Long-term effects of jejunal pouch added to Roux-en-Y reconstruction after total gastrectomy

Roux-en-Y with or without jejunal J-pouch reconstruction after total gastrectomy for gastric cancer: systematic review and meta-analysis of long-term functional outcomes

BACKGROUND

Increased survival of patients undergoing total gastrectomy for gastric cancer has prompted several efforts to improve long-term postgastrectomy syndrome (PGS) outcomes. Whether a J-pouch (JP) reconstruction may be more beneficial than a standard Roux-en-Y (RY) is controversial.

METHODS

A systematic review with meta-analysis was conducted, including studies reporting long-term outcomes of patients treated with total gastrectomy and JP vs RY esophagojejunostomy for gastric adenocarcinoma. A literature search was performed on PubMed, Scopus, and Google Scholar. Primary endpoints were symptom control, weight loss, eating capacity (EC), and quality of life (QoL) with at least 6 months of follow-up. Safety endpoints were explored.

RESULTS

Overall, 892 patients were included from 15 studies (6 randomized controlled trials [RCTs] and 9 non-RCTs): 452 (50.7%) in the JP group and 440 (49.3%) in the RY group. Compared with RY, JP showed a significantly lower rate of dumping syndrome (13.8% vs 26.9%, odds ratio [OR], 0.29; 95% confidence interval [CI], 0.14-0.58; P < .001; I2 = 22%) and heartburn symptoms (20.4% vs 39.0%; OR, 0.29; 95% CI, 0.14-0.64; P = .002; I2 = 0%). Reflux (OR, 0.61; 95% CI, 0.28-1.32; P = .21; I2 = 42%) and epigastric fullness (OR, 0.60; 95% CI, 0.18-2.05; P = .41; I2 = 69%) were similar in both groups. Weight loss and EC were similar between the groups. QoL outcome seemed to be burdened by bias. There was no difference in morbidity, mortality, and anastomotic leak rate between groups. Operative time was significantly longer for JP than for RY (271.9 vs 251.6 minutes, respectively; mean difference, 21.55; 95% CI, 4.64-38.47; P = .01; I2 = 96%).

CONCLUSION

JP reconstruction after total gastrectomy for gastric cancer is as safe as RY and may provide an advantage in postgastrectomy dumping syndrome and heartburn symptoms.

Clinical efficacy of Daikenchuto (DKT: TJ-100) for gastrointestinal symptoms in patients with a history of colon and rectosigmoid cancer surgery: a randomized crossover study

PURPOSE

This randomized crossover trial investigated the effects of Daikenchuto (DKT: TJ-100) on gastrointestinal symptoms of patients after colon and rectosigmoid cancer surgery.

METHODS

Among patients who had completed surgery for colon cancer, including rectosigmoid cancer, over 6 months ago, 20 who complained of gastrointestinal symptoms were enrolled. Subjects were randomly assigned to two sequences: sequences: A and B. In period 1, sequence A subjects were orally administered DKT, whereas sequence B subjects were untreated for 28 days. After a 5-day interval, in period 2, sequences A and B were reversed. Quality-of-life markers (GSRS and VAS), the Sitzmark transit study, the orocecal transit time (lactulose hydrogen breath test) and Gas volume score were evaluated before and after each period with findings compared between the presence of absence of DKT administration.

RESULTS

Between sequences, there were no significant differences in clinicopathological characters or any evaluations before randomization. There was no carryover effect in this crossover trial. The administration of DKT significantly ameliorated the GSRS in total, indigestion, and diarrhea, although the planned number of subjects for inclusion in this trial was not reached.

CONCLUSIONS

DKT may ameliorate subjective symptoms for postoperative patients who complain of gastrointestinal symptoms.

Comparison of effects of six main gastrectomy procedures on patients’ quality of life assessed by Postgastrectomy Syndrome Assessment Scale-45

BACKGROUND

The effects of various gastrectomy procedures on the patient’s quality of life (QOL) are not well understood. Thus, this nationwide multi-institutional cross-sectional study using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), a well-established questionnaire designed to clarify the severity and characteristics of the postgastrectomy syndrome, was conducted.

