discontinuation of adjuvant chemotherapy. The aim of this study is to determine whether rikkunshito, a Japanese herbal medicine, increases food intake and weight after gastrectomy in rats. METHODS Male rats underwent gastrectomy followed by roux-en-Y reconstruction or sham operation and were then treated with rikkunshito for 14 days starting on postoperative day 3. Daily food intake, weight, plasma glucagon-like peptide-1 (GLP-1), and ghrelin levels were measured. A pilot study to measure pre- and postoperative plasma GLP-1 levels was conducted in patients who underwent total gastrectomy for gastric cancer. RESULTS Administration of rikkunshito after gastrectomy in rats significantly increased food intake and weight, which continued for at least 2 weeks after treatment. Both fasting and postprandial plasma GLP-1 levels were increased markedly after gastrectomy compared with sham-operated animals. Increased GLP-1 levels in rats after gastrectomy were suppressed markedly by rikkunshito. rikkunshito had no significant effect on plasma ghrelin levels after gastrectomy. Treatment with a GLP-1 receptor antagonist significantly improved food intake and weight after gastrectomy. Plasma fasting GLP-1 levels in patients with gastric cancer were increased greatly after gastrectomy on postoperative day 1. CONCLUSION Administration of rikkunshito suppresses plasma GLP-1 levels after total gastrectomy, which is associated with recovery from reduced food intake and weight in rats.
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Affiliation(s)
- Masanobu Taguchi
- Division of Integrative Physiology, Department of Physiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan; Department of Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Katsuya Dezaki
- Division of Integrative Physiology, Department of Physiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Masaru Koizumi
- Department of Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Kentaro Kurashina
- Department of Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Yoshinori Hosoya
- Department of Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Toshihiko Yada
- Division of Integrative Physiology, Department of Physiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
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Luu C, Arrington AK, Falor A, Kim J, Lee B, Nelson R, Singh G, Kim J. Impact of Gastric Cancer Resection on Body Mass Index. Am Surg 2014. [DOI: 10.1177/000313481408001024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Major gastric resection alters digestive function and may lead to profound weight loss. The objective of our study was to evaluate trends in body weight loss after curative gastrectomy for malignancy. A review of patients who underwent gastrectomy from 1999 to 2012 at two institutions was conducted. Patient demographics and treatment were assessed. Student's t test and analysis of variance were used to compare groups. Of 168 patients, two patients (1.2%) were Stage 0, 73 (43.5%) Stage I, 46 (27.4%) Stage II, 45 (26.8%) Stage III, and two (1.2%) stage unknown. Fifty-eight patients (34.5%) underwent total gastrectomy with Roux-en-Yesophagojejunostomy and 110 patients (65.5%) underwent subtotal gastrectomy. The average per cent decreases in body mass index (BMI) post-gastrectomy at one month, six months, 12 months, and 24 months were 7.6, 11.7, 11.5, and 11.1 per cent, respectively ( P = 0.003). The decreases in BMI were the same for all time periods whether patients had subtotal or total gastrectomy. Weight loss after gastric cancer resection is an important measure of quality of life. By understanding patterns of weight change after gastrectomy, we can better counsel and prepare our patients for the long-term effects of gastric cancer surgery.
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Affiliation(s)
- Carrie Luu
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California; the
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Amanda K. Arrington
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California; the
| | - Annie Falor
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California; the
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Jae Kim
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California; the
| | - Byrne Lee
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California; the
| | - Rebecca Nelson
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Gagandeep Singh
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California; the
| | - Joseph Kim
- Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California; the
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Worster E, Liu X, Richardson S, Hardwick RH, Dwerryhouse S, Caldas C, Fitzgerald RC. The impact of prophylactic total gastrectomy on health-related quality of life: a prospective cohort study. Ann Surg 2014; 260:87-93. [PMID: 24424140 DOI: 10.1097/sla.0000000000000446] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The advice to individuals with identified CDH1 mutations is generally to undertake prophylactic total gastrectomy (PTG). This study evaluated the effect of PTG on health-related quality of life (HRQL) in asymptomatic individuals with identified CDH1 mutations at high risk for gastric cancer. METHODS Individuals with hereditary diffuse gastric cancer (HDGC) were recruited to a prospective, multicenter UK study. Questionnaires, including the European Organization for Research and Treatment for Cancer core Quality-of-Life Questionnaire (EORTC QLQ C30); the gastric cancer specific module (EORTC QLQ STO22); and the 36-item short form health survey version 2.0, were completed before and at regular intervals after surgery. RESULTS Sixty individuals fulfilled HDGC criteria; 38 (63%) had a CDH1 mutation and 32 (53%) underwent PTG. At baseline, there was no significant difference in mental health depending on CDH1 mutation status and treatment preference. Physical functioning reduced in the first month after surgery but recovered to baseline by 12 months. Similarly mental functioning reduced in the first month after surgery but recovered by 3 to 9 months. However, specific symptoms were identified, such as diarrhoea (70%), fatigue (63%), discomfort when eating (81%), reflux (63%), eating restrictions (45%), and body image (44%), which persisted after PTG. CONCLUSIONS Patients contemplating prophylactic gastrectomy can be reassured about the long-term HRQL outcomes, but some residual symptoms require adjustment.
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Affiliation(s)
- Elizabeth Worster
- *MRC Cancer Unit, University of Cambridge, UK †Department of Oncology, Addenbrooke's Hospital, Cambridge, UK ‡Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge, UK §Cancer Research UK Cambridge Institute, Cambridge, UK
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Kosuga T, Hiki N, Nunobe S, Noma H, Honda M, Tanimura S, Sano T, Yamaguchi T. Feasibility and Nutritional Impact of Laparoscopy-assisted Subtotal Gastrectomy for Early Gastric Cancer in the Upper Stomach. Ann Surg Oncol 2014; 21:2028-2035. [DOI: 10.1245/s10434-014-3520-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Yoon HM, Kim YW, Nam BH, Reim D, Eom BW, Park JY, Ryu KW. Intravenous iron supplementation may be superior to observation in acute isovolemic anemia after gastrectomy for cancer. World J Gastroenterol 2014; 20:1852-1857. [PMID: 24587663 PMCID: PMC3930984 DOI: 10.3748/wjg.v20.i7.1852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether the application of post-operative intravenous (IV)-iron for acute isovolemic anemia after gastrectomy for cancer may be effective.
