Quality of Life after Gastrectomy for Gastric Carcinoma: a Controlled Study of Different Reconstructive Procedures

Abstract

Background: A growing number of surgical trials include Quality of Life (QOL) variables in overall assessment of outcomes. This is believed to broaden the criteria for choice of treatment and the evaluation of treatment regimens. A number of important questions have to be addressed in patients with gastric carcinoma. How are health-related QOL measures presented in patients referred to hospital? Do these patients suffer from mood disorders? Is the QOL of these patients different from that of the general population and other patient groups of similar demographic origin and referred to hospital because of completely different kinds of surgical diseases? What is the impact of surgical therapy on QOL parameters? Does the type of surgical reconstruction affect important QOL parameters? Patients and methods: We have studied QOL in consecutive patients with carcinoma of the stomach considered amenable to curative major surgical procedures. The QOL evaluation was based on a battery of questionnaires, covering general body symptoms, mood level and functional limitations. In a subsequent series of patients, 64 patients were randomized to have either a total (n = 31), a subtotal (n = 13) gastrectomy or a jejunal S-shaped pouch (n = 20) as a gastric substitute. The patients were rated by one of two psychiatrists who were blind to the patient group affiliation. Assessments were made on three occasions: during the week prior to surgery, 3 months and 12 months after the surgical intervention. Results: Patients with gastric cancer reported more neurasthenic complaints such as reduced sexual interest, insomnia and pure appetite as well as lower mood level than the general population. The gastric cancer group also showed a markedly lower mood level compared with a group of cancer survivors 2–3 years after diagnosis than patients with intermittent claudication. Overall, 25% of the gastric cancer patients reported functional limitations regarded to be clinically significant. For instance patients with intermittent claudication reported more limitations and patients with small cell lung cancer markedly more limitations. Irrespective of type of surgical treatment, the patients postoperatively suffered from alimentary symptoms and functional limitations in everyday life, whereas their mental status and well-being improved considerably after surgery. Patients who underwent subtotal gastrectomy had the best outcome, especially with respect to complaints of diarrhoea. Patients given a gastric substitute after gastrectomy showed no difference from those who had only a total gastrectomy with a straight Roux-en-Y oesophagojejunostomy. Conclusion: It can be concluded that all patients with gastric cancer referred to hospital for surgical treatment show a low level of limitation on average, but exhibit problems in the area of sleep/rest; home management and especially eating disturbances were frequently reported. After gastrectomy, significant unfavourable consequences of the operation could be elucidated but the patients recovered with an improved mental status. A pouch reconstruction of total gastrectomy does not improve QOL when assessed during the first 12 months after the operation, but a subtotal gastrectomy has some advantages which have to be considered when the procedure is clinically feasible.

Key Words:

• Gastrectomy
• gastric cancer
• QOL