Published online Feb 27, 2022. doi: 10.4240/wjgs.v14.i2.120
Peer-review started: October 7, 2021
First decision: December 4, 2021
Revised: December 15, 2021
Accepted: February 10, 2022
Article in press: February 10, 2022
Published online: February 27, 2022
For total laparoscopic distal gastrectomies for gastric cancer, the reconstruction method is critical to the clinical outcome of the procedure. However, which reconstruction technique is optimal remains controversial. We originally reported the augmented rectangle technique (ART) as a reconstruction option for total laparoscopic Billroth I reconstructions. Still, little is known about its effect on long-term outcomes, specifically the incidence of postgastrectomy syndrome and its impact on quality of life.
To analyze postgastrectomy syndrome and quality of life after ART using the Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaire.
At Juntendo University, a total of 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 and March 2020 completed the PGSAS-37 questionnaire. Multidimensional analysis was performed, comparing those 94 ART cases from our institution (ART group) to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS-37 as part of a larger national database (PGSAS group).
Patients in the ART group had significantly better total symptom scores in all the symptom subscales (i.e., esophageal reflux, abdominal pain, meal-related distress, indigestion, diarrhea, constipation, and dumping). The loss of body weight was marginally greater for those in the ART group than in the PGSAS group (-9.3% vs -7.9%, P = 0.054). The ART group scored significantly lower in their dissatisfaction of ongoing symptoms, during meals, and with daily life.
ART for Billroth I reconstruction provided beneficial long-term results for postgastrectomy syndrome and quality of life in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.
Core Tip: Reducing the prevalence of postgastrectomy syndrome (PGS) and improving the quality of life (QOL) after gastrectomy for gastric cancer patients has become an important technical challenge for surgeons. We developed the augmented rectangle technique (ART) for Billroth I reconstruction after total laparoscopic distal gastrectomy. Our patient outcome results have been good in the short-term. Long-term patient outcomes have not been studied. Here, we evaluated PGS and QOL after gastrectomy with ART using the Postgastrectomy Syndrome Assessment Scale-37. Application of ART produced beneficial long-term PGS and QOL results in patients undergoing total laparoscopic distal gastrectomies.