METHODS: Among 2078 gastric cancer patients who underwent surgery between February 2007 and August 2009 at the National Cancer Center Korea, 368 patients developed post-operative anemia [hemoglobin-(Hb)-level < 9 g/dL] within the first postoperative week. Patients requiring transfusions were excluded. IV-iron was administered to 63 patients (iron group). Sixty patients were observed without treatment (observation group). The clinical outcomes of the groups were compared concerning clinicopathologic data, morbidity, and changes in Hb levels using Fisher’s exact test, Student’s t-test and the Z-test.
RESULTS: The initial Hb level was higher in the iron group than in the observation group (7.3 ± 1.0 g/dL vs 8.4 ± 0.5 g/dL, P < 0.001). The slope of the changes in the Hb level was significantly higher in the iron group than in the observation group (0.648 ± 0.054 vs 0.349 ± 0.038, P < 0.001). The Hb level 1 and 3 mo post-operatively increased from 10.7 ± 1.3 to 11.9 ± 1.3 g/dL in the iron group (P = 0.033) and from 10.1 ± 1.0 to 10.8 ± 1.4 g/dL in the observation group (P < 0.001). The postoperative hospital stay was significantly longer in the iron group than in the observation group (10.5 ± 6.8 d vs 7.6 ± 5.5 d, P = 0.011). There were no significant differences in the major and surgical complications between the groups (6.3% vs 13.3%, P = 0.192; 9.5% vs 3.3%, P = 0.164).
CONCLUSION: IV-iron supplementation may be an effective treatment for post-operative isovolemic post-gastrectomy anemia and may be a better alternative than observation.
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Yang YS, Chen LQ, Yan XX, Liu YL. Preservation versus non-preservation of the duodenal passage following total gastrectomy: a systematic review. J Gastrointest Surg 2013; 17:877-86. [PMID: 23460248 DOI: 10.1007/s11605-013-2174-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 02/17/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various reconstruction procedures have been proposed for restoring the alimentary tract continuity after total gastrectomy. However, so far there is no consensus on the ideal post-gastrectomy reconstruction procedure. The necessity of preserving the duodenal passage is one of the major focuses of the debate concerning gastrointestinal reconstruction and is the objective of this study. METHODS A systematic literature search of PubMed, EMBASE, the Cochrane Library, SCI, and Chinese Biomedical Literature Database (CBM) was carried out before March 2012 to obtain studies of randomized controlled trials (RCT). Analysis was performed using RevMan 5.0 software. RESULTS Nine RCTs involving 642 participants met the selection criteria. The results of the meta-analyses showed that operative mortality and morbidity were not significantly different between the two procedures (preservation vs. non-preservation of duodenum). However, operative time was considerably prolonged by preserving the duodenal passage. Patients in the preservation group had an improved nutritional parameters (body weight, levels of serum iron and hemoglobin) in the short term (<6 months) after surgery. Beneficial effect on preventing postgastrectomy symptom (heartburn, dumping syndrome) was not found by maintaining the duodenal passage throughout a 2-year follow-up. Moreover, a qualitative measurement showed that no significant quality of life improvement for patients with a preserved duodenal passage. CONCLUSION This systematic review failed to demonstrate obvious advantage in preserving duodenal passage after total gastrectomy.
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Affiliation(s)
- Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
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Dikken JL, Stiekema J, van de Velde CJH, Verheij M, Cats A, Wouters MWJM, van Sandick JW. Quality of care indicators for the surgical treatment of gastric cancer: a systematic review. Ann Surg Oncol 2012; 20:381-98. [PMID: 23054104 DOI: 10.1245/s10434-012-2574-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Quality assurance is increasingly acknowledged as a crucial factor for the (surgical) treatment of gastric cancer. The purpose of the current study was to define a minimum set of evidence-based quality of care indicators for the surgical treatment of locally advanced gastric cancer. METHODS A systematic review of the literature published between January 1990 and May 2011 was performed, using search terms on gastric cancer, treatment, and quality of care. Studies were selected based on predefined selection criteria. Potential quality of care indicators were assessed based on their level of evidence and were grouped into structure, process, and outcome indicators. RESULTS A total of 173 articles were included in the current study. For structural measures, evidence was found for the inverse relationship between hospital volume and postoperative mortality as well as overall survival. Regarding process measures, the most common indicators concerned surgical technique, perioperative care, and multimodality treatment. The only outcome indicator with supporting evidence was a microscopically radical resection. CONCLUSIONS Although specific literature on quality of care indicators for the surgical treatment of locally advanced gastric cancer is limited, several quality of care indicators could be identified. These indicators can be used in clinical audits and other quality assurance programs.
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Affiliation(s)
- Johan L Dikken
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Carey S, Ferrie S, Young J, Allman-Farinelli M. Long-term nutrition support in gastrointestinal disease—A systematic review of the evidence. Nutrition 2012; 28:4-8. [DOI: 10.1016/j.nut.2011.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 01/05/2023]
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Tsujimoto H, Sakamoto N, Ichikura T, Hiraki S, Yaguchi Y, Kumano I, Matsumoto Y, Yoshida K, Ono S, Yamamoto J, Hase K. Optimal size of jejunal pouch as a reservoir after total gastrectomy: a single-center prospective randomized study. J Gastrointest Surg 2011; 15:1777-82. [PMID: 21785918 DOI: 10.1007/s11605-011-1641-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 07/13/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND In order to improve a patient's quality of life after total gastrectomy, jejunal pouch reconstruction has been employed. However, little information exists regarding the optimal size of the jejunal pouch after total gastrectomy. METHODS The study was designed as a single-center randomized trial in which the results of double-tract reconstruction with pouches of two different sizes were compared, i.e., short and long pouch double tract (SPDT and LPDT, respectively). We conducted a clinical assessment with standard questionnaire after surgery. The amount of residual food in the jejunal pouch was determined by endoscopy. RESULTS No demographic differences were noted between the two groups. The eating capacity per meal was higher in the SPDT group than in the LPDT group. The postoperative weight loss 24 months after surgery was lower in SPDT group than that in the LPDT group. Although the incidence of early dumping symptoms was higher in the SPDT group, no difference was noted in the other postprandial abdominal symptoms between the two groups. CONCLUSIONS We conclude that the optimal pouch should be relatively short, as a short pouch improves the eating capacity per meal and the weight loss ratio to the preoperative value.