AIM

To compare the effects of six main gastrectomy procedures on the postoperative QOL.

METHODS

Eligible questionnaires retrieved from 2368 patients who underwent either of six gastrectomy procedures [total gastrectomy with Roux-en-Y reconstruction (TGRY; n = 393), proximal gastrectomy (PG; n = 193), distal gastrectomy with Roux-en-Y reconstruction (DGRY; n = 475), distal gastrectomy with Billroth-I reconstruction (DGBI; n = 909), pylorus-preserving gastrectomy (PPG; n = 313), and local resection of the stomach (LR; n = 85)] were analyzed. Among the 19 main outcome measures of PGSAS-45, the severity and characteristics of postgastrectomy syndrome were compared for the aforementioned six gastrectomy procedures using analysis of means.

RESULTS

TGRY and PG significantly impaired the QOL of postoperative patients. Postoperative QOL was excellent in LR (cardia and pylorus were preserved with minimal resection). In procedures removing the distal stomach, diarrhea subscale (SS) and dumping SS were less frequent in PPG than in DGBI and DGRY. However, there was no difference in the postoperative QOL between DGBI and DGRY. The most noticeable adverse effects caused by gastrectomy were meal-related distress SS, dissatisfaction at the meal, and weight loss, with significant differences among the surgical procedures.

CONCLUSION

Postoperative QOL greatly differed among six gastrectomy procedures. The severity and characteristics of postgastrectomy syndrome should be considered to select gastrectomy procedures, overcome surgical shortcomings, and enhance postoperative care.

Effects of colorectal endoscopic submucosal dissection on postoperative abdominal symptoms: a prospective observational study

BACKGROUND

Endoscopic submucosal dissection (ESD) is an effective procedure to resect large superficial gastrointestinal neoplasms. In gastric ESD, several studies showed the relationship between postoperative abdominal symptoms and endoscopic treatment. However, the influence of colorectal ESD on abdominal symptoms after treatment is still unknown. To the best of our knowledge, this is the first prospective multicenter study performed to investigate the impact of colorectal ESD on postoperative abdominal symptoms. This study aimed to clarify the association between change of abdominal symptoms and ESD.

METHODS

This study was a prospective multicenter observational trial that enrolled 141 out of 171 patients who underwent colorectal ESD and answered the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire from March 2015 to August 2019. We evaluated abdominal symptoms in the patients using the GSRS questionnaire before ESD and a few weeks after ESD.

RESULTS

Comparing the GSRS before and after ESD, overall scores changed from 1.58 ± 0.58 to 1.48 ± 0.48, and the five subscales (reflux syndrome, abdominal pain, indigestion syndrome, diarrhea syndrome, and constipation syndrome) were slightly improved. Overall scores, indigestion syndrome, and constipation syndrome were statistically significantly different before and after ESD (P < 0.05).

CONCLUSIONS

In GSRS, a score of ≥ 3 is often treated as a clinically significant symptom. Therefore, our findings indicated that there was no clinically significant difference. For this reason, colorectal ESD does not affect postoperative abdominal symptoms and is considered a minimally invasive treatment. The analysis of the impact of colon ESD on gastrointestinal symptoms UMIN000016914.

Heterochronous Suture Line Recurrences in the Jejunal Pouch following Total Gastrectomy for Stage II Gastric Cancer: A Case Report and Literature Review

We report the case of a 65-year-old male who developed heterochronous local recurrences of gastric cancer in the jejunal pouch (J-pouch) four times after total gastrectomy. He underwent total gastrectomy, J-pouch, and Roux-en-Y reconstruction for stage II gastric cancer in 2005. Four local recurrences appeared on the esophago-jejunal anastomosis, the suture line within the pouch, the esophago-jejunal anastomosis, and the anastomosis between the jejunum and Y-loop, which were resected by partial excision or endoscopic submucosal dissection. Suture line recurrence of gastric cancer is rare. The common features for each recurrence included the surgically negative resection margins, observation of the same histopathological subtype, absence of remote metastasis or peritoneal seeding, and the recurrence on the anastomotic suture line, suggesting that the cause of recurrence was the implantation of exfoliated cancer cells probably in the suture line. However, there is no established procedure for preventing implantation recurrence currently, the effectiveness of lumen lavage is suggested.

