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van der Wielen N, Brenkman H, Seesing M, Daams F, Ruurda J, van der Veen A, van der Peet DL, Straatman J, van Hillegersberg R. Minimally invasive versus open gastrectomy for gastric cancer. A pooled analysis of two European randomized controlled trials. J Surg Oncol 2024; 129:911-921. [PMID: 38173355 DOI: 10.1002/jso.27578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/06/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Minimally invasive techniques have shown better short term and similar oncological outcomes compared to open techniques in the treatment of gastric cancer in Asian countries. It remains unknown whether these outcomes can be extrapolated to Western countries, where patients often present with advanced gastric cancer. MATERIALS AND METHODS A pooled analysis of two Western randomized controlled trials (STOMACH and LOGICA trial) comparing minimally invasive gastrectomy (MIG) and open gastrectomy (OG) in advanced gastric cancer was performed. Postoperative recovery (complications, mortality, hospital stay), oncological outcomes (lymph node yield, radical resection rate, 1-year survival), and quality of life was assessed. RESULTS Three hundred and twenty-one patients were included from both trials. Of these, 162 patients (50.5%) were allocated to MIG and 159 patients (49.5%) to OG. A significant difference was seen in blood loss in favor of MIG (150 vs. 260 mL, p < 0.001), whereas duration of surgery was in favor of OG (180 vs. 228.5 min, p = 0.005). Postoperative recovery, oncological outcomes and quality of life were similar between both groups. CONCLUSION MIG showed no difference to OG regarding postoperative recovery, oncological outcomes or quality of life, and is therefore a safe alternative to OG in patients with advanced gastric cancer.
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Affiliation(s)
- Nicole van der Wielen
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Hylke Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten Seesing
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Jelle Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arjen van der Veen
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Kanda M, Tanaka C, Misawa K, Mochizuki Y, Watanabe T, Sueoka S, Ishiyama A, Yamada T, Oshima T, Hattori M, Koike S, Ishigure K, Teramoto H, Murotani K, Kodera Y. A multi-institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602). World J Surg 2024; 48:681-691. [PMID: 38340062 DOI: 10.1002/wjs.12088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Proximal gastrectomy (PG) has become an increasingly preferred procedure for treating early cancer in the upper third of the stomach. However, advantages of PG in postoperative quality of life (QOL) over total gastrectomy (TG) has not fully proven. METHODS We conducted a multi-institutional prospective observational study (CCOG1602) of patients who undergo TG or PG for cStage I gastric cancer. We used the PGSAS-37 and EORTC-QLQ-C30 to evaluate the changes in body weight and QOL over a 3-year postoperative period. The primary endpoint was the weight loss rate 3 years after surgery. RESULTS We enrolled 109 patients from 18 institutions and selected 65 and 19 patients for inclusion in the TG and PG groups, respectively. Mean postoperative weight loss rates were 16.0% and 11.7% for the TG and PG groups, respectively (p = 0.056, Cohen's d 0.656) during postoperative year 1% and 15.0% and 10.8% for TG and PG (p = 0.068, Cohen's d 0.543), respectively, during postoperative year 3, indicating that the PG group achieved a better trend with a moderate effect size. According to the PGSAS-37, the PG group experienced a better trend in the indigestion subscale (p < 0.001, Cohen's d -1.085) and total symptom score (p = 0.050, Cohen's d -0.59) during postoperative year 3 compared with the TG group. In contrast, the EORTC-QLQ-C30 detected no difference between the groups at any time point during 3-year postoperative period. CONCLUSIONS This prospective study demonstrates that PG tended to be more favorable compared with TG with respect to postoperative weight loss and QOL, particularly regarding indigestion.
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Affiliation(s)
- Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazunari Misawa
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - Takuya Watanabe
- Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Satoshi Sueoka
- Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | | | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Masashi Hattori
- Department of Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Shinya Koike
- Department of Surgery, Atsumi Hospital, Tahara, Japan
| | | | - Hitoshi Teramoto
- Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Kenta Murotani
- Graduate School of Medicine, Biostatistics Center, Kurume University, Kurume, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Park SH, Hur H, Park JH, Lee CM, Son YG, Jung MR, Lee HH, Hwang SH, Lee MS, Seo SH, Jeong IH, Son MW, Kim CH, Yoo MW, Oh SJ, Hwang SH, Il Choi S, Choi HS, Keum BR, Yang KS, Park S. Reappraisal of optimal reconstruction after distal gastrectomy - a study based on the KLASS-07 database. Int J Surg 2024; 110:32-44. [PMID: 37755373 PMCID: PMC10793744 DOI: 10.1097/js9.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUNDS This study aimed to compare the incidence of bile reflux, quality of life (QoL), and nutritional status among Billroth II (BII), Billroth II with Braun anastomosis (BII-B), and Roux-en-Y (RY) reconstruction after laparoscopic distal gastrectomy (LDG). MATERIALS AND METHODS We reviewed the prospective data of 397 patients from a multicentre database who underwent LDG for gastric cancer between 2018 and 2020 at 20 tertiary teaching hospitals in Korea. Postoperative endoscopic findings, QoL surveys using the European Organization for Research and Treatment of Cancer questionnaire (C30 and STO22), and nutritional and surgical outcomes were compared among groups. RESULTS In endoscopic findings, bile reflux was the lowest in the RY group ( n =67), followed by the BII-B ( n =183) and BII groups ( n =147) at 1 year (3.0 vs. 67.8 vs. 84.4%, all P <0.05). The anti-reflux capability of BII-B was statistically better than that of BII, but not as perfect as that of RY. From the perspective of QoL, BII-B was not inferior to RY, but better than BII reconstruction in causing fewer STO22 reflux symptoms at 6 and 12 months. However, only RY caused fewer C30 nausea symptoms than BII at 6 and 12 months, but not BII-B. Nutritional status and morbidities were similar among the three groups, and the operative time did not differ between the BII-B and RY groups. CONCLUSIONS BII-B cannot substitute for RY in preventing bile reflux, shortening the operative time, or reducing morbidities. Regarding short-term QoL, BII-B was sufficient to reduce STO22 reflux symptoms but failed to reduce C30 nausea symptoms postoperatively.
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Affiliation(s)
- Shin-Hoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon
| | - Jong-Hyun Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
| | - Chang-Min Lee
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Department of Surgery, Korea University Ansan Hospital, Ansan
| | - Young-Gil Son
- Department of Surgery, Keimyung University Dongsan Medical Centre, Daegu
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Jeollanam-do
| | - Han Hong Lee
- Department of Surgery, Catholic University of Seoul St Mary’s Hospital, Seoul, Republic of Korea
| | - Sun-Hwi Hwang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Moon-Soo Lee
- Department of Surgery, Eulji University Hospital, Daejeon
| | - Sang Hyuk Seo
- Department of Surgery, Busan Paik Hospital, Inje University
| | - In Ho Jeong
- Department of Surgery, Jeju National University School of Medicine, Jeju
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Hospital Cheonan, Cheonan
| | - Chang Hyun Kim
- Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Moon-Won Yoo
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan
| | - Seong Ho Hwang
- Department of Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul
| | - Hyuk Soon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Bo-Ra Keum
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul
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Christodoulidis G, Kouliou MN, Koumarelas KE, Giakoustidis D, Athanasiou T. Quality of Life in Patients Undergoing Surgery for Upper GI Malignancies. Life (Basel) 2023; 13:1910. [PMID: 37763313 PMCID: PMC10532582 DOI: 10.3390/life13091910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Upper gastrointestinal (GI) conditions vastly affect each individual's physical, social, and emotional status. The decision-making process by the medical personnel about these patients is currently based on a patient's life quality evaluation scale, HRQL scales. By utilizing HRQL scales, a better understanding of the various surgical and non-surgical treatment options, as well as their long-term consequences, can be achieved. In our study, an organ-based approach is used in an attempt to examine and characterized the effect of upper GI surgery on HRQL. Therefore, HRQL scales' function as a prognostic tool is useful, and the need for future research, the creation of valid training programs, and modern guidelines is highlighted.
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Affiliation(s)
- Grigorios Christodoulidis
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Marina-Nektaria Kouliou
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Konstantinos-Eleftherios Koumarelas
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Dimitris Giakoustidis
- Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece;
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Survival outcomes of management in metastatic gastric adenocarcinoma patients. Sci Rep 2021; 11:23142. [PMID: 34848751 PMCID: PMC8633380 DOI: 10.1038/s41598-021-02391-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022] Open
Abstract
Chemotherapy is generally considered as the main treatment for metastatic gastric adenocarcinoma. The role of gastrectomy for metastatic gastric cancer without obvious symptoms is controversial. The objective of this study is to investigate survival outcomes of treatment modalities using a real-world data setting. A retrospective cohort study was designed using the Taiwan Cancer Registry database. We identified the treatment modalities and used Kaplan–Meier estimates and Cox regressions to compare patient survival outcomes. From 2008 to 2015, 5599 gastric adenocarcinoma patients were diagnosed with metastatic disease (M1). The median overall survival (OS) of patients with surgery plus chemotherapy had the longest survival of 14.2 months. The median OS of the patients who received chemotherapy alone or surgery alone was 7.0 and 3.9, respectively. Age at diagnosis, year of diagnosis, tumor grade, and treatment modalities are prognostic factors for survival. The hazard ratios for patients who received surgery plus chemotherapy, surgery alone, and supportive care were 0.47 (95% CI 0.44–0.51), 1.22 (95% CI 1.1–1.36), and 3.23 (95% CI 3.01–3.46), respectively, by multivariable Cox regression analysis when using chemotherapy alone as a referent. Chemotherapy plus surgery may have a survival benefit for some selected gastric adenocarcinoma patients with metastatic disease.