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Affiliation(s)
- Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
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Abstract
Gastric resection, whether partial or total gastrectomy, often results in nutrition-related complications including weight loss, diet intolerances, and micronutrient deficiencies. The physiology of normal and postgastrectomy digestion is the basis for most of the current diet recommendations after gastric surgery. A careful review reveals that there is not sufficient literature to support a standard postgastrectomy diet. Rather, individualized diet manipulation for symptom relief is recommended. This review highlights the physiology behind common postgastrectomy complications, provides guidelines for the medical and nutrition management of these complications, and presents a basic approach to postgastrectomy gastrointestinal symptoms.
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Affiliation(s)
- Christie Rogers
- Nutrition Support Services, University of Virginia Health System, Charlottesville, VA 22908, USA.
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CAREY S, HE L, FERRIE S. Nutritional management of patients undergoing major upper gastrointestinal surgery: A survey of current practice in Australia. Nutr Diet 2010. [DOI: 10.1111/j.1747-0080.2010.01466.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jeon TY, Lee S, Kim HH, Kim YJ, Lee JG, Jeong DW, Kim YJ. Long-term changes in gut hormones, appetite and food intake 1 year after subtotal gastrectomy with normal body weight. Eur J Clin Nutr 2010; 64:826-831. [PMID: 20485300 DOI: 10.1038/ejcn.2010.83] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/19/2010] [Accepted: 04/19/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES No prospective study on the long-term effects of gastric resection on gastrointestinal hormonal changes in patients with normal body weight has been reported. The aim of this study was to evaluate the 1-year effect of subtotal gastrectomy on ghrelin and peptide YY (PYY)(3-36) levels. SUBJECTS/METHODS Eighteen patients with early gastric cancer underwent subtotal gastrectomy with Billroth I reconstruction. We assessed appetite, food intake, body composition, and ghrelin and PYY(3-36) levels preoperatively and 1 year after surgery. RESULTS There were no significant difference in the preoperative daily food intake and 1 year after subtotal gastrectomy. Weight loss occurred in all study subjects; 11.7% (n=2), 55.5% (n=10) and 33.3% (n=6) of the patients lost <5%, 5-10% and >10% of their preoperative body weight, respectively. Body mass index, waist circumference and body fat significantly decreased 1 year after subtotal gastrectomy. There were no significant differences in the appetite visual analogue scale preoperatively and 1 year after subtotal gastrectomy. The plasma ghrelin concentration decreased significantly (P=0.006), whereas PYY(3-36) did not show a significant change 1 year after subtotal gastrectomy. CONCLUSIONS Ghrelin levels and body fat decreased significantly, whereas PYY(3-36) levels as well as appetite and food intake did not change significantly 1 year after subtotal gastrectomy with normal body weight. These findings suggest that decreased ghrelin might contribute directly to reduced body fat.
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Affiliation(s)
- T Y Jeon
- Department of Surgery, Pusan National University Hospital, Busan, South Korea
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Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients. World J Gastroenterol 2010; 16:3310-7. [PMID: 20614488 PMCID: PMC2900724 DOI: 10.3748/wjg.v16.i26.3310] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients.
METHODS: From October 2005 to July 2006, we studied 80 patients with no evidence of recurrent disease and no loss to follow-up after curative surgery for gastric cancer. In this group, 9 patients underwent total gastrectomy and 71 patients subtotal gastrectomy. At admission, 6 and 12 mo after surgery, the patients were assessed on the subjective global assessment (SGA), nutritional risk screening (NRS-2002), nutritional risk index (NRI) and by anthropometric measurements and laboratory data. Differences between the independent groups were assessed with the Student’s t test and one-way analysis of variance. Spearman’s rank correlation coefficients were calculated to evaluate the association between the scores and variables.
RESULTS: The prevalence of malnutrition at admission was 31% by SGA and 43% by NRS-2002. At admission, the anthropometric data were lower in the malnourished groups defined by the SGA and NRS-2002 assessments, but did not differ between the groups using the NRI assessment. Body weight (BW), body mass index (BMI), triceps skin fold and midarm circumference were significantly reduced, but the total lymphocyte count, albumin, protein, cholesterol and serum iron levels did not decrease during the postoperative period. Six months after surgery, there was a good correlation between the nutritional assessment tools (SGA and NRS-2002) and the other nutritional measurement tools (BW, BMI, and anthropometric measurements). However, 12 mo after surgery, most patients who were assessed as malnourished by SGA and NRS-2002 had returned to their preoperative status, although their BW, BMI, and anthropometric measurements still indicated a malnourished status.
CONCLUSION: A combination of objective and subjective assessments is needed for the early detection of the nutritional status in case of gastric cancer patients after gastrectomy.
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Rêgo ACM, Neto AV, Azevedo ÍM, Araújo-Filho I, Egito EST, Medeiros AC. Biodistribution of Technetium-99m Pertechnetate after Total Gastrectomy and Roux-en-Y Jejunal Pouch. J INVEST SURG 2010; 23:94-100. [DOI: 10.3109/08941930903469409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
OBJECTIVES Whether reconstruction after total gastrectomy for gastric malignancies should be done with or without a pouch is a controversial issue in clinical research. There is still no consensus on the reconstruction technique of choice. The aim of this report was to assess the value of pouch formation as a gastric substitute after total gastrectomy compared with reconstruction techniques without a pouch. METHODS A systematic literature search of the Medline database and the Cochrane Library was carried out and a meta-analysis executed according to the Quality of Reporting Meta-Analyses (QUOROM) statement. Only randomized controlled trials (RCTs) comparing reconstruction techniques with and without a pouch were eligible for inclusion. All trials were independently assessed by two authors. Data on perioperative parameters, postgastrectomy symptoms, eating capability, body weight, and quality of life were extracted from the RCTs for meta-analysis using random-effects models for the calculation of pooled estimates of treatment effects. RESULTS Nine RCTs comparing Roux-en-Y reconstructions with and without pouch and four RCTs comparing jejunal interpositions with and without a pouch were included. The results of the meta-analyses show that additional pouch formation does not significantly increase morbidity or mortality and does not considerably extend the operating time or the hospital stay. Patients with a pouch complained significantly less of dumping and heartburn and showed a significantly better food intake postoperatively. Quality of life was significantly improved in patients with a pouch compared with patients without a pouch. This difference even increased over time from 6 to 12 and 24 months postoperatively. CONCLUSIONS This meta-analysis highlights some clinical advantages of pouch reconstruction after total gastrectomy.