Jejunal pouch reconstruction after total gastrectomy is associated with better short-term absorption capacity and quality of life in early-stage gastric cancer patients

Background

No consensus exists regarding the best reconstruction style after total gastrectomy (TG). Roux-en-Y oesophagojejunostomy is a simple option for gastrointestinal tract reconstruction. Recently, jejunal pouch reconstruction has been suggested as an appropriate approach. We compared the postoperative outcomes of the two surgical approaches using a well-characterized cohort of gastric carcinoma patients.

Methods

A total of 60 patients who underwent TG were divided into two groups according to the reconstruction style. Both groups were compared regarding patient characteristics, perioperative data and quality of life (QoL), which was assessed using the Spitzer QoL index (QLI) and Visick grade. The incidence of long-term surgery-related complications, including reflux oesophagitis, dumping syndrome, and retention syndrome, was also compared to evaluate postoperative restoration.

Results

Both study groups were comparable with respect to general patient characteristics. No mortality or no significant differences in surgery-related data were found except in the operation time. Compared to Orr Roux-en-Y reconstruction, pouch reconstruction was associated with a longer procedure time, a lower incidence of dumping/retention syndrome and better QoL parameters (p < 0.05).

Conclusion

In this study, jejunal pouch reconstruction after TG was superior to the traditional Roux-n-Y oesophagojejunostomy with respect to improved dietary intake and QoL.

Nutritional Results of Roux-en-Y Pouch Reconstruction After Total Gastrectomy for Gastric Cancer

Objective:

The aim of the present study was to describe the nutritional advantage of pouch reconstruction.

Summary of background data:

Roux-en-Y (RY) pouch reconstruction might improve patients' quality of life compared with RY reconstruction without a pouch after total gastrectomy for gastric cancer.

Methods:

Clinical records were retrospectively reviewed in 9 and 30 patients with gastric cancer for stages I to III diseases in the pouch and RY groups, respectively, and perioperative and nutritional results were studied. Nutritional results were studied for hemoglobin, serum albumin, total lymphocyte count, and prognostic nutritional index for 5 years postoperatively.

Results:

Intraoperative blood loss did not differ between 2 groups, and operative time in the pouch group was prolonged compared with the RY group. All parameters we studied for nutritional results did not differ between the pouch and RY groups in patients with stages I to III diseases. When nutritional results were investigated in patients with stage I diseases, the total lymphocyte count at 2 years and prognostic nutritional index at 2 and 3 years postoperatively were greater in the pouch group than RY group, but the increase was not obvious at 4 to 5 years after the operation, and serum albumin and hemoglobin did not differ between 2 groups.

Conclusions:

These results indicate that the nutritional advantage of pouch reconstruction is very limited after total gastrectomy because the nutritional benefits of pouch reconstruction were observed in 2 of 4 parameters in patients with stage I at 2 and 3 years postoperatively.

Long-Term Consequences of Total Gastrectomy: Quality of Life, Nutritional Status, Bacterial Overgrowth and Adaptive Changes in Esophagojejunostomic Mucosa

OBJECTIVES

The aim of the study was to evaluate long-term quality of life and adaptive changes in the mucosa of the proximal section of the small intestine used for esophagojejunostomy reconstruction in stomach cancer patients after total gastrectomy.

MATERIAL AND METHODS

Thirty-one patients who had undergone stomach cancer-related total gastrectomy were included in the study, which spanned a period of 48 to 127 months (79.6 months on the average) after the surgery. The analysis included: a) evaluation of selected biochemical parameters; b) microbiological evaluation of esophagojejunostomic area; c) evaluation of adaptive changes in esophagojejunostomic mucosa using light and electron microscopy; d) quality of life evaluation with a Troidl questionnaire.