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Health-Related Quality of Life in Locally Advanced Gastric Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13235934. [PMID: 34885043 PMCID: PMC8657098 DOI: 10.3390/cancers13235934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Current treatment strategies have been designed to improve survival in locally advanced gastric cancer patients. Besides its impact on survival, treatment also affects health-related quality of life (HRQOL), but an overview of reported studies is currently lacking. The aim of this systematic review was therefore to determine the short- and long-term impact of chemotherapy, surgery, and (chemo)radiotherapy on HRQOL in locally advanced, non-metastatic gastric cancer patients. METHODS A systematic review was performed including studies published between January 2000 and February 2021. We extracted studies published in Medline, Embase, and Scopus databases that assessed HRQOL in patients with locally advanced, non-metastatic gastric cancer treated with curative intent. Studies using non-validated HRQOL questionnaires were excluded. Short-term and long-term HRQOL were defined as HRQOL scores within and beyond 6 months after treatment, respectively. RESULTS Initially, we identified 8705 articles (4037 of which were duplicates, i.e., 46%) and ultimately included 10 articles. Most studies reported that short-term HRQOL worsened in the follow-up period from 6 weeks to 3 months after surgery. However, recovery of HRQOL to preoperative levels occurred after 6 months. After completion of chemoradiotherapy, the same pattern was seen with worse HRQOL after treatment and a recovery of HRQOL after 6-12 months. CONCLUSIONS In patients with locally advanced, non-metastatic gastric cancer, HRQOL deteriorated during the first 3 months after surgery and chemoradiotherapy. However, the long-term data showed a recovery of HRQOL after 6-12 months. To implement HRQOL in clinical decision making in current clinical practice, more research is needed.
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Park SH, Suh YS, Kim TH, Choi YH, Choi JH, Kong SH, Park DJ, Lee HJ, Yang HK. Postoperative morbidity and quality of life between totally laparoscopic total gastrectomy and laparoscopy-assisted total gastrectomy: a propensity-score matched analysis. BMC Cancer 2021; 21:1016. [PMID: 34511059 PMCID: PMC8436526 DOI: 10.1186/s12885-021-08744-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the surgical outcome and quality of life (QoL) of totally laparoscopic total gastrectomy (TLTG) compared with laparoscopy-assisted total gastrectomy (LATG) in patients with clinical stage I gastric cancer. METHODS From 2012 to 2018, EGC patients who underwent TLTG (n = 223), including the first case with intracorporeal hemi-double stapling, were matched to those who underwent LATG (n = 114) with extracorporeal circular stapling, using 2:1 propensity score matching (PSM). Prospectively collected morbidity was compared between the TLTG and LATG groups in conjunction with the learning curve. The European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires QLQ-C30, STO22, and OG25 were prospectively surveyed during postoperative 1 year for patient subgroups. RESULTS After PSM, grade I pulmonary complication rate was lower in the TLTG group (n = 213) than in the LATG group (n = 111) (0.5% vs. 5.4%, P = 0.007). Other complications were not different between the groups. The learning curve of TLTG was overcome at the 26th case in terms of the comprehensive complication index. The TLTG group after learning curve showed lower grade I pulmonary complication rate than the matched LATG group (0.5% vs. 4.7%, P = 0.024). Regarding postoperative QoL, the TLTG group (n = 63) revealed less dysphagia (P = 0.028), pain (P = 0.028), eating restriction (P = 0.006), eating (P = 0.004), odynophagia (P = 0.023) than the LATG group (n = 21). Multivariate analyses for each QoL item demonstrated that TLTG was the only common independent factor for better QoL. CONCLUSIONS TLTG reduced grade I pulmonary complications and provided better QoL in dysphagia, pain, eating, odynophagia than LATG for patients with clinical stage I gastric cancer.
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Affiliation(s)
- Shin-Hoo Park
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Foregut Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Surgery, Seoul National University Bundang Hospital, 137-82 Gumiro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Tae-Han Kim
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Yoon-Hee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Choi
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Pinheiro RN, Mucci S, Zanatto RM, Picanço Junior OM, Oliveira AF, Lopes Filho GDJ. Health-related quality of life after gastric cancer treatment in Brazil: Narrative review and reflections. World J Clin Cases 2021; 9:4123-4132. [PMID: 34141775 PMCID: PMC8173417 DOI: 10.12998/wjcc.v9.i17.4123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
In Brazil, gastric cancer is the third most common type of cancer among men and fifth among women, with an estimated 13360 new cases among men and 7870 among women each year during the 2020-2022 period. This study presents reflections and attempts to add knowledge to the theme of quality of life (QoL) in patients with gastric adenocarcinoma and describes some of its characteristics in three regions of Brazil, with an evaluation of the disease’s impacts in various dimensions of life, as reported by the patients themselves. We performed a narrative review of the literature and a data analysis of studies on QoL in Brazilian patients treated for gastric adenocarcinoma from three different cities in three geographic regions: Brasília (the midwest), Jaú (the southeast), and Macapá (the north).
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Affiliation(s)
- Rodrigo Nascimento Pinheiro
- Surgical Oncology Service, Surgical Oncology Residency and Academic League of Oncology, Federal District Base Hospital, Brasília 70330-150, Distrito Federal, Brazil
| | - Samantha Mucci
- Department of Psychiatry, Federal University of São Paulo, Paulista School of Medicine (UNIFESP-EPM), São Paulo 04024-002, São Paulo, Brazil
| | - Renato Morato Zanatto
- Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú 17210-070, São Paulo, Brazil
| | | | | | - Gaspar de Jesus Lopes Filho
- Postgraduate Program in Interdisciplinary Surgical Science, Federal University of São Paulo, Paulista School of Medicine (UNIFESP-EPM), São Paulo 04024-002, São Paulo, Brazil
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Grosek J, Zavrtanik H, Tomažič A. Health-related quality of life after curative resection for gastric adenocarcinoma. World J Gastroenterol 2021; 27:1816-1827. [PMID: 33967559 PMCID: PMC8072188 DOI: 10.3748/wjg.v27.i16.1816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/05/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With improved survival in gastric cancer patients, health-related quality of life has become an important clinical endpoint alongside primary oncological outcomes.
AIM To investigate health-related quality of life after various surgical procedures for gastric cancer treatment.
METHODS The validated Slovenian version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30) and its gastric cancer-specific module (QLQ STO-22) was sent for self-completion to patients that underwent curative resection for gastric adenocarcinoma between January 2014 and December 2018 at our centre. In total, 116 patients responded. Scores were compared between patients after subtotal distal vs total gastrectomy and patients after subtotal distal gastrectomy with Billroth II vs Roux-en-Y reconstruction.
RESULTS Interestingly, the extent of resection did not influence daily functioning; however, more dysphagia and eating restrictions were reported in patients after total gastrectomy when compared to patients after subtotal distal gastrectomy. Moreover, patients with Billroth II reconstruction after subtotal distal resection experienced worse physical and role functioning and reported more pain, fatigue and reflux compared to Roux-en-Y reconstruction.
CONCLUSION Based on our results, Roux-en-Y reconstruction after subtotal distal gastrectomy should be preferred over Billroth II reconstruction. The data obtained from this study will help surgeons when preoperatively informing their patients about expected functional outcomes after gastrectomy and enable them to ensure proper supportive care of their patients in the postoperative period.
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Affiliation(s)
- Jan Grosek
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Hana Zavrtanik
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Aleš Tomažič
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana 1000, Slovenia
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Shim EJ, Ha H, Suh YS, Kong SH, Lee HJ, Yang HK, Hahm BJ. Network analyses of associations between cancer-related physical and psychological symptoms and quality of life in gastric cancer patients. Psychooncology 2021; 30:946-953. [PMID: 33760355 DOI: 10.1002/pon.5681] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study applied network analyses to illustrate patterns of associations between cancer-related physical and psychological symptoms (CPPS) and quality of life (QOL) before and after surgery. METHODS Participants consisted of 256 gastric cancer patients admitted for curative section surgery at the surgical department in a teaching hospital in Korea between May 2016 and November 2017. Participants completed the survey, including MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-Gastric Cancer before surgery (T0), 1 week after surgery (T1), and 3-6 months after surgery (T2). RESULTS Three networks featured several salient connections with varying magnitudes between CPPS and QOL across all time points. Particularly, anxiety was tightly connected to emotional wellbeing (EWB) across all time points and physical wellbeing (PWB) at T1. On the other hand, depression was connected to functional wellbeing at T0 and T2, gastric cancer concerns (CS) at T1, and PWB at T2. Distress and sadness were the most central symptoms in the three networks. Other central symptoms included shortness of breath at T0, fatigue at T0 and T1, and PWB and CS at T2. Anxiety, depression, and EWB served as bridges connecting CPPS to QOL across all time points with varying degrees of importance, as did PWB at T1 and T2. CONCLUSIONS Treating psychological distress and enhancing EWB and PWB can be high impact intervention targets throughout the cancer trajectory.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, Korea
| | - Hyeju Ha
- Department of Psychology, Pusan National University, Busan, Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Kore
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Taste alteration after gastrectomy in patients with gastric cancer. Surg Today 2021; 51:777-784. [PMID: 33387026 DOI: 10.1007/s00595-020-02194-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/05/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the relationship between changes in taste due to surgical procedures and other clinical factors, we performed a detailed investigation of taste alteration in patients who underwent gastrectomy. METHODS Questionnaires on taste alteration were distributed to patients who visited our outpatient clinic from July 2018 to January 2019 for the postoperative evaluation of gastric cancer. Associations of clinical characteristics with changes in sensitivity to the four major taste types (sweet, sour, salty, and bitter) were examined. RESULTS Of the 243 eligible patients, 42 (17.3%) experienced taste alteration after gastrectomy; taste sensitivity decreased in 21 (8.6%) patients and increased in 31 (12.7%) patients. The frequency of a decreased sensitivity to sweet was significantly higher in patients who underwent total gastrectomy than in those who underwent distal gastrectomy (18.8% vs. 3.3%, P = 0.001). Patients who underwent total gastrectomy were significantly more likely than those who received distal gastrectomy to experience increased sensitivity to sour (12.5% vs. 2.2%, respectively; P = 0.004) and bitter (15.6% vs. 3.8%, respectively; P = 0.007) tastes. A multivariate analysis revealed that total gastrectomy was an independent risk factor for total taste alteration. CONCLUSIONS Patients who underwent total gastrectomy showed a high likelihood of both loss and gain of taste sensitivity.