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Validity of the ActiReg® system and a physical activity interview in assessing total energy expenditure in long-term survivors after total gastrectomy. Clin Nutr 2008; 27:842-8. [DOI: 10.1016/j.clnu.2008.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 06/23/2008] [Accepted: 07/09/2008] [Indexed: 11/21/2022]
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Kalmár K, Káposztás Z, Varga G, Cseke L, Papp A, Horváth OP. Comparing aboral versus oral pouch with preserved duodenal passage after total gastrectomy: does the position of the gastric substitute reservoir count? Gastric Cancer 2008; 11:72-80. [PMID: 18595013 DOI: 10.1007/s10120-008-0455-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 03/10/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total gastrectomy results in a significant weight loss, different postgastrectomy symptoms, and a reduction in quality of life. Elaborate surgical reconstruction methods are evaluated to improve results. The present study compares two types of reconstructions--an aboral pouch with preserved duodenal passage and an oral pouch with preserved duodenal passage--differing only in the site of the pouch. METHODS Twenty-eight patients entered the study. Primary outcome measures--body weight, body mass index, and quality of life, and secondary outcome measures--serum nutritional parameters, scintigraphic small-intestinal passage, and lipid and carbohydrate absorption were measured 6, 12, and 24 months after surgery. RESULTS No significant differences were found in anthropometric parameters or in quality of life between the groups. Regarding the secondary outcome measures, albumin levels were higher in the oral pouch group, while protein and immunoglobulin-A levels were higher in the aboral pouch group. CONCLUSION The site of the reservoir does not significantly influence the outcome after total gastrectomy and reconstruction with a preserved duodenal passage.
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Affiliation(s)
- Katalin Kalmár
- Department of Surgery, University of Pécs, 13 Ifjuság str., 7624, Pécs, Hungary
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Abstract
BACKGROUND Gastric pouches have the potential to improve nutrition following total gastrectomy, compared with standard reconstruction. However, a consensus view of clinical benefit is not available, at least partly due to a lack of standardization of pouch design or size. This study was undertaken to identify optimal conditions for pouch design. METHODS A mathematical model was established and a porcine model constructed to evaluate the pressure/volume dynamics of the pouch. A "J" pouch was constructed at anastomotic lengths of 5, 10, 15, and 20 cm. Each pouch was distended with saline and the pressure/volume relationship established. RESULTS Mathematically, increasing the anastomotic length of the pouch to 15 cm increases the volume significantly; thereafter, there is minimal benefit of increasing the pouch length further. For smaller pouches (5 and 10 cm) a 350-to 400-ml volume (approximate meal volume in the elderly) is never achieved until higher pressures (45 cmH(2)O) are applied. However, in the larger pouches (15 and 20 cm) a 350-to 400-ml volume is readily achieved at basal pressures of 15 cmH(2)O. CONCLUSION Smaller pouches never achieve adequate volumes at basal pressures; accordingly, it is unlikely that they will lead to any clinical benefit. Further in-vivo studies should therefore be based upon 15-cm pouch designs.
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Fein M, Fuchs KH, Thalheimer A, Freys SM, Heimbucher J, Thiede A. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg 2008; 247:759-65. [PMID: 18438112 DOI: 10.1097/sla.0b013e318167748c] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Roux-en-Y reconstruction with and without jejunal pouch was compared in a randomized controlled trial to identify the optimal reconstruction procedure in terms of quality of life. BACKGROUND DATA Randomized trials comparing techniques of reconstruction after total gastrectomy have shown controversial results. METHODS One hundred and thirty-eight patients with gastric cancer were intraoperatively randomized for Roux-en-Y reconstruction with pouch (n = 71) or without pouch (n = 67) after gastrectomy and stratified into curative or palliative resection. Intra- and postoperative complications were recorded. Body weight and quality of life were determined every 6 months with a follow-up of up to 12 years. RESULTS Both groups were comparable for age, sex, incidence of concomitant disease, and staging. There were no differences in operative time, postoperative complications, and mortality. Short- and long-term weight loss was similar in both groups. In the first postoperative year, there were no benefits of pouch reconstruction in terms of quality of life, independent of the resection status. In the third, fourth, and fifth year after surgery quality of life was significantly improved for patients with a pouch. CONCLUSIONS Roux-en-Y pouch reconstruction after gastrectomy is simple to perform and safe. Long-term survivors benefit from pouch reconstruction. Therefore, a pouch is recommended for patients with a good prognosis.
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Affiliation(s)
- Martin Fein
- Department of Surgery, University of Wuerzburg, Germany
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Foukakis T, Lundell L, Gubanski M, Lind PA. Advances in the treatment of patients with gastric adenocarcinoma. Acta Oncol 2007; 46:277-85. [PMID: 17450463 DOI: 10.1080/02841860701218634] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite a decline in its incidence in the Western world, gastric cancer (GC) remains the fourth most frequent cancer diagnosis worldwide and is, after lung cancer, the second leading cause of death from a malignant disease globally. Based on the published literature, treatment guidelines and reports from international meetings, we here review the current treatment options for GC and discuss insights and perspectives from the latest clinical studies. The management of GC in the early stages of the disease is based on an optimal surgical resection of the primary tumor and the regional lymph nodes. However, less than one third of patients have a resectable disease at diagnosis and among those operated, more than half are not cured by surgery alone, due to a high rate of relapse. Thus, for the majority of patients, systemic cytotoxic therapy, and sometimes radiotherapy, is a treatment option both as an adjunct to surgery and in the palliative setting. Adjuvant chemotherapy offers only a marginal benefit and has not become a standard of care in the West. In North America, adjuvant chemoradiation is broadly used, shown to significantly improve overall survival, albeit with the cost of high toxicity. Furthermore, a recently reported study from the United Kingdom demonstrated a significant disease-free and survival benefit by the use of perioperative combination chemotherapy. Several chemotherapeutic agents have been tested as a palliative therapy in advanced GC including 5- fluorouracil (5-FU), oral pyrimidines, platinum derivatives, anthracyclines, taxanes and camptothecans. It is now accepted that chemotherapy is better than best supportive care only and that 5-FU based combinations are more effective than monotherapy. However, the response rates have generally been moderate and there is no consensus on the optimal combination of cytotoxic agents and the potential role of more recently developed "targeted therapies".
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Affiliation(s)
- Theodoros Foukakis
- Department of Oncology, Karolinska University Hospital-Södersjukhuset, Stockholm, Sweden.