RESULTS

Quality of life was subjectively rated as good or very good by almost all subjects. The analyzed biochemical parameters were within the range of normal values in all the subjects with the exception of mild abnormalities in alkaline phosphatase and vitamin B12 levels in some patients. Microbiological examination of mucosal specimens from below the esophagojejunostomy revealed significant bacterial flora overgrowth in all the patients, with streptococci being the most abundant species. Light and electron microscopy examination of the epithelium confirmed it was normal and characteristic of a healthy small intestine.

CONCLUSIONS

Long-term quality of life in patients after complete stomach resection is considered good or very good, irrespective of the reconstruction method used, and the esophagojejunostomic mucosa of the reconstructed area is normal and typical for a healthy small intestine.

Development and validation of a symptom scale to evaluate postoperative patients with esophagogastric cancer

BACKGROUND

Postgastrectomy or esophagectomy symptoms can be a significant burden for patients. However, no standard scale for evaluating these symptoms has been established. We recently developed a postoperative symptom-specific scale.

STUDY DESIGN

After a draft scale was prepared based on a pilot study, psychometric methods were used to assess its reliability and validity. This study involved specialized and multifaceted discussions by a team consisting of gastrointestinal surgeons, gastroenterologists, psychologists, and epidemiologic researchers. The draft questionnaire included 40 questions and 3 domains. A factor analysis was carried out to refine the items and subscale design. To assess the reliability, Cronbach's alpha and score distributions were estimated. To assess the criterion-related validity, the correlations with the Short Form (SF)-12, Gastrointestinal Symptom Rating Scale (GSRS), endoscopic findings, and nutritional indicators were analyzed.

RESULTS

A total of 344 patients were enrolled in this study. In an exploratory factor analysis (principal factor method), the eigenvalue attenuation data showed 4 domains. The final scale, named the Esophagus and Stomach Surgery Symptom Scale (ES(4)), included 23 items and 4 domains; 7 items for cervico-thoracic symptoms, 6 for abdominal hypersensitivity symptoms, 4 for abdominal distention symptoms, and 6 items for systemic symptoms. Cronbach's alphas for these domains were 0.82, 0.81, 0.79, and 0.74, respectively. The scale scores were normally distributed, and there were significant associations with the endoscopic findings, nutritional indicators, the summary score of the SF-12, and the GSRS.

CONCLUSIONS

The ES(4) scale has high psychometric validity and can evaluate the profiles and severity of postoperative symptoms. This scale is applicable as an outcomes measure for various interventional studies on esophagogastric surgery aimed at alleviating postoperative symptoms.

Tissue engineering of the stomach

Tissue engineering combines engineering principles with the biological sciences to create functional replacement tissues. The underlying principle of tissue engineering is that isolated cells combined with biomaterials can form new tissues and organs in vitro and in vivo. This review focuses on stomach tissue engineering, which is a promising approach to the treatment of gastric cancer, the fourth most common malignancy in the world and the second-leading cause of cancer mortality worldwide. Although gastrectomy is a reliable intervention to achieve complete removal of cancer lesions, the limited capacity for food intake after resection results in lower quality of life for patients. To address this issue, we have developed a tissue-engineered stomach to increase the capacity for food intake by creating a new food reservoir. We have transplanted this neo-stomach as a substitute for the original native stomach in a rat model and confirmed functional adaptation. Furthermore, we have demonstrated the feasibility of transplanting a tissue-engineered gastric wall patch in a rat model to alleviate the complications after resection of a large area of the gastric wall. Although progress has been achieved, significant challenges remain to bring this approach to clinical practice. Here, we summarize our work and present the state of the art in stomach tissue engineering.

Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan

The Japanese Society for the Study of Postoperative Morbidity after Gastrectomy conducted a nationwide questionnaire survey to clarify the current status of reconstruction after gastrectomy. One hundred and forty-five institutions (66%) responded to the survey. The questionnaire dealt with the reconstruction after a distal gastrectomy, pylorus-preserving gastrectomy (PPG), total gastrectomy, and proximal gastrectomy. The most common method of reconstruction after distal gastrectomy was Billroth I in 112 institutions (74%), and Roux-en-Y (RY) in 30 (21%). Seventy-seven institutions (53%) responded to the PPG questions. The lengths of the antral cuff were widely distributed among the institutions. Segmental gastrectomy was performed by 23 institutions for limited cases. The most common method of reconstruction after total gastrectomy was RY in 138 institutions (95%). Reconstruction with a pouch after total gastrectomy was done in 26 institutions (18%). The most common reconstructions after proximal gastrectomy were esophagogastrostomy in 69 institutions (48%), jejunal interposition in 41 (28%), double tract in 19 (13%) and pouch reconstruction in 6 (7%). Although most Japanese surgeons are concerned about the revised methods of reconstruction and quality of life after gastrectomy, surgeons have not yet reached a full consensus on these issues.