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12
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Rupp SK, Stengel A. Influencing Factors and Effects of Treatment on Quality of Life in Patients With Gastric Cancer-A Systematic Review. Front Psychiatry 2021; 12:656929. [PMID: 34276435 PMCID: PMC8280526 DOI: 10.3389/fpsyt.2021.656929] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Gastric cancer (GC) is one of the leading causes of death worldwide. It is associated with several disease-related impairments contributing to the psycho-social burden of those patients, such as deterioration of well-being and overall quality of life (QOL). The aim of this study is to present the wide range of factors potentially impacting patients' overall well-being and possible preventive interventions. Methods: This systematic review was conducted in October 2020 with a search in the PubMed, MedLine, PsycInfo, and Google Scholar databases. We used the keywords "gastric cancer," "gastric neoplasm," and each of them combined with "quality of life," "depression," and "anxiety" to identify all relevant articles reporting about potential impact factors influencing the overall well-being of patients suffering from gastric cancer. Results: Finally, 125,490 articles were found, of which 125,431 were excluded in several steps of screening. Inclusion criteria were studies carried out on human ≥18 years of age, studies in English or German language, clinical trials, registry-based studies, cohort studies, population-based studies, and certain titles and abstracts. After screening for eligibility 35 potential factors influencing overall well-being in patients with GC were identified and classified into 9 important categories: genetic condition, treatment method, blood markers, nutritional status, daily living, state of health, mental state, supportive care, and alternative treatment. Conclusion: Since various factors are involved in the development of patients' overall well-being, timely treatment of psycho-social impairments by physicians and psychologists is of enormous importance. Preventing psycho-social burden by improving patients' QOL should be of high importance in the treatment regimen of patients with GC.
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Affiliation(s)
- Sophia Kristina Rupp
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Section Psychooncology, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Tübingen, Germany.,Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charite-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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13
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Han DS, Ahn J, Ahn HS. Are the elderly patient's changes in the health-related quality of life one year after gastrectomy for stomach cancer different from those in young patients? Ann Surg Treat Res 2020; 100:8-17. [PMID: 33457392 PMCID: PMC7791192 DOI: 10.4174/astr.2021.100.1.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Gastrectomy for elderly patients can significantly deteriorate the health-related quality of life (HRQoL). There was no report comparing HRQoL of elderly patients with young patients after gastrectomy for gastric cancer. This study assessed the differences in the changes of HRQoL at one year after gastrectomy according to age. Methods From May 2014 to Feb 2016, we prospectively enrolled patients undergoing gastrectomy for gastric cancer. They completed the European Organization for Research and Treatment of Cancer and gastric questionnaires preoperatively and at postoperative 1, 3, 6, 9, and 12 months. Results We included 57 elderly patients (≥70 years old) and 74 younger patients. The elderly had similar demographic, surgical, and pathological characteristics with young patients except that elderly had more comorbidity, laparoscopic gastrectomies, and lesser postoperative chemotherapy. One month after gastrectomy, the score of global health status/quality of life, physical, role, and social functioning were significantly impaired in elderly patients. Among them, physical and role functioning were more impaired than those of young patients. The scores of physical functioning, role functioning, cognitive functioning, and social functioning were not fully recovered till 1 year after surgery. There was a significant age group difference in the changes in physical function over the 1-year follow-up. Conclusion Elderly patients' global health status/quality of life and social functioning significantly decreased at postoperative 1 month and recovered by 6 months after gastrectomy. There was a significant age-specific difference in physical functioning throughout the 1-year follow-up. Surgeons need to pay more attention to recovery of the elderly patients' HRQoL after gastrectomy.
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Affiliation(s)
- Dong-Seok Han
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington DC, USA
| | - Hye Seong Ahn
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
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14
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Hu Y, McMurry TL, Goudreau B, Leick KM, Le TM, Zaydfudim VM. Comparative Effectiveness of Lymphadenectomy Strategies During Curative Resection for Gastric Adenocarcinoma. J Gastrointest Surg 2020; 24:2212-2218. [PMID: 31515762 PMCID: PMC7065947 DOI: 10.1007/s11605-019-04393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The purpose of this study was to compare the long-term effectiveness of three lymphadenectomy strategies in patients with gastric cancer. We hypothesized that, compared with the traditional standard (D2) lymph node dissection strategy, the less aggressive modified standard (mD2) lymphadenectomy may offer superior effectiveness due to reduced operative morbidity and comparable long-term recurrence-free survival. METHODS A Markov decision analysis model was created to simulate 5-year outcomes across three lymphadenectomy approaches for gastric cancer: limited regional (D1), traditional standard (D2), and modified standard (mD2). The primary outcome was discounted quality-adjusted life-years (dQALY). Model variable estimates were derived from outcomes data and quality of life estimates published in Europe and America within the last 15 years. One-way and probabilistic sensitivity analyses were performed for clinically relevant variables. RESULTS The mD2 lymphadenectomy offered 3.03 dQALY over 5 years, outperforming D2 (2.62 dQALY) and D1 (2.37 dQALY). Monte Carlo simulations indicated that both mD2 and D2 lymph node dissection strategies outperformed D1 in 94.9% of simulations. Sensitivity analyses demonstrated that the mD2 approach would be less effective than D2 if the perioperative mortality rate of mD2 was greater than 6.9% (3.2% baseline). CONCLUSIONS Across modern series, the modified standard mD2 lymphadenectomy is an effective alternative to the traditional D2 lymphadenectomy for patients with gastric cancer. A D1-limited regional lymphadenectomy is not recommended during gastric cancer resection.
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Affiliation(s)
- Yinin Hu
- Division of Surgical Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Timothy L. McMurry
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA,Surgical Outcomes Research Center, University of Virginia School of Medicine, Charlottesville, VA
| | - Bernadette Goudreau
- Division of Surgical Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Katie M. Leick
- Division of Surgical Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Tri M. Le
- Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Victor M. Zaydfudim
- Division of Surgical Oncology, University of Virginia School of Medicine, Charlottesville, VA,Surgical Outcomes Research Center, University of Virginia School of Medicine, Charlottesville, VA
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15
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Gosselin-Tardif A, Abou-Khalil M, Mata J, Guigui A, Cools-Lartigue J, Ferri L, Lee L, Mueller C. Laparoscopic versus open subtotal gastrectomy for gastric adenocarcinoma: cost-effectiveness analysis. BJS Open 2020; 4:830-839. [PMID: 32762036 PMCID: PMC7528510 DOI: 10.1002/bjs5.50327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022] Open
Abstract
Background Laparoscopic subtotal gastrectomy (LSG) for cancer is associated with good perioperative outcomes and superior quality of life compared with the open approach, albeit at higher cost. An economic evaluation was conducted to compare the two approaches. Methods A cost–effectiveness analysis between LSG and open subtotal gastrectomy (OSG) for gastric cancer was performed using a decision‐tree cohort model with a healthcare system perspective and a 12‐month time horizon. Model inputs were informed by a meta‐analysis of relevant literature, with costs represented in 2016 Canadian dollars (CAD) and outcomes measured in quality‐adjusted life‐years (QALYs). A secondary analysis was conducted using inputs extracted solely from European and North American studies. Deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed. Results In the base‐case model, costs of LSG were $935 (€565) greater than those of OSG, with an incremental gain of 0·050 QALYs, resulting in an incremental cost–effectiveness ratio of $18 846 (€11 398) per additional QALY gained from LSG. In the DSA, results were most sensitive to changes in postoperative utility, operating theatre and equipment costs, as well as duration of surgery and hospital stay. PSA showed that the likelihood of LSG being cost‐effective at willingness‐to‐pay thresholds of $50 000 (€30 240) per QALY and $100 000 (€60 480) per QALY was 64 and 68 per cent respectively. Secondary analysis using European and North American clinical inputs resulted in LSG being dominant (cheaper and more effective) over OSG, largely due to reduced length of stay after LSG. Conclusion In this decision analysis model, LSG was cost‐effective compared with OSG for gastric cancer.
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Affiliation(s)
| | - M Abou-Khalil
- Division of General Surgery, Montreal, Quebec, Canada
| | - J Mata
- Division of General Surgery, Montreal, Quebec, Canada
| | - A Guigui
- Division of Finance, Montreal, Quebec, Canada
| | - J Cools-Lartigue
- Division of Thoracic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - L Ferri
- Division of Thoracic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - L Lee
- Division of General Surgery, Montreal, Quebec, Canada
| | - C Mueller
- Division of Thoracic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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16
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Maia FDCP, Silva TA, Generoso SDV, Correia MITD. Malnutrition is associated with poor health-related quality of life in surgical patients with gastrointestinal cancer. Nutrition 2020; 75-76:110769. [DOI: 10.1016/j.nut.2020.110769] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
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17
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Tae CH, Shim KN, Kim BW, Kim JH, Hong SJ, Baik GH, Song HJ, Kim YS, Jang SH, Jung HK. Comparison of subjective quality of life after endoscopic submucosal resection or surgery for early gastric cancer. Sci Rep 2020; 10:6680. [PMID: 32317659 PMCID: PMC7174391 DOI: 10.1038/s41598-020-62854-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/03/2020] [Indexed: 12/30/2022] Open
Abstract
Quality of life (QoL) has become an important issue after early gastric cancer (EGC) treatment. We aimed to compare the QoL of EGC survivors after ESD (n = 241) or laparoscopic subtotal gastrectomy (n = 241) without recurrence and to evaluate the QoL over the 5-year period after adjusting for various confounding factors related to QoL. QoL related to the gastric cancer subscale (GCS) was significantly higher in the ESD group than surgery group (p < 0.001). After adjusting for all possible confounding factors, survivors who underwent ESD still had higher QoL related to CSG than those who underwent surgery. On the analysis of interaction effects for all QoL subscales, higher QoL related to GCS of ESD group than those of surgery group has been kept over time (p = 0.983). Therefore, we concluded that EGC survivors who undergo ESD have significantly better QoL related to GCS over a 5-year period after treatment than those who undergo surgery. This may be a useful consideration when selecting treatment modalities for patients with EGC.