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35
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Copland L, Liedman B, Rothenberg E, Bosaeus I. Effects of nutritional support long time after total gastrectomy. Clin Nutr 2007; 26:605-13. [PMID: 17681646 DOI: 10.1016/j.clnu.2007.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 04/12/2007] [Accepted: 06/17/2007] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Long-term effects of total gastrectomy on nutritional status are not well known, neither is the role of nutritional support. Dietary counselling is usually individualized, but generally not well defined. We aimed to evaluate effects of individualized oral nutritional support long time after total gastrectomy. METHODS Dietary advice was given, aiming for an energy and protein rich diet, using ordinary food and liquid supplements tailored to individual needs and preferences. Counselling was repeated monthly. Body weight and a 4-day food record were obtained at baseline, and thereafter-at month 1, 3, 6 and 12. Body composition, resting and total energy expenditure were measured at baseline and at 12 months. RESULTS Thirteen of 15 included patients completed the study. Though a trend of weight gain was seen after 1 month, there was no significant weight change at 12 months as weight development was quite heterogeneous. Six patients who remained healthy during the study (all with BMI<25) gained weight (p<0.05), while five patients with intercurrent co-morbidity and two with initial BMI>25 lost weight or remained stable. CONCLUSIONS Nutritional intervention long time after total gastrectomy did not change body weight, body composition or energy metabolism. Intercurrent co-morbidity appeared to have a major impact on outcome, as the nutritional support was more effective in patients who remained healthy and had a BMI<25.
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Affiliation(s)
- Lotta Copland
- Department of Clinical Nutrition, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden.
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Chaiyasate K, Jacobs M, Brooks SE, del Rosario G, Andrus L, Kestenberg W, Mittal V. The uncut Roux-en-Y with jejunal pouch: a new reconstruction technique for total gastrectomy. Surgery 2007; 142:33-9. [PMID: 17629998 DOI: 10.1016/j.surg.2007.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 03/01/2007] [Accepted: 03/03/2007] [Indexed: 01/01/2023]
Abstract
BACKGROUND Roux Stasis Syndrome is a well-known complication after Roux-en-Y reconstruction. It has been hypothesized that reconstruction with an uncut Roux limb and jejunal pouch after total gastrectomy would preserve unidirectional intestinal myoelectrical activity, improve postoperative weight gain and nutritional parameters, and diminish Roux Stasis Syndrome in canines. METHODS A total gastrectomy was performed, and 2 methods were used for reconstruction: Roux-en-Y esophagojejunostomy (RY) was performed on 5 canines (control), and the uncut Roux-en-Y with a jejunal pouch (URYJP) was performed on 5 other canines (experimental). The canines were monitored for 10 weeks postoperatively. Serial weight and nutritional parameters were measured. Emptying profiles and motility studies were performed in the fasting and postprandial states. RESULTS Ten weeks after operation, the URYJP group had significantly improved nutritional parameters, including weight, total protein, albumin, hemoglobin, serum total iron binding capacity, and serum IgA, IgG, and IgM. The emptying times for both groups were similar, with an increase of disordered propagation of the jejunal pacesetter potential in the RY group. The aboral propagation occurred more frequently in the URYJP group during fasting and after feeding (98% +/- 1% vs 39% +/- 16%; P = .02, and 99% +/- 1% vs 43% +/- 18%; P = .03). The sites of luminal occlusions were intact in the URYJP group at 10 weeks. CONCLUSIONS The combination of jejunal pouch and uncut Roux limb improved overall nutritional parameters when compared with the traditional Roux-en-Y, while preserving aboral propagation of jejunal pacesetter potentials.
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Affiliation(s)
- Kongkrit Chaiyasate
- Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, USA.
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Pedrazzani C, Marrelli D, Rampone B, De Stefano A, Corso G, Fotia G, Pinto E, Roviello F. Postoperative complications and functional results after subtotal gastrectomy with Billroth II reconstruction for primary gastric cancer. Dig Dis Sci 2007; 52:1757-63. [PMID: 17404848 DOI: 10.1007/s10620-006-9655-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 10/15/2006] [Indexed: 12/22/2022]
Abstract
Subtotal gastrectomy is considered the preferred treatment for gastric cancer with antral location. The aim of this study was to assess the incidence of early postoperative complications and late functional results in patients who underwent subtotal gastrectomy with Billroth II reconstruction for primary gastric adenocarcinoma. The results of 310 patients were analyzed with regard to postoperative complications and death rates. Functional results as they relate to the gastric resection were evaluated in 195 disease-free patients. Of the 310 patients, 77 developed postoperative general and surgical complications (24.8%) and 13 consequently died (in-hospital mortality: 4.2%). Although infrequent (6 cases, 1.9%), anastomotic leak was the most serious complication (4 cases died during the postoperative phase). Considering functional results, weight loss continued for the first trimester after surgery, after which it stabilized. Loss of appetite was rarely observed; early after the operation the majority of patients were consuming a normal diet and regularly consumed less than five meals per day (83.6%). Dumping syndrome was uncommon and usually resolved within one year (12.3% at three months, 9.5% after one year, 5.2% after two years). On the other hand, postprandial abdominal fullness was frequently observed (43.1% at three months, 36.1% after one year, 21.3% after three years, and 16.5% after five years). Billroth II reconstruction after subtotal gastrectomy is associated with a limited risk of anastomotic complications. Anastomotic leak, although infrequent, is a life-threatening complaint and requires prompt recognition and aggressive surgical treatment. The incidence of late complications was low and the majority of patients recovered from them within one year after surgery, although the occurrence of postprandial abdominal fullness was not completely irrelevant.
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Affiliation(s)
- Corrado Pedrazzani
- Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Siena, Italy
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38
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Yoon DY, Kim HK, Kim JA, Choi CS, Yun EJ, Chang SK, Lee YJ, Park CH. Changes in the abdominal fat distribution after gastrectomy: computed tomography assessment. ANZ J Surg 2007; 77:121-5. [PMID: 17305982 DOI: 10.1111/j.1445-2197.2006.03990.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND We investigated the postoperative changes in visceral fat, as compared with subcutaneous fat in patients who underwent total gastrectomy (TG) or subtotal gastrectomy (STG). METHODS Thirty-eight patients of gastric cancer who underwent abdominal and pelvic computed tomography scans before and after STG (n = 28) or TG (n = 10) were examined. The volumes of the total, visceral and subcutaneous adipose tissues (TAT, VAT and SAT, respectively) were calculated in each scan using the multislice method. Changes between the preoperative data and results obtained at 6 and 12 months after surgery were evaluated. RESULTS In the first 6 months, there were significant decreases in TAT, VAT and SAT values in the TG (-2424 +/- 1309, -1535 +/- 1056 and -889 +/- 613 cm(3), respectively) and STG (-1590 +/- 1309, -1024 +/- 645, and -578 +/- 659 cm(3), respectively) groups. From 6 to 12 months after surgery, a further significant reduction in VAT (-351 +/- 196 cm(3)) in the TG group and significant regains in TAT and SAT (850 +/- 1205 and 757 +/- 1032 cm(3), respectively) in the STG group were observed. The ratio of VAT to SAT calculated in both groups decreased continuously in all periods of observation. CONCLUSION Patients who underwent gastrectomy lost TAT, VAT and SAT during the postoperative period up to 6 months and the decrease in VAT was greater and more persistent than the decrease in SAT, particularly in the TG group.
