Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1111-1120
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1111
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
ARTICLE HIGHLIGHTS
Research background

Postgastrectomy syndromes (PGS) are serious drawbacks after curative gastrectomy for gastric cancer. The main causes of PGS are gastrectomy and lymph node dissection. Nevertheless, a variety of other background factors are thought to be involved, such as age, sex, and postoperative period.

Research motivation

Although various background factors were considered to be involved in PGS, there have been no well-validated reports on this issue. In addition, there are two types of background factors: interventional and non-interventional. The non-interventional factors are age, sex, and postoperative period. The interventional factors are the laparoscopic approach and preservation of the celiac branch of the vagus. It is crucial to examine the effect of these interventional factors on PGS according to the type of gastrectomy in order to alleviate symptoms and improve quality of life (QoL).

Research objectives

We determined the influence of each background factor on PGS. However, as the invasiveness differs for each type of gastrectomy, the influence of background factors on PGS is likely to be different depending on the specific procedure. Therefore, we examined the influences of each background factor on PGS according to the type of gastrectomy.

Research methods

We conducted this retrospective study by using the dataset obtained from the PGS assessment study (PGSAS). The PGSAS was a nationwide, large-scale, retrospective observational study that investigated the symptoms, living status, and QoL of patients who underwent gastrectomy and completed the Postgastrectomy Syndrome Assessment Scale-45 questionnaire (PGSAS-45). A dataset comprising 2368 patients was analyzed. Multiple regression analysis was performed to explore the independent effects of each background factor on main outcome measures (MOMs) of PGSAS-45 for each gastrectomy type. The MOMs were classified into three domains, the symptom domain, the living status domain, and the QoL domain. The background factors included postoperative period, age, sex, surgical approach (laparoscopic or open), and the status of the celiac branch of the vagal nerve.

Research results

Regarding the postoperative period, several MOMs were alleviated because of the length of the postoperative period. These MOMs were mainly in the living status or the QoL domains. Regarding the gastrectomy procedure, several MOMs improved with the passage of time after DGRY; in contrast, no MOM improved with the passage of time after TGRY or PG. Age and sex also affected several MOMs of the PGSAS. For older patients, several MOMs belonging to the symptom domain were alleviated; in contrast, many MOMs belonging to the living status or QoL domain had worsened. There were many MOMs that were worse for women after DGBI and DGRY, but not after TG and LR. A few MOMs were attained after laparoscopic distal gastrectomy and laparoscopic PPG compared to conventional open surgery, which included MOMs in the living status or QoL domain, but not the symptom domain. Preservation of the celiac branch of the vagus positively affected the MOMs of the symptom domain for DGBI patients and the MOMs of the living status or QoL domain for PG and PPG patients.

Research conclusions

Various background factors affected the PGS. The degree of the effect varied according to the type of gastrectomy. The influence patterns of each background factor on the PGSAS MOMs were different. Many MOMs were alleviated over time yet worsened among women. Older age reduced the MOMs of the symptom domain, yet worsened the MOMs in the living status or QoL domains. Furthermore, surgical interventions, such as laparoscopic surgery and preservation of the celiac branch of the vagus, can alleviate some of the negative outcomes in patients undergoing DG and PPG.

Research perspectives

We confirmed that various background factors affected many MOMs of the PGSAS-45. The influence of background factors on MOMs was different for each factor. Arranging these factors in descending order of influence yields the following: sex, age, postoperative period, celiac branch saving, and the laparoscopic approach. The preservation of the celiac branch of the vagus can reduce some PGS for the procedures that retains physiological food passage. Laparoscopic DG or PPG may be recommended to alleviate some negative outcomes relating to living status and QoL.