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Affiliation(s)
- Chung Hyun Tae
- Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Medical Research Institute, Seoul, Republic of Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Medical Research Institute, Seoul, Republic of Korea.
| | - Byung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jie-Hyun Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Hong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Gwang Ho Baik
- Institute for Liver and Digestive Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Yong Sung Kim
- Wonkwang Digestive Disease Research Institute, Wonkwang University, Iksan, Republic of Korea
| | - Seung-Ho Jang
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Medical Research Institute, Seoul, Republic of Korea
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18
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Hu Y, Zaydfudim VM. Quality of Life After Curative Resection for Gastric Cancer: Survey Metrics and Implications of Surgical Technique. J Surg Res 2020; 251:168-179. [PMID: 32151826 DOI: 10.1016/j.jss.2020.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/07/2020] [Accepted: 02/01/2020] [Indexed: 02/07/2023]
Abstract
Gastric cancer is one of the most common cancers worldwide, and radical gastrectomy is an integral component of curative therapy. With improvements in perioperative morbidity and mortality, attention has turned to short- and long-term post-gastrectomy quality of life (QoL). This article reviews the common psychometric surveys and preference-based measures used among patients following gastrectomy. It also provides an overview of studies that address associations between surgical decision-making and postoperative health-related QoL. Further attention is focused on reported associations between technical aspects of the operation, such as extent of gastric resection, minimally-invasive approach, pouch-based conduits, enteric reconstruction, and postoperative QoL. While there are several randomized studies that include QoL outcomes, much remains to be explored. The relationship between symptom profiles and preference-based measures of health state utility is an area in need of further research.
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Affiliation(s)
- Yinin Hu
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Victor M Zaydfudim
- Division of Surgical Oncology, University of Virginia, Charlottesville, Virginia; Department of Surgery, Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia.
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19
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Pinheiro RN, Mucci S, Zanatto RM, Picanço Junior OM, Bottino AAG, Fontoura RP, Lopes Filho GDJ. Quality of life as a fundamental outcome after curative intent gastrectomy for adenocarcinoma: lessons learned from patients. J Gastrointest Oncol 2019; 10:989-998. [PMID: 31602337 DOI: 10.21037/jgo.2019.06.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Gastric cancer has an important epidemiologic impact, and the main curative therapeutic modality for gastric cancer is surgical resection. However, even curative intent therapy can have negative effects on the quality of life (QoL) of these patients, which is undesirable; thus, it is difficult to balance the standardized treatment reported in the literature and treatment response to achieve full patient satisfaction. The purpose of our study was to evaluate the QoL and identify the association of scores on the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) and Short Form 36 Health Survey version 2 (SF36v2) questionnaires with sociodemographic, clinical and anatomopathological aspects of gastric adenocarcinoma patients undergoing curative surgery. Methods This was a cross-sectional study involving 104 patients from three regions of Brazil. Inferential analyses were used to compare (multiple regression and Mann-Whitney or Kruskal-Wallis tests) the relationships between these scores and variables (Spearman's coefficient). Results In the multiple regression analysis, we found correlations between Helicobacter pylori status and physical well-being (PWB) (P=0.026), between gender and emotional well-being (EWB) (P=0.008), between Lauren's histology and physical functioning (P=0.009), as well as the Short Form 36 Health Survey version 2 (SF-36v2) role-physical (P=0.027), between the tumor site and EWB (P=0.038), between the SF-36v2 mental health and N (the lower the staging, the better the score, P=0.006) and between the SF-36v2 mental health and lymph nodes removed (P=0.029). According to the Mann-Whitney or Kruskal-Wallis test, women had worse FACT-Ga total (P=0.049), PWB (P=0.005), EWB (P=0.007), gastric cancer subscale (GaCS, P=0.011), trial outcome index (TOI, P=0.030) and mental health scores than men (P=0.011). Patients with distal tumors had better scores (FACT-Ga, P=0.018; GaCS, P=0.014; TOI, P=0.020) than patients with proximal tumors. Patients with tumors located in the cardia had better physical functioning than those with proximal tumors (P=0.042). Patients who underwent partial gastrectomy had better FACT-Ga total scores (P=0.011), PWB (P=0.033), GaCS scores (P=0.006) and TOI scores (P=0.008) than those who underwent total gastrectomy. Patients who did not receive adjuvant therapy had worse bodily pain as reported on the SF-36v2 than those who received therapy (P=0.048). According to Spearman's coefficient, a higher lymph node stage corresponded to worse FACT-Ga total (s=-0.200, P=0.034), GaCS (s=-0.206, P=0.037), TOI (s=-0.216; P=0.028) and vitality (s=-0.215, P=0.029) scores. A longer time after treatment corresponded to a better SF-36v2 role-physical domain score (s=0.223; P=0.023). Conclusions The type of treatment instituted, postoperative time and sociodemographic and anatomopathological factors influence the QoL.
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Affiliation(s)
- Rodrigo Nascimento Pinheiro
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Federal District Surgical Oncology Unity, Base Hospital Institute, Brasília, Brazil.,Academic League of Oncology, Base Hospital Institute, Brasília, Brazil
| | - Samantha Mucci
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Psychiatry Department, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Renato Morato Zanatto
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Amaral Carvalho Cancer Hospital, Jaú, São Paulo, Brazil
| | - Olavo Magalhães Picanço Junior
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,High Complexity Unity in Oncology, Alberto Lima Hospital, Federal University of Amapá, Macapá, Brazil
| | | | | | - Gaspar de Jesus Lopes Filho
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Calderón C, Jiménez-Fonseca P, Hernández R, Mar Muñoz MD, Mut M, Mangas-Izquierdo M, Vicente MÁ, Ramchandani A, Carmona-Bayonas A. Quality of life, coping, and psychological and physical symptoms after surgery for non-metastatic digestive tract cancer. Surg Oncol 2019; 31:26-32. [PMID: 31493647 DOI: 10.1016/j.suronc.2019.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 07/17/2019] [Accepted: 08/22/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of curative surgery for non-metastatic digestive tract cancers on quality of life (QoL), psychological status, and coping strategies. METHODS A prospective, transversal, multicenter study was conducted in 404 patients: 361 with colorectal, 44 with gastroesophageal, and 35 with pancreaticobiliary cancer six months after surgery. Participants completed questionnaires evaluating QoL, including functioning (EORTC-QLC-C30), coping strategies (Mini-MAC), and psychological distress (BSI-18). RESULTS The effects of surgery had a strong impact on functional domains, global QoL, and symptoms, especially in pancreaticobiliary and gastroesophageal cancer. Patients with pancreaticobiliary and gastroesophageal cancer had lower functional scale scores than those with colorectal cancer. Fatigue, appetite loss, diarrhea, depression, and psychological distress were the most common symptoms after surgery. Subjects with pancreaticobiliary cancer reported more fatigue, pain, insomnia, depression, somatization and psychological distress, whereas individuals with gastroesophageal cancer exhibited more fatigue, nausea/vomiting, diarrhea, depression, psychological distress, and helplessness than those with colorectal cancer. Only participants with colorectal cancer displayed improved QoL six months post-surgery, albeit their psychological state had worsened. CONCLUSION Surgeons should discuss expectations regarding symptoms and QoL with patients prior to surgery to minimize physical and psychological impact.
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Affiliation(s)
- Caterina Calderón
- Department of Clinical Psychology and Psychobiology. Faculty of Psychology. University of Barcelona, Spain.
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central of Asturias, Oviedo, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Margarida Mut
- Department of Medical Oncology, Hospital Universitario Son Espases, Mallorca, Spain
| | | | - M Ángeles Vicente
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Avinash Ramchandani
- Department of Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
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Carrillo González GM, Santamaria NP, Oliveros Wilches R. Follow-up of Gastrectomized Patients due to Gastric Cancer in a Cancer Center of Bogota, Colombia. AQUICHAN 2019. [DOI: 10.5294/aqui.2019.19.2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To determine the perceived burden and functional status of gastric cancer patients with gastrectomy in a center of cancer in Bogota (Colombia) between 2013 and 2016. Materials and methods: Retrospective description of patients intervened by gastrectomy distributed in three groups: Patients with gastrectomy from 1 to 12 months of surgical intervention, 13 to 14 months and 25 to 36 months. For this, it was used the disease burden perception instrument and the Karnofsky scale. Results: 127 patients were included. 63 from 1 to 12 months, 43 from 13 to 24 months, and 21 from 25 to 36 months of intervention. Gastric adenocarcinoma of intestinal pattern stage III and II predominate. More than 50 % of the patients required total gastrectomy and received adjuvant chemotherapy. The majority of participants performed regular activities with mild signs and symptoms, presented low overall perceived burden and functional performance without statistically significant differences between groups. Patients from 1 to 12 months of intervention reported greater levels of physical discomfort. Conclusions: In patients with gastrectomy for gastric cancer, physical symptoms persist such as emotional disturbances, economic difficulties and limitations in the work role, findings to be included in follow-up programs.
