Should peri-gastrectomy gastric acidity be our focus among gastric cancer patients?

Table 1 General clinicopathological features of patients enrolled in the study (mean ± SD)

	Total gastrectomy	Distal gastrectomy	Proximal gastrectomy
Number of patients	35	34	30
Gender (male/female)	20/15	19/15	19/11
Smoking (yes/no)	19/16	18/16	18/12
Drinking (yes/no)	17/18	18/16	17/13
Age (yr)	62.49 ± 9.69	63.68 ± 9.48	59.40 ± 10.61
Body mass index (kg/m2)	20.55 ± 4.02	20.92 ± 2.57	19.70 ± 2.43
Hemoglobin (g/L)	114.83 ± 26.00	125.59 ± 24.99	122.23 ± 21.46
Lymphocyte count (109/L)	1.61 ± 0.50	1.34 ± 0.47	1.65 ± 0.51
Albumin (g/L)	38.43 ± 4.92	41.58 ± 3.50	40.99 ± 1.85
Pre-albumin (mg/L)	252.20 ± 60.65	282.71 ± 70.35	262.23 ± 45.65
RDQ score pre-operation	3.77 ± 2.58	3.35 ± 2.36	3.50 ± 2.36
GERD-Q score pre-operation	1.49 ± 1.15	1.47 ± 1.05	1.63 ± 1.40
Days in hospital pre-operation	3.09 ± 0.92	3.06 ± 0.92	3.00 ± 0.87
Days to peri-bed activities post-operation	1.14 ± 0.36	1.12 ± 0.33	1.13 ± 0.35
Days to borborygmus recovery post-operation	1.51 ± 0.51	1.56 ± 0.50	1.57 ± 0.50
Flatus duration post-operation (d)	3.11 ± 0.63	3.29 ± 0.80	3.47 ± 0.68
Transverse diameter of tumor (cm)	4.71 ± 1.87	4.90 ± 1.46	4.78 ± 2.04
Longitudinal diameter of tumor (cm)	4.06 ± 1.86	4.20 ± 1.15	4.40 ± 1.54
Depth of tumor (cm)	1.41 ± 0.64	1.66 ± 0.47	1.16 ± 0.66
Tumor stage (early/advanced)	4/31	5/29	3/27
Tumor differentiation (well/moderately/poorly)	6/15/14	7/12/15	4/13/13
Tumor TNM classification (I/II/III)1	4/5/26	7/6/21	3/8/19
Postoperative NRS score	3.34 ± 0.97	3.32 ± 0.98	3.30 ± 1.02

¹There was no patient with tumor-node-metastasis (TNM) IV tumor in our study. RDQ: Reflux disease questionnaire; GERD-Q: Gastroesophageal reflux disease questionnaire; NRS: Numerical rating scale.

Table 2 Results of multiple linear regression suggesting potential factors influencing gastric pH pre-gastrectomy

	b	b’	t	P value
Gender	-0.062	-0.020	-0.270	0.788
Age	0.036	0.249	2.461	0.016c
Body mass index	0.031	0.067	0.919	0.361
Tumor size	0.132	0.176	2.401	0.019c
Tumor location	0.099	0.108	1.371	0.174
TNM classification	-0.032	-0.048	-0.436	0.664
Differentiation grade	0.493	0.359	2.866	0.005d
Potassium ion	-0.053	-0.222	-2.317	0.023c
Sodium ion	0.001	0.022	0.224	0.823
Bicarbonate ion	0.584	0.210	2.122	0.037c
Urea nitrogen	0.087	0.090	1.145	0.256
Direct bilirubin	-0.244	-0.030	-0.440	0.661
Indirect bilirubin	0.254	0.108	1.347	0.182
Total bile acid	0.051	0.043	0.582	0.562

b: Partial regression coefficient; b’: Standardized partial regression coefficient.

^cP < 0.05;

^dP < 0.01. TNM: Tumor-node-metastasis.

