Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Background factors influencing postgastrectomy syndromes after various types of gastrectomy
Shinichi Kinami, Masazumi Takahashi, Takashi Urushihara, Masami Ikeda, Masashi Yoshida, Yoshikazu Uenosono, Atsushi Oshio, Yoshimi Suzukamo, Masanori Terashima, Yasuhiro Kodera, Koji Nakada
Shinichi Kinami, Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
Masazumi Takahashi, Division of Gastroenterological Surgery, Yokohama Municipal Citizen’s Hospital, Yokohama 240-8555, Japan
Takashi Urushihara, Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
Masami Ikeda, Department of Surgery, Asama General Hospital, Saku 385-0222, Japan
Masashi Yoshida, Department of Surgery, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
Yoshikazu Uenosono, Department of Surgery, Imamura General Hospital, Kagoshima 890-0064, Japan
Atsushi Oshio, Faculty of Letters, Arts and Sciences, Waseda University, Tokyo 169-8666, Japan
Yoshimi Suzukamo, Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
Masanori Terashima, Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
Yasuhiro Kodera, Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
Koji Nakada, Department of Laboratory Medicine, The Jikei University Daisan Hospital
Author contributions: Kinami S wrote the paper; Kinami S and Nakada K designed the study; Kinami S, Takahashi M, Urushihara T, Ikeda M, Yoshida M, Uenosono Y, Terashima M, Kodera Y, and Nakada K collected the data; Oshio A contributed to the statistical analysis; Suzukamo Y supervised the PGSAS-45 questionnaire.
Supported by a grant from the Jikei University School of Medicine and Japanese Society for Gastro-surgical Pathophysiology.
Institutional review board statement: This study was reviewed and approved by the local ethics committees at each institution.
Informed consent statement: Written informed consent was obtained from all patients before study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interests related to the publication of the study.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Shinichi Kinami, MD, PhD, Associate Professor, Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan. kinami@kanazawa-med.ac.jp
Telephone: +81-76-2862211 Fax: +81-76-2864626
Received: September 24, 2018
Peer-review started: September 24, 2018
First decision: October 17, 2018
Revised: October 27, 2018
Accepted: November 14, 2018
Article in press: November 15, 2018
Published online: December 26, 2018
BACKGROUND
Postgastrectomy syndromes (PGS) after curative gastrectomy for gastric cancer are influenced by not only gastrectomy type but also by background factors. Recently, a nationwide PGS study was performed using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire.
AIM
To determine the influence of each background factor on PGS for each gastrectomy type using PGS assessment study (PGSAS) data as an additional analysis.
METHODS
The data of 2368 patients were obtained from the PGSAS. This included patients undergoing distal gastrectomy (DG) with Billroth I reconstruction, DG with Roux-en-Y reconstruction, total gastrectomy with Roux-en-Y, proximal gastrectomy, pylorus-preserving gastrectomy (PPG), and local resection. Multiple regression analysis was performed to explore the independent effects of each background factor on the main outcome measures (MOMs) of PGSAS-45 for each gastrectomy type. The background factors included postoperative period, age, sex, surgical approach (laparoscopic or open), and the status of the celiac branch of the vagal nerve.
RESULTS
The MOMs of DG and PPG were highly affected by background factors, whereas those of total gastrectomy with Roux-en-Y, proximal gastrectomy, and local resection were not. Worse PGS were found in females, whereas a longer postoperative period alleviated some of the MOMs. For DG and PPG, a laparoscopic approach and preservation of the celiac branch improved several MOMs.
CONCLUSION
Various background factors affected PGS, and their influence varied with the type of gastrectomy performed. Laparoscopic surgery and celiac branch preservation can improve PGS in patients undergoing DG and PPG.
Core tip: We determined the influence of each background factor on postgastrectomy syndromes (PGS) for each gastrectomy type in 2368 patients from the PGS assessment study (PGSAS) dataset. The postoperative period, age, and sex affected PGS, and their influence varied with gastrectomy type. PGS after distal gastrectomy and pylorus preserving gastrectomy were highly affected, whereas that after total gastrectomy, proximal gastrectomy, and local resection was not. Worse PGS were observed in females, whereas a longer postoperative period alleviated some of the PGS. Laparoscopic surgery and celiac branch preservation can improve PGS in patients undergoing distal gastrectomy and pylorus preserving gastrectomy.