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22
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Vivir después de una gastrectomía: experiencia de pacientes con cáncer gástrico. ENFERMERIA CLINICA 2019; 29:27-33. [DOI: 10.1016/j.enfcli.2018.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 01/07/2023]
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Brenkman HJF, Tegels JJW, Ruurda JP, Luyer MDP, Kouwenhoven EA, Draaisma WA, van der Peet DL, Wijnhoven BPL, Stoot JHMB, van Hillegersberg R. Factors influencing health-related quality of life after gastrectomy for cancer. Gastric Cancer 2018; 21:524-532. [PMID: 29067597 PMCID: PMC5906484 DOI: 10.1007/s10120-017-0771-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023]
Abstract
AIM Insight in health-related quality of life (HRQoL) may improve clinical decision making and inform patients about the long-term effects of gastrectomy. This study aimed to evaluate and identify factors associated with HRQoL after gastrectomy. METHODS This cross-sectional study used prospective databases from seven Dutch centers (2001-2015) including patients who underwent gastrectomy for cancer. Between July 2015 and November 2016, European Organization for Research and Treatment of Cancer HRQoL questionnaires QLQ-C30 and QLQ-STO22 were sent to all surviving patients without recurrence. The QLQ-C30 scores were compared to a Dutch reference population using a one-sample t test. Spearman's rank test was used to correlate time after surgery to HRQoL, and multivariable linear regression was performed to identify factors associated with HRQoL. RESULTS A total of 222 of 274 (81.0%) patients completed the questionnaires. Median follow-up was 29 months (range, 3-171) and 86.9% of patients had a follow-up >1 year. The majority of patients had undergone neoadjuvant treatment (64.4%) and total gastrectomy (52.7%). Minimally invasive gastrectomy (MIG) was performed in 50% of the patients. Compared to the general population, gastrectomy patients scored significantly worse on most functional and symptom scales (p < 0.001) and slightly worse on global HRQoL (78 vs. 74, p = 0.012). Time elapsed since surgery did not correlate with global HRQoL (Spearman's ρ = 0.06, p = 0.384). Distal gastrectomy, neoadjuvant treatment, and MIG were associated with better HRQoL (p < 0.050). CONCLUSION After gastrectomy, patients encounter functional impairments and symptoms, but experience only a slightly impaired global HRQoL. Distal gastrectomy, the ability to receive neoadjuvant treatment, and MIG may be associated with HRQoL benefits.
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Affiliation(s)
- Hylke J. F. Brenkman
- Department of Surgery, Division Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Juul J. W. Tegels
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | - Jelle P. Ruurda
- Department of Surgery, Division Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Misha D. P. Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Werner A. Draaisma
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | | | | | - Jan H. M. B. Stoot
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, Division Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - on behalf of the LOGICA Study Group
- Department of Surgery, Division Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Brenkman HJF, Gertsen EC, Vegt E, van Hillegersberg R, van Berge Henegouwen MI, Gisbertz SS, Luyer MDP, Nieuwenhuijzen GAP, van Lanschot JJB, Lagarde SM, de Steur WO, Hartgrink HH, Stoot JHMB, Hulsewe KWE, Spillenaar Bilgen EJ, van Det MJ, Kouwenhoven EA, van der Peet DL, Daams F, van Sandick JW, van Grieken NCT, Heisterkamp J, van Etten B, Haveman JW, Pierie JP, Jonker F, Thijssen AY, Belt EJT, van Duijvendijk P, Wassenaar E, van Laarhoven HWM, Wessels FJ, Haj Mohammad N, van Stel HF, Frederix GWJ, Siersema PD, Ruurda JP. Evaluation of PET and laparoscopy in STagIng advanced gastric cancer: a multicenter prospective study (PLASTIC-study). BMC Cancer 2018; 18:450. [PMID: 29678145 PMCID: PMC5910577 DOI: 10.1186/s12885-018-4367-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3–4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but evidence is scarce. The aim of this study is to evaluate the impact and cost-effectiveness of PET and SL in addition to initial staging in patients with locally advanced gastric cancer. Methods This prospective observational cohort study will include all patients with a surgically resectable, advanced gastric adenocarcinoma (cT3–4b, N0–3, M0), that are scheduled for treatment with curative intent after initial staging with gastroscopy and CT. The modalities to be investigated in this study is the addition of PET and SL. The primary outcome of this study is the proportion of patients in whom the PET or SL lead to a change in treatment strategy. Secondary outcome parameters are: diagnostic performance, morbidity and mortality, quality of life, and cost-effectiveness of these additional diagnostic modalities. The study recently started in August 2017 with a duration of 36 months. At least 239 patients need to be included in this study to demonstrate that the diagnostic modalities are break-even. Based on the annual number of gastrectomies in the participating centers, it is estimated that approximately 543 patients are included in this study. Discussion In this study, it is hypothesized that performing PET and SL for locally advanced gastric adenocarcinomas results in a change of treatment strategy in 27% of patients and an annual cost-reduction in the Netherlands of €916.438 in this patient group by reducing futile treatment. The results of this study may be applicable to all countries with comparable treatment algorithms and health care systems. Trial registration NCT03208621. This trial was registered prospectively on June 30, 2017.
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Affiliation(s)
- H J F Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E C Gertsen
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E Vegt
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | - S S Gisbertz
- Academic Medical Center, Amsterdam, The Netherlands
| | - M D P Luyer
- Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - S M Lagarde
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - W O de Steur
- Leiden University Medical Center, Leiden, The Netherlands
| | - H H Hartgrink
- Leiden University Medical Center, Leiden, The Netherlands
| | - J H M B Stoot
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - K W E Hulsewe
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | | | | | | | - F Daams
- VU University Medical Center, Amsterdam, The Netherlands
| | - J W van Sandick
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - J Heisterkamp
- Elisabeth Twee-Steden Hospital, Tilburg, The Netherlands
| | - B van Etten
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J W Haveman
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J P Pierie
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - F Jonker
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A Y Thijssen
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - E J T Belt
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - E Wassenaar
- Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - H W M van Laarhoven
- Academic Medical Center, Amsterdam, The Netherlands.,Propsective Observational Cohort study of Oesophageal-gastric cancer Patients (POCOP) of the Dutch Upper GI Cancer Group (DUCG), Amsterdam, The Netherlands
| | - F J Wessels
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - N Haj Mohammad
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H F van Stel
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - G W J Frederix
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P D Siersema
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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25
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Carrillo GM, Bayona HA, Arias EM. Perfil y carga de la enfermedad de personas con cáncer gástrico sometidas a gastrectomía. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n1.60273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Los tratamientos quirúrgicos del cáncer gástrico implican adaptaciones a un nuevo estilo de vida ligado a la limitación que pueden ocasionar carga.Objetivos. Determinar el perfil y la carga de adultos con cáncer gástrico que han sido sometidos a gastrectomía en una institución de oncología en Bogotá.Materiales y métodos. Estudio de abordaje cuantitativo y corte transversal que incluyó 60 pacientes con cáncer gástrico posgastrectomía, en su mayoría hombres de estratos socioeconómicos bajos y mínimos niveles de escolaridad, con una edad promedio de 56.33 años. Se utilizó una encuesta de caracterización y el instrumento carga de la enfermedad para el paciente.Resultados. Predomina el adenocarcinoma gástrico intestinal avanzado y la gastrectomía total como cirugía de elección que genera mayor carga. Se identifica alta carga emocional por angustia, tristeza e incertidumbre y baja carga física por síntomas como molestias gastrointestinales, agotamiento y debilidad. Las dificultades económicas y la alteración del rol laboral generan carga sociofamiliar y cultural. Hay relación inversa y estadísticamente significativa entre el estado funcional del paciente y el agotamiento, la fatiga, la alteración del equilibrio y las alteraciones del sueño.Conclusiones. Los sobrevivientes de cáncer gástrico posgrastectomía presentan carga emocional, sociofamiliar y cultural que requiere ser atendida.
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He X, Lai S, Su T, Liu Y, Ding Y, Quan S, Si J, Sun L. Survival benefits of gastrectomy in gastric cancer patients with stage IV: a population-based study. Oncotarget 2017; 8:106577-106586. [PMID: 29290972 PMCID: PMC5739757 DOI: 10.18632/oncotarget.22535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/28/2017] [Indexed: 12/27/2022] Open
Abstract
Objective The aim of the current study is to investigate the role of gastrectomy for survival among metastatic gastric cancer patients. Results We finally identified 12,986 eligible patients with stage IV GC between 2004 and 2012, including 1,981 (15.3%) patients with gastrectomy and 11,005 (84.7%) without surgery. The median overall survival time for patients with and without surgery were 9.0 (95%, 8.3–9.7) and 4.0 (95%, 3.9–4.1) months respectively. Patients who received gastrectomy had a significantly better survival outcome compared with those without surgery (P < 0.05). In the multivariate Cox analysis, gastrectomy was associated with decreased overall mortality (HR, 0.47, 95% CI 0.44–0.49, P < 0.001) and cancer-specific mortality (HR, 0.46, 95% CI 0.44–0.50, P < 0.001). The survival benefits associated with surgery persisted even after performing the propensity score matching analysis (overall survival, HR, 0.47, 95% CI 0.43–0.50, cancer-specific survival, HR, 0.47, 95% CI 0.44–0.50). Conclusions Based on population-based study, we demonstrated that there was a survival advantage of gastrectomy in stage IV GC patients. Further prospective trials need to verify our findings. Materials and Methods We included an eligible cohort of stage IV gastric cancer (GC) patients in the Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2012. The survival difference of patients with and without gastrectomy were assessed by Kaplan–Meier analysis and log-rank test. Multivariate Cox analyses were performed to analyze the effect of gastrectomy on overall and cancer-specific mortality. Furthermore, we performed propensity score matching (PSM) to reduce the potential selection bias.