Optimal size of jejunal pouch as a reservoir after total gastrectomy: a single-center prospective randomized study

BACKGROUND

In order to improve a patient's quality of life after total gastrectomy, jejunal pouch reconstruction has been employed. However, little information exists regarding the optimal size of the jejunal pouch after total gastrectomy.

METHODS

The study was designed as a single-center randomized trial in which the results of double-tract reconstruction with pouches of two different sizes were compared, i.e., short and long pouch double tract (SPDT and LPDT, respectively). We conducted a clinical assessment with standard questionnaire after surgery. The amount of residual food in the jejunal pouch was determined by endoscopy.

RESULTS

No demographic differences were noted between the two groups. The eating capacity per meal was higher in the SPDT group than in the LPDT group. The postoperative weight loss 24 months after surgery was lower in SPDT group than that in the LPDT group. Although the incidence of early dumping symptoms was higher in the SPDT group, no difference was noted in the other postprandial abdominal symptoms between the two groups.

CONCLUSIONS

We conclude that the optimal pouch should be relatively short, as a short pouch improves the eating capacity per meal and the weight loss ratio to the preoperative value.

Early dumping syndrome and reflux esophagitis prevention with pouch reconstruction

BACKGROUND

Total gastrectomy causes numerous disorders, such as reflux esophagitis, dumping syndrome, malabsorption, and malnutrition. To minimize the consequences, different variants of reconstruction are performed. The aim of our study is the comparison of two reconstructive methods: the standard Roux-en-Y and a new modality of pouch interposition, preduodenal-pouch interposition. This study aims to investigate the advantage of bile reflux prevention and to reduce symptoms of dumping syndrome after 3- and 6-mo follow-up.

MATERIALS AND METHODS

A total of 60 patients were divided in two groups: (A) 30 patients with Roux-en-Y reconstruction, and (B) 30 patients with the preduodenal-pouch (PDP) type of reconstruction. Endoscopic examination and endoluminal jejunal limb pressure measurements were performed. Scintigraphic measurements of half-emptying time were performed to evaluate meal elimination in the context of reflux esophagitis and early dumping syndrome. The Japan Society of Gastrointestinal Surgery has provided guidelines with which to classify the symptoms of early dumping syndrome. Patients were followed up for periods of 3 and 6 mo after the surgery.

RESULTS

Our study groups did not differ with regard to the level of reflux esophagitis (P = 0.688). Average values of pressure at 10 and 15 cm below the esophago-jejunal junction were significantly lower in the PDP group (P < 0.001). Elimination of the test meal between two groups was not significant (P = 0.222). Evaluation of early dumping syndrome symptoms revealed a significant reduction among PDP patients after 3 and 6 mo.

CONCLUSION

Our study showed significant superiority of the new pouch reconstruction over the standard Roux-en-Y approach in the treatment of early dumping syndrome.

Effects on the pouch of different digestive tract reconstruction modes assessed by radionuclide scintigraphy

AIM: To determine the effect of three digestive tract reconstruction procedures on pouch function, after radical surgery undertaken because of gastric cancer, as assessed by radionuclide dynamic imaging.

METHODS: As a measure of the reservoir function, with a designed diet containing technetium-99m (^99mTc), the emptying time of the gastric substitute was evaluated using a ^99mTc-labeled solid test meal. Immediately after the meal, the patient was placed in front of a γ camera in a supine position and the radioactivity was measured over the whole abdomen every minute. A frame image was obtained. The emptying sequences were recorded by the microprocessor and then stored on a computer disk. According to a computer processing system, the half-emptying actual curve and the fitting curve of food containing isotope in the detected region were depicted, and the half-emptying actual curves of the three reconstruction procedures were directly compared.