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Affiliation(s)
- Dae Young Yoon
- Department of Radiology, Hallym University College of Medicine, Kangdong-Gu, Seoul, Korea.
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Bae JM, Kim S, Kim YW, Ryu KW, Lee JH, Noh JH, Sohn TS, Hong SK, Park SM, You CH, Kim JH, Lee MK, Yun YH. Health-related quality of life among disease-free stomach cancer survivors in Korea. Qual Life Res 2006; 15:1587-96. [PMID: 17036253 DOI: 10.1007/s11136-006-9000-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Accepted: 06/28/2006] [Indexed: 12/13/2022]
Abstract
Previous studies about the quality of life (QOL) in stomach cancer survivors focused on selected clinical parameters and did not consider the broader implications for overall health and QOL. We evaluated the impact of demographic and treatment-related factors on the QOL of stomach cancer survivors. We asked 391 stage I-III stomach cancer survivors who had been disease-free for at least 1 year after surgery to complete a demographic questionnaire, the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire, and its stomach module, QLQ-STO22.Survivors undergoing total gastrectomy reported greater eating restrictions than those undergoing subtotal gastrectomy. Receiving chemotherapy or radiotherapy did not significantly affect any QLQ-C30 or QLQ-STO22 scores. Role and emotional functioning improved with increasing age, and stomach-specific symptoms (pain, eating restrictions, and anxiety) lessened. Compared with female survivors, male survivors had better physical and role functioning. Smoking status was also a significant negative predictor of physical functioning and anxiety. Comorbidities and selected demographic characteristics had a greater effect than type of treatment on the QOL of post-operative stomach cancer patients.
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Affiliation(s)
- Jae-Moon Bae
- Research Institute and Hospital, Quality of Cancer Care Branch, National Cancer Center, 809 Madu-dong, Ilsan-gu, 411-769 Goyang, Gyeonggi, Korea
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Svedlund J, Sullivan M, Liedman B, Lundell L. Relationship of tumor burden and patients' minimization of distress in facing surgery for gastric cancer. PSYCHOSOMATICS 2005; 46:233-43. [PMID: 15883144 DOI: 10.1176/appi.psy.46.3.233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with gastric cancer considered amenable to a curative surgical procedure on the basis of a conventional preoperative workup (N=98) answered health-related quality-of-life questionnaires and completed a psychiatrist's interview before the intervention. All patients were blinded to the type of surgical procedure that would ultimately be performed; 64 patients eventually received a potentially curative resection, and 34 had palliative surgery. The curative resection group reported significantly more hopelessness before the operation than the palliative surgery group. The latter group had more eating dysfunction but minimized their distress to a greater degree than those with a more limited tumor burden. Eating dysfunction, hopelessness, and the tendency to minimize distress were independent predictors of prognosis. The findings highlight the need for careful medical interviewing to enhance patient-physician communication about symptoms and signs of malignant diseases.
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Affiliation(s)
- Jan Svedlund
- Psychiatry Section, Institute of Clinical Neuroscience, Göteborg University, Sweden.
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Hyltander A, Bosaeus I, Svedlund J, Liedman B, Hugosson I, Wallengren O, Olsson U, Johnsson E, Kostic S, Henningsson A, Körner U, Lundell L, Lundholm K. Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: a randomized study. Clin Gastroenterol Hepatol 2005; 3:466-74. [PMID: 15880316 DOI: 10.1016/s1542-3565(05)00151-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to investigate whether specialized supportive enteral and parenteral feeding have superior effects compared to oral nutrition on recovery during long-term postoperative treatment of cancer patients with preoperative weight loss and reduced maximum exercise capacity. METHODS One hundred twenty-six patients referred for resection of the esophagus (n = 48), stomach (n = 28), or pancreas (n = 50) were considered to be included before operation. Included patients (n = 80) received supportive enteral or parenteral nutrition postoperatively at home corresponding to 1000 kcal/d until the patients did not wish to continue with artificial nutrition for any reason. Patients randomized to oral nutrition only served as control subjects. Caloric intake, body composition (dual-energy x-ray absorptiometry), and respiratory gas exchanges at rest and during exercise were measured including health-related quality of life. RESULTS Survival and hospital stay did not differ among the groups, whereas overall complications were higher on artificial nutrition (P < .05). Changes in resting energy expenditure and biochemical tests did not differ during follow-up among the groups. Body weight and whole body fat declined similarly over time in all groups (P < .005), whereas lean body mass was unchanged during follow-up compared to preoperative values. Maximum exercise capacity and maximum oxygen consumption were normalized within 6 months postoperatively in all groups. There was no difference in recovery of food intake among the groups. Parenteral feeding was associated with the highest rate of nutrition-related complications, whereas enteral feeding reduced quality of life most extensively. CONCLUSION After major surgery, specialized supportive enteral and parenteral nutrition are not superior to oral nutrition only when guided by a dietitian.