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Affiliation(s)
- Xingkang He
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
| | - Sanchuan Lai
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
| | - Tingting Su
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
| | - Yangyang Liu
- Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China.,Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, China
| | - Yue Ding
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
| | - Sheng Quan
- Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China.,Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, China
| | - Jianmin Si
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
| | - Leimin Sun
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China.,Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
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Total Gastrectomy for Hereditary Diffuse Gastric Cancer at a Single Center: Postsurgical Outcomes in 41 Patients. Ann Surg 2017; 266:1006-1012. [PMID: 27759617 DOI: 10.1097/sla.0000000000002030] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to describe postoperative outcomes of total gastrectomy at our institution for patients with hereditary diffuse gastric cancer (HDGC). BACKGROUND HDGC, which is mainly caused by germline mutations in the E-cadherin gene (CDH1), renders a lifetime risk of gastric cancer of up to 70%, prompting a recommendation for prophylactic total gastrectomy. METHODS A prospective gastric cancer database identified 41 patients with CDH1 mutation who underwent total gastrectomy during 2005 to 2015. Perioperative, histopathologic, and long-term data were collected. RESULTS Of the 41 patients undergoing total gastrectomy, median age was 47 years (range 20 to 71). There were 14 men and 27 women, with 25 open operations and 16 minimally invasive operations. Median length of stay was 7 days (range 4 to 50). In total, 11 patients (27%) experienced a complication requiring intervention, and there was 1 peri-operative mortality (2.5%). Thirty-five patients (85%) demonstrated 1 or more foci of intramucosal signet ring cell gastric cancer in the examined specimen. At 16 months median follow-up, the median weight loss was 4.7 kg (15% of preoperative weight). By 6 to 12 months postoperatively, weight patterns stabilized. Overall outcome was reported to be "as expected" by 40% of patients and "better than expected" by 45%. Patient-reported outcomes were similar to those of other patients undergoing total gastrectomy. CONCLUSION Total gastrectomy should be considered for all CDH1 mutation carriers because of the high risk of invasive diffuse-type gastric cancer and lack of reliable surveillance options. Although most patients have durable weight loss after total gastrectomy, weights stabilize at about 6 to 12 months postoperatively, and patients report outcomes as being good to better than their preoperative expectations. No patients have developed gastric cancer recurrence after resections.
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28
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Serial intermediate-term quality of life comparison after endoscopic submucosal dissection versus surgery in early gastric cancer patients. Surg Endosc 2017; 32:2114-2122. [DOI: 10.1007/s00464-017-5909-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/03/2017] [Indexed: 12/14/2022]
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29
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Hur H, Ahn CW, Byun CS, Shin HJ, Kim YB, Son SY, Han SU. A Novel Roux-en-Y Reconstruction Involving the Use of Two Circular Staplers after Distal Subtotal Gastrectomy for Gastric Cancer. J Gastric Cancer 2017; 17:255-266. [PMID: 28970956 PMCID: PMC5620095 DOI: 10.5230/jgc.2017.17.e32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 01/28/2023] Open
Abstract
Purpose Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction. Materials and Methods A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery. Results No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026). Conclusions The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).
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Affiliation(s)
- Hoon Hur
- Division of Gastrointestinal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | | | - Cheul Su Byun
- Department of Surgery, Dongsuwon Hospital, Suwon, Korea
| | - Ho Jung Shin
- Division of Gastrointestinal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Young Bae Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Yong Son
- Division of Gastrointestinal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Uk Han
- Division of Gastrointestinal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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30
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Influence of Surgical Resection of Hepatic Metastases From Gastric Adenocarcinoma on Long-term Survival: Systematic Review and Pooled Analysis. Ann Surg 2017; 263:1092-101. [PMID: 26797324 DOI: 10.1097/sla.0000000000001542] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The objectives of this systematic review and pooled analysis were to examine long-term survival, morbidity, and mortality following surgical resection of gastric cancer hepatic metastases and to identify prognostic factors that improve survival. BACKGROUND Patients with hepatic metastases from gastric cancer are traditionally treated with palliative chemotherapy. METHODS A systematic literature search was undertaken (1990 to 2015). Publications were included if they studied more than 10 patients undergoing hepatectomy for hepatic metastasis from gastric adenocarcinoma in the absence of peritoneal disease or other distant organ involvement. The primary outcome was the hazard ratio (HR) for overall survival. The influence of liver metastasis related factors; multiple vs single and metachronous vs synchronous upon survival was also assessed. RESULTS The median number of resections for the 39 studies included was 21 (range 10 to 64). Procedures were associated with a median 30-day morbidity of 24% (0% to 47%) and mortality of 0% (0% to 30%). The median 1-year, 3-year, and 5-year survival were 68%, 31%, and 27%, respectively. Survival was improved in Far Eastern compared with Western studies; 1-year (73% vs 59%), 3-year (34% vs 24.5%), and 5-year (27.3% vs 16.5%). Surgical resection of hepatic metastases was associated with a significantly improved overall survival (HR = 0.50; P < 0.001). Meta-analysis confirmed the additional survival benefit of solitary compared with multiple hepatic metastases (odds ratio = 0.31; P = 0.011). CONCLUSIONS The observed improved survival rates following the resection of hepatic metastasis from gastric adenocarcinoma in selected patients merit a prospective study to formally address the survival benefits and the influence on quality of life of such approach.
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Climent M, Munarriz M, Blazeby JM, Dorcaratto D, Ramón JM, Carrera MJ, Fontane L, Grande L, Pera M. Weight loss and quality of life in patients surviving 2 years after gastric cancer resection. Eur J Surg Oncol 2017; 43:1337-1343. [PMID: 28222970 DOI: 10.1016/j.ejso.2017.01.239] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/28/2016] [Accepted: 01/24/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Malnutrition is common in patients undergoing gastric cancer resection, leading to weight loss, although little is known about how this impacts on health-related quality of life (HRQL). This study aimed to explore the association between HRQL and weight loss in patients 2 years after curative gastric cancer resection. METHODS Consecutive patients undergoing curative gastric cancer resection and surviving at least 2 years without disease recurrence were recruited. Patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the specific module for gastric cancer (STO22) before and 2 years postoperatively and associations between HRQL scores and patients with and without ≥ 10% body weight loss (BWL) were examined. RESULTS A total of 76 patients were included, of whom 51 (67%) had BWL ≥10%. At 2 years postoperatively, BWL ≥10% was associated with deterioration of all functional aspects of quality of life, with persistent pain (21.6%), diarrhoea (13.7%) and nausea/vomiting (13.7%). By contrast, none of the patients with BWL <10% experienced severe nausea/vomiting, pain or diarrhoea. CONCLUSIONS Disabling symptoms occurred more frequently in patients with ≥10% BWL than in those with <10% BWL, with a relevant negative impact on HRQL. A cause-effect relationship between weight loss and postoperative outcome remains unsolved.
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Affiliation(s)
- M Climent
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Munarriz
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M Blazeby
- School of Social and Community Medicine, University of Bristol, and University Hospital Bristol National Health Services Foundation Trust, Bristol, UK
| | - D Dorcaratto
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J M Ramón
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M J Carrera
- Nutrition Unit, Service of Endocrinology, Hospital Universitari del Mar, Barcelona, Spain
| | - L Fontane
- Nutrition Unit, Service of Endocrinology, Hospital Universitari del Mar, Barcelona, Spain
| | - L Grande
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Pera
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain.
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Muir J, Aronson M, Esplen MJ, Pollett A, Swallow CJ. Prophylactic Total Gastrectomy: a Prospective Cohort Study of Long-Term Impact on Quality of Life. J Gastrointest Surg 2016; 20:1950-1958. [PMID: 27752808 DOI: 10.1007/s11605-016-3287-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 09/23/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hereditary diffuse gastric cancer (HDGC) syndrome is caused by germline mutations in the CDH1 gene and carries a lifetime gastric cancer risk of approximately 70 % in men and 56 % in women. Current consensus guidelines recommend that people of age ≥20 who harbor a CDH1 mutation undergo prophylactic total gastrectomy (PTG). However, the decision to proceed with a major visceral resection for prophylactic reasons may be difficult, especially since long-term outcomes are not well defined. We examined the decision-making process, physical symptoms, and psychosocial outcomes in adults who underwent PTG. METHODS Participants completed pre- and post-operative questionnaires that included standardized measures of health-related quality of life (HRQOL), body image, psychological distress, regret, and decisional conflict. Those who declined surgery completed a questionnaire that measured decisional conflict and explored reasons for their choice. RESULTS Forty of fifty (80 %) questionnaires distributed to 18 individuals were completed. In the 13 patients who underwent PTG, global HRQOL tended to decrease immediately post-operatively, climb to baseline by 6-12 months, then decrease again at 24 months. Body image and level of psychological distress remained relatively stable, and most patients expressed little decisional conflict or regret. All five individuals who declined surgery did so for practical reasons and would consider surgery in the future. CONCLUSIONS While most patients do not experience negative psychosocial consequences following PTG, mild physical symptoms persist and may affect long-term HRQOL. The present study emphasizes the need for long-term follow-up of this unique population of survivors.
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Affiliation(s)
- Jennifer Muir
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Melyssa Aronson
- Familial Gastrointestinal Cancer Registry, Mount Sinai Hospital, Toronto, ON, Canada
| | - Mary-Jane Esplen
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aaron Pollett
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Carol J Swallow
- Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, 600 University Avenue, Suite 1225, Toronto, ON, M5G 1X5, Canada.