RESULTS: Of the three reconstruction procedures, the half-emptying time of food containing isotope in the Dual Braun type esophagojejunal anastomosis procedure (51.86 ± 6.43 min) was far closer to normal, significantly better than that of the proximal gastrectomy orthotopic reconstruction (30.07 ± 15.77 min, P = 0.002) and P type esophagojejunal anastomosis (27.88 ± 6.07 min, P = 0.001) methods. The half-emptying actual curve and fitting curves for the Dual Braun type esophagojejunal anastomosis were fairly similar while those of the proximal gastrectomy orthotopic reconstruction and P type esophagojejunal anastomosis were obviously separated, which indicated bad food conservation in the reconstructed pouches.

CONCLUSION: Dual Braun type esophagojejunal anastomosis is the most useful of the three procedures for improving food accommodation in patients with a pouch and can retard evacuation of solid food from the reconstructed pouch.

Development of a 32-item scale to assess postoperative dysfunction after upper gastrointestinal cancer resection

AIM

The purpose of this study was to develop a 32-item scale to assess postoperative dysfunction in patients who underwent surgery for gastric and oesophageal cancer and to evaluate its reliability and validity.

BACKGROUND

For the objective assessment of postoperative dysfunction in patients with upper gastointestinal cancer, we performed a preliminary survey by mail using a 34-item questionnaire as a initial version. The results of the survey were assessed by item analysis of the scale. The scale items were further refined by researchers and specialists, and a 32-item scale for the assessment of postoperative dysfunction (initial scale) was developed.

METHODS

Using this 32-item scale (initial scale), a mail survey was performed of 379 subjects selected by random sampling.

RESULTS

The questionnaire was returned by 292 patients (77.1%) and 283 responses (74.7%) were valid. Of these, 221 respondents had gastric cancer and 62 oesophageal cancer. The mean age of respondents was 64.9 SD 9.8 (range 35-89) years. The mean total score of the 32-items on the initial version for the assessment of postoperative dysfunction was 60.8 SD 16.7. The mean total score for gastric cancer patients and oesophageal cancer patients was 58.1 SD 15.8 and 70.1 SD 16.7 respectively. After the elimination of scale items regarded as irrelevant based on statistical considerations and the judgement of experts, factor analysis was performed. Seven factors were valid: 'regurgitation reflux', 'limited activity because of decreased food consumption', 'passage dysfunction immediately after eating', 'dumping-like symptoms', 'transfer dysfunction', 'hypoglycaemic symptoms' and 'diarrhoea-like symptoms'. The cumulative proportion of variance by scale reliability was confirmed by a Cronbach's alpha-coefficient of 0.926. The Cronbach's alpha-coefficient for all 32 items on the initial version was 0.926, the Cronbach's alpha-coefficient for sub-items was 0.705-0.856, and Pearson's correlation coefficient of re-test for the total score of the 32 items was 0.865, which confirmed a high degree of internal consistency. The construct validity of the scale was confirmed using the known-group technique by operative procedures, and from the result of factorial validity. This scale was named 'Postoperative Dysfunction for Upper Gastrointestinal Cancer 32; PODUGC-32'.

CONCLUSION

This scale is sufficiently reliable and valid and will be useful clinically. Relevance to clinical practice. We can use the new scale to assess postoperative dysfunction in patients with upper gastointestinal cancer for nursing practice.

Clinical results of various reconstructions employed after total gastrectomy

Methods of restoring continuity after total gastrectomy, particularly those creating a "reservoir," have led to many publications over the last 20 years. These publications are herein reviewed in an attempt to answer questions regarding the clinical value of a jejunal "reservoir". The conclusion we reached from this review was that such a reconstruction does reduce unpleasant symptoms, aids weight maintenance, and is a valuable operative approach.