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Affiliation(s)
- Anders Hyltander
- Department of Surgery, Institute of Clinical Neuroscience, Sahlgrenska University of Hospital, Göteborg University, Sweden
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Kiyama T, Mizutani T, Okuda T, Fujita I, Tokunaga A, Tajiri T, Barbul A. Postoperative changes in body composition after gastrectomy. J Gastrointest Surg 2005; 9:313-9. [PMID: 15749590 DOI: 10.1016/j.gassur.2004.11.008] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Nutritional status is one of the most important clinical determinants of outcome after gastrectomy. The aim of this study was to compare changes in the body composition of patients undergoing laparoscopy-assisted gastrectomy (LAG), distal gastrectomy (DG), or total gastrectomy (TG). Total body protein and fat mass were measured by performing a multifrequency bioelectrical impedance analysis using an inBody II machine (Biospace, Tokyo, Japan) in 108 patients (72 men, 36 women) who had undergone LAG (n=24), DG (n=39), or TG (n=45). Changes between the preoperative data and results obtained on postoperative day 14 and 6 months after surgery were then evaluated. The mean preoperative body weight of the subjects was 57.6+/-10.7 kg, the mean body mass index was 22.5+/-3.4 kg/m(2), and the mean fat % was 24%+/-7%. In the immediate postoperative period (14 days), the body weight loss in the LAG group was significantly lower than in the DG and TG groups (2.5+/-0.9 kg vs. 3.5+/-1.8 kg and 4.0+/-1.9 kg, respectively; P < 0.0001). The body composition studies demonstrated a loss of total body protein rather than fat mass. Six months after surgery, body weight was not significantly different from preoperative values in the LAG and DG groups (-1.2+/-3.8 kg and -1.8+/-4.7 kg, respectively), but had decreased by 8.9+/-4.9 kg in the TG group (P=0.0003). A body composition analysis revealed a loss of fat mass in the DG and TG groups. The patients who underwent gastrectomy lost body protein mass during the early postoperative period. The type and extent of surgery has an effect on long-term body mass and composition. Bioelectric impedance analysis can be used to assess body composition and may be useful for nutritional assessment in patients who have undergone gastrectomy.
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Affiliation(s)
- Teruo Kiyama
- Department of Surgery I, Nippon Medical School, Tokyo 113-8603, Japan.
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Gockel I, Pietzka S, Junginger T. Lebensqualit�t nach subtotaler Magenresektion und Gastrektomie beim Magenkarzinom. Chirurg 2005; 76:250-7. [PMID: 15551010 DOI: 10.1007/s00104-004-0950-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recently, quality of life has become a main objective in surgical therapy. Apart from the oncological consequences, the quality of results after gastric carcinoma resection are mainly determined by social and psychological aspects of life, early postoperative complications, and long-term nutritive/functional parameters. Of 338 patients who underwent gastric resection for adenocarcinoma of the stomach, quality of life was assessed in 73 recurrence-free patients by means of the Gastrointestinal Life Quality Index (GLQI). The median age was 71.9 years, and surgery had been carried out at least 1 year prior to the investigation (median follow-up 4.5 years). Patients with subtotal gastric resection displayed significantly higher GLQI scores (120 [97-138] points) than patients with gastrectomy (116 [70-139] points;p=0.047). Among partial parameters of the life quality index, physical functions were significantly better after subtotal resection (p=0.040), while the emotional status (p=0.147) and social activities (p=0.337) did not differ between the two groups. Abdominal symptoms (p=0.081) and the nutritional function (p=0.228) were insignificantly different. The number of meals (4 vs. 5 meals per day) and the loss of weight since surgery (5 vs. 10 kg) were less after subtotal resection than after gastrectomy. However, the latter parameter did not reach statistical significance.
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Affiliation(s)
- I Gockel
- Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität Mainz.
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44
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Mochiki E, Kamiyama Y, Aihara R, Nakabayashi T, Kamimura H, Asao T, Kuwano H. Postoperative functional evaluation of jejunal interposition with or without a pouch after a total gastrectomy for gastric cancer. Am J Surg 2004; 187:728-35. [PMID: 15191866 DOI: 10.1016/j.amjsurg.2003.07.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2003] [Revised: 07/06/2003] [Indexed: 12/11/2022]
Abstract
BACKGROUND The objective of this study was to compare the motility of a gastric substitute after jejunal interposition without a pouch and jejunal interposition with a pouch and to evaluate the relationship of both methods with nutritional outcome. METHODS Twelve patients with gastric cancer treated by total gastrectomy and reconstruction with jejunal interposition without a pouch (J-I) and 14 patients treated by total gastrectomy and reconstruction with jejunal interposition with a pouch (J-P) were investigated in regard to the motor activity of the interposed jejunum and changes in body weight and dietary intake. RESULTS Phase III of the interposed jejunum without a pouch was observed over a 3-month follow-up, but phase III of the interposed jejunum with a pouch was not observed in any patient within 3 months of surgery. In the fed state, the motor activity of the interposed jejunum without a pouch increased significantly in patients within 12 months of follow-up, but in the interposed jejunum with a pouch, it did not. The amount of food consumed by the J-I group was significantly greater than that consumed by the J-P group. CONCLUSIONS This study demonstrates that the interposed jejunum with a pouch shows marked disturbances from the motor pattern of a normal jejunum during the fasting and fed states. These motor abnormalities may be responsible for insufficient food intake of the J-P group.
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Affiliation(s)
- Erito Mochiki
- First Department of Surgery, Faculty of Medicine, Gunma University, 3-39-15, Showa-machi, Maebashi 371-8511, Japan.
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Lehnert T, Buhl K. Techniques of reconstruction after total gastrectomy for cancer. Br J Surg 2004; 91:528-39. [PMID: 15122602 DOI: 10.1002/bjs.4512] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Jejunal pouch formation and restoration of duodenal transit have been suggested for reconstruction after total gastrectomy. Opinions about the clinical value vary. METHODS The literature was searched for prospective randomized trials comparing reconstructive procedures after total gastrectomy for malignancy. Reports with at least an English or German abstract were included. Immediate results were evaluated in terms of postoperative deaths and complications. Long-term outcome was analysed using trends in bodyweight and quality of life. RESULTS A total of 19 randomized trials including 866 patients was identified. The operative risk of total gastrectomy was low, with a median mortality rate of 0 (range 0-22) per cent, irrespective of the method of reconstruction. Neither gastric substitution nor restoration of duodenal transit was associated with significant procedure-related complications. Results for specific reconstructions varied considerably within and between individual trials. Jejunal pouch reconstruction, but not restoration of duodenal passage, was associated with improved food intake and a tendency for weight gain in the early postoperative months. A favourable perception of quality of life persisted in the long term in some studies. CONCLUSION Preservation of duodenal transit offers little clinical benefit. Construction of a small-bowel reservoir after total gastrectomy should be considered to improve early postoperative eating capacity, bodyweight and quality of life.
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Affiliation(s)
- T Lehnert
- Department of Surgery, Klinikum Bremen-Mitte, St Jürgen-Strasse 1, D-28205 Bremen, Germany.