Table 3 Results of multiple linear regression suggesting possible factors influencing reflux syndrome change (6 mo post- minus pre-gastrectomy)

	Scale	b	b’	t	P value
Gender	RDQ	-1.342	-0.139	-1.393	0.167
	GERD-Q	-0.604	-0.098	-1.046	0.299
Age	RDQ	0.072	0.160	1.506	0.136
	GERD-Q	0.056	0.194	1.952	0.054
Body mass index	RDQ	0.339	0.265	2.629	0.010c
	GERD-Q	0.227	0.277	2.939	0.004d
TNM classification	RDQ	-0.119	-0.059	-0.546	0.587
	GERD-Q	-0.014	-0.011	-0.108	0.914
pH	RDQ	0.121	0.017	0.17	0.865
	GERD-Q	-0.142	-0.031	-0.331	0.741
Potassium ion	RDQ	0.079	0.155	1.295	0.099
	GERD-Q	0.074	0.227	2.025	0.046c
Sodium ion	RDQ	0.017	0.117	1.137	0.259
	GERD-Q	0.013	0.136	1.417	0.160
Bicarbonate ion	RDQ	0.381	0.198	2.019	0.147
	GERD-Q	0.192	0.156	1.701	0.193
Urea nitrogen	RDQ	-0.074	-0.087	-0.781	0.437
	GERD-Q	-0.070	-0.129	-1.242	0.218
Direct bilirubin	RDQ	-0.985	-0.374	-2.970	0.004d
	GERD-Q	-0.704	-0.416	-3.542	0.001d
Indirect bilirubin	RDQ	0.077	0.252	2.251	0.027c
	GERD-Q	0.073	0.374	3.585	0.001d
Total bile acid	RDQ	0.005	0.178	1.517	0.033c
	GERD-Q	0.005	0.272	2.485	0.015c

b: Partial regression coefficient; b’: Standardized partial regression coefficient; RDQ: Reflux disease questionnaire; GERD-Q: Gastroesophageal reflux disease questionnaire.

^cP < 0.05;

^dP < 0.01.

Table 4 Gastrointestinal juice contents pre- and 6 mo post-gastrectomy in the 3 groups

Gastric juice content	Way of gastrectomy	Pre-gastrectomy	Six months post-gastrectomy
Potassium ion (mmol/L)	TG	11.77 ± 4.41	16.54 ± 11.80
	DG	14.18 ± 5.70	12.65 ± 5.90
	PG	16.80 ± 7.17	16.80 ± 6.55
Sodium ion (mmol/L)	TG	56.16 ± 34.09	111.68 ± 36.06
	DG	78.68 ± 21.71	104.10 ± 23.27
	PG	54.32 ± 25.44	89.06 ± 27.44
Bicarbonate ion (mmol/L)	TG	1.05 ± 0.52	4.36 ± 2.51
	DG	1.19 ± 0.47	3.28 ± 2.09
	PG	1.19 ± 0.58	3.58 ± 2.25
Urea nitrogen (mmol/L)	TG	3.63 ± 0.83	10.60 ± 6.00
	DG	4.80 ± 1.58	9.74 ± 4.83
	PG	4.42 ± 1.80	7.17 ± 4.39
Direct bilirubin (μmol/L)	TG	0.17 ± 0.16	0.87 ± 1.40
	DG	0.14 ± 0.17	2.20 ± 1.92
	PG	0.16 ± 0.21	1.39 ± 1.43
Indirect bilirubin (μmol/L)	TG	0.49 ± 0.55	13.61 ± 12.74
	DG	0.64 ± 0.65	17.85 ± 11.91
	PG	0.61 ± 0.65	23.41 ± 17.56
Total bile acid (μmol/L)	TG	1.98 ± 1.32	187.13 ± 199.14
	DG	3.00 ± 1.08	212.94 ± 103.39
	PG	2.73 ± 1.00	232.21 ± 126.40

TG: Total gastrectomy; DG: Distal gastrectomy; PG: Proximal gastrectomy.