Function-preserving surgery for gastric cancer

Early gastric cancer (EGC) with 5-year survival rates exceeding 90% now accounts for nearly 50% of all gastric cancers treated at major institutions in Japan. D2 lymphadenectomy with resection of at least two-thirds of the stomach has been the mainstay of treatment for every stage of gastric cancer, including EGC. Post-gastrectomy syndrome is inevitable after surgery. Most of the symptoms resolve with time, though some patients suffer immensely for prolonged periods. Mucosal cancers rarely metastasize (3% or less). Surgeons have altered the traditional strategy for treatment which focused only on highly radical operations. The new strategy preserves patients' quality of life, while at the same time maintaining a high level of radicality, by employing a function-preserving operation which prevents post-gastrectomy syndrome. The Japanese gastric cancer treatment guidelines have standardized indications for the function-preserving surgery that is widely performed in Japan. There are various kinds of function-preserving operations, such as those reducing the extent of gastrectomy, and those providing nerve preservation, sphincter preservation, and formation of a new-stomach. Evaluation of preserved function is not satisfactory, because there is no gold standard for measuring gastrointestinal motor function and patients' quality of life.

Reliability and validity of a new scale to assess postoperative dysfunction after resection of upper gastrointestinal carcinoma

PURPOSE

We evaluated the purpose reliability and validity of a preliminary scale, which we developed to assess postoperative dysfunction after surgery for gastric and esophageal carcinoma.

METHODS

After interviews with 12 patients, reviews of previous studies, and discussions with experts, we identified the physical symptoms that develop after resection of upper gastrointestinal (GIT) carcinoma, and devised a preliminary scale comprised of 34 items. A questionnaire survey based on this scale was then sent to 283 patients.

RESULTS

The questionnaire was returned by 223 patients (78.8%), and 219 responses (98.2%) were valid. Among the 219 respondents, 168 had gastric carcinoma and 51 had esophageal carcinoma. After the elimination of scale items regarded as irrelevant based on statistical considerations and the judgment of experts, factor analysis was done. Seven factors were valid, namely, limited activity due to decreased food consumption, reflux, gastric dumping, nausea and vomiting, deglutition difficulty, pain, and difficulty with passing stools, which were often poorly formed. Scale reliability was confirmed by a Cronbach alpha-coefficient of 0.924. The validity of the construction of this scale was confirmed using the known-group technique based on the operative procedures performed, and the results of factorial validity.

CONCLUSION

Our preliminary scale is sufficiently reliable and valid, and will prove to be clinically useful.

Quality of life in gastric cancer

AIM: To summarize the empirical research on assessing quality of life (QOL) in patients with gastric carcinoma.

METHODS: Literature searches were conducted in MedLine from 1966 to February 2004.

RESULTS: Twenty-six studies were identified. QOL was used as an outcome measure in virtually all identified studies, such as those examining the effects of gastric cancer and various medical or surgical treatments in the patients. QOL was assessed mainly with generic measures; the social dimensions of QOL were largely neglected. The lack of gastric cancer-specific QOL measures hampers QOL research up to now. The gastric cancer-specific EORTC-QLQ-STO22 and the FACT-Ga are important additions to the arsenal of disease-specific QOL measures. In most of the studies, the label QOL is used for questionnaires, which only assess symptoms or performance status, or are physician-reported rather than patient-reported outcomes.

CONCLUSION: QOL in patients with gastric cancer deserves more systematic studies, especially as one of the outcome measures in randomized clinical trials. Results of studies that include QOL in patients with gastric cancer should be applied in clinical care, which aims at improving QOL of these patients.

Postgastrectomy syndromes--diagnosis and treatment

The stomach has a variety of functions that are lost with gastrectomy. Since nowadays a significant number of patients are long-term survivors, consequences of this loss need to be considered by gastroenterologists and surgeons alike. Abnormal transit, disturbed general nutrition and micronutrient deficiencies are the most common problems. The main resulting symptoms are early and late dumping, reflux esophagitis, weight loss, anemia, and osteopathy. It is not definitively clear if pouch reconstruction can really improve the situation. Dietary measures, rarely re-operation, and in particular adequate follow-up of metabolic and nutrition parameters with consequent substitution are the main therapeutic necessities.