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Modest overall survival improvements from 1998 to 2009 in metastatic gastric cancer patients: a population-based SEER analysis. Gastric Cancer 2016; 19:723-34. [PMID: 26391158 DOI: 10.1007/s10120-015-0541-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/01/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND An increasing fraction of gastric cancer patients present with distant metastases at diagnosis. The objective of the present 11-year population-based trend analysis was to assess the survival rates in patients who underwent and in patients who did not undergo palliative gastrectomy. METHODS Patients with metastatic gastric cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2009. Time trend and impact of palliative gastrectomy on survival were assessed by both a multivariate Cox proportional hazards model and propensity score matching. RESULTS We identified 8249 patients with stage IV gastric cancer. The rate of metastatic disease increased from 31.0 % in 1998 to 37.5 % in 2009 (P < 0.001). The palliative gastrectomy rate dropped from 18.8 to 10.2 % (P = 0.004). The median survival for patients who underwent palliative gastrectomy (N = 1445, 17.4 %) and for patients who did not undergo palliative gastrectomy (N = 6804, 82.4 %) was 7 and 3 months, respectively. There was an increase in median overall survival from 2 months (1998) to 3 months (2009) in the no-gastrectomy group, and from 6.5 to 8 months in the gastrectomy group. The 3-year cancer-specific survival rates were 2.1 % (95 % confidence interval 1.7-2.5 %) for patients who did not undergo palliative gastrectomy and 9.4 % (95 % confidence interval 7.8-11.2 %) for patients who underwent palliative gastrectomy (P < 0.001). Palliative gastrectomy was associated with an increased cancer-specific survival in propensity-score-adjusted Cox regression analyses (hazard ratio 0.50, 95 % confidence interval 0.46-0.55, P < 0.001). CONCLUSION On a population-based level, only modest improvements in prognosis for metastatic gastric cancer were observed in patients who underwent and in patients who did not undergo palliative gastrectomy. Considering the low rate of midterm survivors in both groups, only a small subgroup of patients benefits from palliative gastrectomy.
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McCall MD, Graham PJ, Bathe OF. Quality of life: A critical outcome for all surgical treatments of gastric cancer. World J Gastroenterol 2016; 22:1101-1113. [PMID: 26811650 PMCID: PMC4716023 DOI: 10.3748/wjg.v22.i3.1101] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/16/2015] [Accepted: 11/09/2015] [Indexed: 02/07/2023] Open
Abstract
Surgery represents the main curative therapeutic modality for gastric cancer, and it is occasionally considered for palliation as well as prophylaxis. Most frequently, surgical outcomes are conveyed in terms of oncological outcomes such as recurrence and survival. However, quality of life (QoL) is also important and should be considered when making treatment decisions - including the extent of and approach to surgery. Measurement of QoL usually involves the application of questionnaires. While there are multiple QoL questionnaires validated for use in oncology patients, there are very few that have been validated for use in those with gastric cancer. In this review, we discuss and compare the current status of QoL questionnaires in gastric cancer. More importantly, the impact of surgery for treatment, palliation and prophylaxis of gastric cancer on QoL will be described. These data should inform the surgeon on the optimal approach to treating gastric cancer, taking into account oncological outcomes. Knowledge gaps are also identified, providing a roadmap for future studies.
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Yu W, Park KB, Chung HY, Kwon OK, Lee SS. Chronological Changes of Quality of Life in Long-Term Survivors after Gastrectomy for Gastric Cancer. Cancer Res Treat 2016; 48:1030-6. [PMID: 27004956 PMCID: PMC4946352 DOI: 10.4143/crt.2015.398] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/19/2015] [Indexed: 02/07/2023] Open
Abstract
Purpose A few studies have prospectively evaluated changes in quality of life (QoL) after surgery in short-term survivors; however, no prospective study has evaluated the longitudinal changes in QoL in long-terms survivors. We prospectively evaluated the chronological changes in QoL after a gastrectomy over a 5-year postoperative period in a large group of patients. Materials and Methods QoL data from the European Organization for Research and Treatment of Cancer QLQ-C30 and the QLQ-STO22 questionnaires were obtained from 254 patients who completed the entire series of QoL assessments preoperatively and at 1, 2, 3, 4, and 5 years after surgery. Results There was no statistically significant change in global health status/QoL during the 5-year postoperative period. Decreases in QoL from upper gastrointestinal symptoms including diarrhea (p < 0.001), dysphagia (p < 0.001), reflux symptoms (p=0.029), and eating restrictions (p < 0.001) were observed among the long-term survivors. Decreased physical functioning (p < 0.001), role functioning (p < 0.001), and cognitive functioning (p < 0.001), along with fatigue (p=0.045) and a poor body image (p=0.003), negatively impacted the patients’ QoL for a long time. Conclusion Management of gastrointestinal symptoms should be specifically targeted as a part of long-term patient care after a gastrectomy. Proper nutritional care will improve food intake resulting in weight gain and improved physical functioning, role functioning, and body image. In addition, patients should be encouraged to preserve self-esteem and maintain social activity.
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Affiliation(s)
- Wansik Yu
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea.,Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Ki Bum Park
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Ho Young Chung
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Oh Kyoung Kwon
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
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Shan B, Shan L, Morris D, Golani S, Saxena A. Systematic review on quality of life outcomes after gastrectomy for gastric carcinoma. J Gastrointest Oncol 2015; 6:544-60. [PMID: 26487949 DOI: 10.3978/j.issn.2078-6891.2015.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Despite advances in chemotherapy and radiotherapy, gastrectomy is the only curative intervention for gastric carcinoma. This study reviews post-operative health-related quality of life (HRQOL) after gastrectomy. METHODS A literature search was conducted on PubMed for all studies published after January 2000 matching strict eligibility criteria. Bibliographies of included studies were also reviewed. Quality appraisal and data tabulation were performed using pre-determined forms. Results were synthesised by narrative review according to PRISMA guidelines with full tabulation of results of all included studies. RESULTS A total of 21 studies (3,575 patients) were included. Post-operative HRQOL improvements were demonstrated across most or all domains in different HRQOL instruments. Patients experienced declines in HRQOL 1 month after surgery, but reached at least pre-operative levels with recovery by 1 year. The greatest improvements were demonstrated in the emotional health domain with favourable functional benefits. Partial gastrectomy appears to be superior to total gastrectomy in physical, emotional and functional health domains. However, patients remain susceptible to gastrointestinal symptoms following surgery, which negatively impact upon HRQOL. Post-operative complications did not appear to affect HRQOL. Most studies were prospective, but data is heterogeneous. CONCLUSIONS Gastrectomy results in significant HRQOL benefits across a broad range of health domains. This is critical outcome of surgery and an important consideration in pre-operative decision making.
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Affiliation(s)
- Bernard Shan
- 1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ; 2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, NSW, Australia ; 4 Department of Surgery, Wollongong Hospital, Kogarah, NSW, Australia ; 5 Surgical Skills Network, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Leonard Shan
- 1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ; 2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, NSW, Australia ; 4 Department of Surgery, Wollongong Hospital, Kogarah, NSW, Australia ; 5 Surgical Skills Network, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - David Morris
- 1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ; 2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, NSW, Australia ; 4 Department of Surgery, Wollongong Hospital, Kogarah, NSW, Australia ; 5 Surgical Skills Network, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sanjeev Golani
- 1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ; 2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, NSW, Australia ; 4 Department of Surgery, Wollongong Hospital, Kogarah, NSW, Australia ; 5 Surgical Skills Network, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Akshat Saxena
- 1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ; 2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, NSW, Australia ; 4 Department of Surgery, Wollongong Hospital, Kogarah, NSW, Australia ; 5 Surgical Skills Network, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Straatman J, van der Wielen N, Joosten PJ, Terwee CB, Cuesta MA, Jansma EP, van der Peet DL. Assessment of patient-reported outcome measures in the surgical treatment of patients with gastric cancer. Surg Endosc 2015; 30:1920-9. [PMID: 26310527 PMCID: PMC4848335 DOI: 10.1007/s00464-015-4415-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]
Abstract
Background Gastric cancer is responsible for 10 % of all cancer-related deaths worldwide. With improved operative techniques and neo-adjuvant therapy, survival rates are increasing. Outcomes of interest are shifting to quality of life (QOL), with many different tools available. The aim of this study was to assess which patient-reported outcome measures (PROMs) are used to measure QOL after a gastrectomy for cancer. Methods A comprehensive search was conducted for original articles investigating QOL after gastrectomy. Two authors independently selected relevant articles, conducted clinical appraisal and extracted data (P.J. and J.S.). Results Out of 3414 articles, 26 studies were included, including a total of 4690 patients. These studies included ten different PROMs, which could be divided into generic, symptom-specific and disease-specific questionnaires. The EORTC and the FACT questionnaires use an oncological overall QOL module and an organ-specific module. Only one validation study regarding the use of the EORTC after surgery for gastric cancer was available, demonstrating good psychometric properties and clinical validity. Conclusions A great variety of PROMs are being used in the measurement of QOL after surgery for gastric cancer. A questionnaire with a general module along with a disease-specific module for the assessment of QOL seems most desirable, such as the EORTC and the FACT with their specific modules. Both are developed in different treatment modalities, such as in surgical patients. EORTC is the most widely used questionnaire and therefore allows for comparison of new studies to existing data. Future studies are needed to assess content validity in surgical gastric cancer patients.