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Tono C, Terashima M, Takagane A, Abe K. Ideal reconstruction after total gastrectomy by the interposition of a jejunal pouch considered by emptying time. World J Surg 2003; 27:1113-8. [PMID: 12925904 DOI: 10.1007/s00268-003-7030-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To establish the ideal form of the pouch for jejunal pouch interposition reconstruction (JPI) after total gastrectomy, the postoperative gastrointestinal function and symptoms were investigated in comparison with jejunal interposition reconstruction (JI). A total of 20 patients who underwent curative surgery for gastric cancer were enrolled in this study. In the JI group (n = 9), an isoperistaltic jejunum about 40 cm in length was interposed between the esophagus and the duodenum. In the JPI group n = 11), a proximal pouch about 15 cm in length with a 10-cm conduit was also interposed between the esophagus and the duodenum. At follow-up 6 months postoperatively, food transit was evaluated using a radiolabeled semisolid test meal. The half-emptying time was 6.9 minutes in the JI group and 46 minutes in the JPI group. The reservoir function influenced the recovery of the patients' body weight and development of the serum total protein in the early postoperative period. An early half-emptying time caused dumping symptoms in JI group. In the JPI group, there were no dumping symptoms; however, extended food clearance of pouch causes postprandial symptoms such as reflux (1 patient), vomiting (2 patients), and discomfort (2 patients). In those patients with symptoms, half-emptying times were longer than 60 minutes. There was a statistically significant correlation between the pouch length and the half-emptying time of the gastric substitute in JPI group (p = 0.0039, r = 0.789). If we estimate that the appropriate half-emptying time is 20 to 60 minutes, correlation of the pouch length and the half-emptying time shows that the ideal pouch length is about 12-15 cm in JPI. In jejunal pouch interposition reconstruction after total gastrectomy, an adequate procedure leads to nutritional advantage and prevents postoperative symptoms.
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Affiliation(s)
- Chiriro Tono
- Department of Surgery 1, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan
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Abstract
Total gastric resection and the subsequent selection of the optimum procedure for reconstruction of the oesophageal-intestinal tract is a highly debated topic. Many different types of reconstruction have been proposed, but attempts to objectively validate the potential advantages of these techniques of have not produced any definitive conclusions. The main aim of reconstruction should be to maintain the nutritional status and quality of life of the patient, with the additional goal of achieving similar function to normal gut. In this review, we discuss the prospectively randomised studies of gastrointestinal reconstruction that were done between 1987 and 2002.
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Affiliation(s)
- Anthony C Chin
- Department of Surgery, The University of Illinois at Chicago, 60012, USA
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Schwarz A. Preventive gastrectomy in patients with gastric cancer risk due to genetic alterations of the E-cadherin gene defect. Langenbecks Arch Surg 2003; 388:27-32. [PMID: 12690477 DOI: 10.1007/s00423-003-0351-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2003] [Accepted: 01/10/2003] [Indexed: 01/21/2023]
Abstract
BACKGROUND Germline mutations in the E-cadherin gene CDH1 have recently been described that seem to be responsible for the development of hereditary diffuse gastric cancer. METHODS The world literature on familial gastric cancer is reviewed in terms of mutations of the E-cadherin gene CDH1. RESULTS There are reports of 18 families worldwide with hereditary diffuse gastric cancer due to germline mutations of the E-cadherin gene CDH1. Germline mutations of the E-cadherin gene CDH1 lead to hereditary diffuse gastric cancer with a penetrance of about 70%. An early onset with an average age of 38 years in men and women is typical for this autosomal dominant inherited disease. Until now preventive total gastrectomies with hereditary diffuse gastric cancer have been reported in five patients. CONCLUSIONS Preventive total gastrectomy should be the procedure of choice in patients with a germline mutation of the E-cadherin gene CDH1. Patients with a genetic risk for familial gastric cancer who reject preventive total gastrectomy must be followed-up intensively by endoscopy every 6-12 months.
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Affiliation(s)
- A Schwarz
- Department of General Surgery, University of Ulm, Steinhoevelstrasse 9, 89075 Ulm, Germany.
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Yu W, Seo BY, Chung HY. Postoperative body-weight loss and survival after curative resection for gastric cancer. Br J Surg 2002; 89:467-70. [PMID: 11952589 DOI: 10.1046/j.0007-1323.2001.02046.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Body-weight loss has been reported as a poor prognostic factor for some malignancies. The purpose of this study was to evaluate the prognostic value of postoperative body-weight loss in patients with gastric cancer. METHODS In 564 patients who underwent curative resection for gastric cancer, usual body-weight, body-weight at the time of resection and that 6 and 12 months after resection were recorded prospectively. RESULTS The 5-year survival rate of patients who lost more than 5 per cent of their 6-month postoperative weight by 12 months after resection was 63 per cent while that of patients who maintained 95 per cent or more of their 6-month postoperative weight was 84 per cent (P < 0.001). Multivariate analysis revealed that serosal invasion, nodal metastasis, body-weight loss during the second 6-month interval after resection and extent of gastric resection were independent prognostic indicators. CONCLUSION When a patient loses body-weight during the second 6-month interval after curative resection for gastric cancer, recurrent disease should be suspected.
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Affiliation(s)
- W Yu
- Department of Surgery, School of Medicine, Kyungpook National University, 50 Samduk-dong, Taegu, 700-721, Korea.
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Seto Y, Yamaguchi H, Shimoyama S, Shimizu N, Aoki F, Kaminishi M. Results of local resection with regional lymphadenectomy for early gastric cancer. Am J Surg 2001; 182:498-501. [PMID: 11754858 DOI: 10.1016/s0002-9610(01)00747-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In 1999, the authors reported preliminary results of local resection with regional lymphadenectomy(LR) for early gastric cancer. METHODS Twenty-four patients underwent LR until May 2000. Laparoscopic techniques were recently applied. The dissected area for lymphadenectomy depended on the lymphatic flow from the tumor. Local gastric resection was performed with a 2 cm cancer-free margin. Among the 24 patients, 14 who had been followed up for more than 1 year were eligible for the nutritional study, and the nutritional parameters were compared with those for patients undergoing pylorus-preserving gastrectomy (PPG). RESULTS Twenty-two patients not receiving additional gastrectomy needed no restriction of food intake and had neither postgastrectomy symptoms nor recurrence. All nutritional parameters remained stable between the preoperative and the subsequent period. Nutritional superiority of LR over PPG was observed. CONCLUSIONS For selected patients with early gastric cancer, LR can be a treatment of choice to provide a good quality of life.
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Affiliation(s)
- Y Seto
- Department of Gastrointestinal Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
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