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Affiliation(s)
- Jennifer Straatman
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands.
| | - Nicole van der Wielen
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Pieter J Joosten
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Miguel A Cuesta
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Elise P Jansma
- Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
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Choi JH, Kim ES, Lee YJ, Cho KB, Park KS, Jang BK, Chung WJ, Hwang JS, Ryu SW. Comparison of quality of life and worry of cancer recurrence between endoscopic and surgical treatment for early gastric cancer. Gastrointest Endosc 2015; 82:299-307. [PMID: 25892060 DOI: 10.1016/j.gie.2015.01.019] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/03/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The quality of life (QOL) of patients who survive early gastric cancer (EGC) is an area of increasing interest. OBJECTIVE To compare the QOL and degree of worry of cancer recurrence in EGC patients who underwent endoscopic submucosal dissection (ESD) or surgery. DESIGN Cross-sectional study. SETTINGS A tertiary referral center. PATIENTS A total of 565 patients with EGC who received ESD or surgery. INTERVENTION Questionnaires. MAIN OUTCOME MEASUREMENTS QOL was evaluated using the Short-form Health Survey and the European Organization for Research and Treatment of Cancer QOL questionnaires (QLQ-C30 and EORTC-QLQ-STO22). Mood disorders and the worry of cancer recurrence were estimated using the Hospital Anxiety and Depression Scale (HADS) and Worry of Cancer Scale, respectively. RESULTS Questionnaires were completed by 55.7% of the ESD (137/246) and 58.9% of the surgery (188/319) patients. The surgery group had more QOL-related symptomatic and functional problems, including fatigue (P=.044), nausea/vomiting (P=.032), appetite loss (P=.023), diarrhea (P<.001), pain (P=.013), reflux symptoms (P=.005), eating restrictions (P<.001), anxiety (P=.015), taste impairment (P=.011), and poor body image (P<.001). The ESD group had significantly higher worry of cancer recurrence scores after adjusting for covariates, especially when visiting their physicians. The HADS results did not differ between the groups. LIMITATIONS Cross-sectional design. CONCLUSIONS Endoscopic treatment for EGC provides a better QOL, but stomach preservation might provoke cancer recurrence worries. Endoscopists should address this issue for relieving a patient's concern of cancer recurrence during follow-up period after ESD. ( CLINICAL TRIAL REGISTRATION NUMBER WHO ICTRP KCT0000791.).
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Affiliation(s)
- Jae Hyuk Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Eun Soo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Yoo Jin Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Kwang Bum Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Kyung Sik Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Byoung Kuk Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Woo Jin Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Jae Seok Hwang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University School of Medicine, Daegu, South Korea
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Dietary alterations and restrictions following surgery for upper gastrointestinal cancers: Key components of a health-related quality of life intervention. Eur J Oncol Nurs 2015; 19:343-8. [PMID: 25697545 DOI: 10.1016/j.ejon.2015.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/14/2015] [Accepted: 01/22/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE The surgical treatment of upper gastrointestinal (GI) cancers, specifically esophageal and gastric cancers, often result in extensive health-related quality of life (HRQOL) concerns, particularly those associated with dietary adjustments. This paper provides a review of HRQOL changes following esophagectomy and gastrectomy, and describes key components of an intervention to improve dietary adjustments following surgery. METHODS Intervention development was informed by 1) current published evidence on HRQOL changes for patients following upper GI surgery, 2) examination of usual post-operative care related to dietary restrictions to identify areas for continued education and support and 3) the inclusion of a conceptual framework (the Chronic Care Model) to guide intervention design and inform the selection of appropriate outcome measures. RESULTS Three key components of an HRQOL intervention are identified, and should focus on HRQOL concerns associated with dietary alterations and restrictions following treatment, involve family caregivers, and be tailored and flexible to patient and family caregiver's needs and preferences. CONCLUSIONS Evidence-based interventions to support long-term dietary alterations and restrictions following upper GI surgery are lacking, despite evidence confirming its impact on morbidity and mortality. Interventions are needed to support dietary adjustments, prevent malnutrition and excessive weight loss, and enhance HRQOL following surgery for upper GI cancers.
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Rausei S, Mangano A, Galli F, Rovera F, Boni L, Dionigi G, Dionigi R. Quality of life after gastrectomy for cancer evaluated via the EORTC QLQ-C30 and QLQ-STO22 questionnaires: surgical considerations from the analysis of 103 patients. Int J Surg 2014; 11 Suppl 1:S104-9. [PMID: 24380539 DOI: 10.1016/s1743-9191(13)60028-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Gastric surgery is a major operation which can cause a related potential deterioration in the patient's quality of life (QoL). This retrospective study investigates the factors which can influence QoL in patients who underwent curative total or subtotal gastrectomy for cancer. METHODS One hundred and three patients were treated via gastrectomy between August 1990 and September 2012: 48 total gastrectomies with Roux-en-Y reconstruction and 55 subtotal resections (among the latter there were 15 Roux-en-Y and 40 Billroth II reconstructions). All patients were interviewed to evaluate their QoL using the EORTC QLQ-C30 and QLQ-STO22 questionnaires. Non-parametric tests were used to analyze the data collected during the interviews considering patient-, tumor- and treatment-related factors. The analysis was corrected for potential confounding factors, in particular considering new onset variables (e.g. comorbidity, treatment and age at time of the interview). RESULTS QoL correlated negatively with tumor stage and total gastrectomy. In particular, a larger resection for an advanced cancer seems to cause a worse QoL. Furthermore, total gastrectomy is associated with several upper-gastrointestinal tract symptoms. Moreover, after distal resection, patients with a Billroth II reconstruction complain more frequently of dumping syndrome-related symptoms than patients with a Roux-en-Y reconstruction. CONCLUSIONS QoL after gastric surgery for cancer is affected by tumor- and treatment-related factors. In order to improve patients' QoL, subtotal resection with Roux-en-Y reconstruction should be preferred whenever oncologically acceptable.
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Affiliation(s)
- Stefano Rausei
- Department of Surgical Sciences Insubria University Varese-Como, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Alberto Mangano
- Department of Surgical Sciences Insubria University Varese-Como, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Federica Galli
- Department of Surgical Sciences Insubria University Varese-Como, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Francesca Rovera
- Department of Surgical Sciences Insubria University Varese-Como, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Luigi Boni
- Department of Surgical Sciences Insubria University Varese-Como, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Gianlorenzo Dionigi
- Department of Surgical Sciences Insubria University Varese-Como, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Renzo Dionigi
- Department of Surgical Sciences Insubria University Varese-Como, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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Hwang IC, Yun YH, Kim YW, Ryu KW, Kim YA, Kim S, Bae JM, Noh JH, Sohn TS. Factors related to clinically relevant fatigue in disease-free stomach cancer survivors and expectation–outcome consistency. Support Care Cancer 2014; 22:1453-60. [DOI: 10.1007/s00520-013-2110-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 12/25/2013] [Indexed: 12/17/2022]
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McNair A, Brookes S, Kinnersley P, Blazeby J. What surgeons should tell patients with oesophago-gastric cancer: A cross sectional study of information needs. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2013; 39:1278-86. [DOI: 10.1016/j.ejso.2013.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/25/2013] [Accepted: 08/05/2013] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Gastrectomy remains a major operation with potential for significant deterioration in patients' health-related quality of life (QOL). This study assessed differences in QOL among patients after distal (DG), proximal (PG), or total (TG) gastrectomy. METHODS We prospectively enrolled patients undergoing gastrectomy at our institution between 2002 and 2007. Participants completed the European Organization for Research and Treatment of Cancer cancer (QLQ-C30) and gastric (QLQ-STO22) questionnaires preoperatively and at 5 postoperative intervals up to 18 months. We compared changes from baseline in patients based on extent of resection (proximal, distal, or total) using generalized linear models, adjusting for age, stage of disease, and (neo)adjuvant therapy. We converted QOL raw scores to reflect the proportion of patients with clinically significant deterioration based on the minimal important difference. RESULTS We included 134 patients: 82 DG, 16 PG, and 36 TG. In the immediate postoperative period, 55% of patients suffered significant impairment in their global QOL. This improved in most patients by 6 months, although 20% to 35% continued to have substantially worse QOL than before surgery. Patients who underwent PG suffered from significantly more clinical reflux [70% vs 35% (DG), 40% (TG)], nausea/vomiting (60% vs 25%, 30%), and global QOL impairment (60% vs 30%, 30%) than patients who underwent DG or TG, whose QOL scores were similar. These differences persisted up to 18 months postoperatively. CONCLUSIONS Surgeons should discuss expectations of QOL impairment with their patients before gastrectomy and reassure them that most symptoms resolve by 6 months after operation. Patients who undergo PG suffer from worse QOL impairment than patients who undergo DG or TG.
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Changes of quality of life in gastric cancer patients after curative resection: a longitudinal cohort study in Korea. Ann Surg 2013; 256:1008-13. [PMID: 23154395 DOI: 10.1097/sla.0b013e31827661c9] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Little is known about how quality of life (QOL) changes over time after gastrectomy. We prospectively examined changes of QOL in Korean patients with gastric cancer after curative resection. BACKGROUND As early detection and improved treatment have led to higher survival rates and an increasing number of long-term survivors, the importance of QOL has increased. METHODS Patients newly diagnosed with gastric cancer, who were expected to undergo curative resection, were studied. QOL was assessed, using the European Organization for Research and Treatment of Cancer QLQ-C30 and its gastric module QLQ-STO22, before and after 3 and 12 months of gastrectomy. RESULTS In total, 465 patients were included in the study, and 377 and 88 patients underwent subtotal gastrectomy and total gastrectomy, respectively. For most of the functional or symptom scales, the mean score deteriorated at 3 months and generally improved during follow-up period. Patients with total gastrectomy had more functional and symptomatic problems related to QOL than those with subtotal gastrectomy during the follow-up. For both groups, there were temporal, unrecovered, improved, and unchanged problems in QOL. Fatigue; digestive symptoms such as diarrhea, dysphagia, and eating restrictions; body image disturbance; and cognitive functioning were the representative unrecovered problems, which persisted at 12 months after surgery. CONCLUSIONS Our findings show that there are various functional and symptomatic problems, which health care providers need to manage during the postsurgical period. We need to continuously address fatigue, diarrhea, dysphagia, eating restrictions, body image disturbance, and cognitive functioning. In addition, it would be necessary to inform patients about possible QOL outcomes while they are receiving information about surgery and signing informed consent for surgery.
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Li W, Zhao C, Hong Y, Li J, Zhang C, Xiong H. Regulation of Growth of Gastric Cancer Cells and Sensitivity to Cisplatin by Modulation of DNA Binding Inhibitor or Differentiation Protein Expression. Lab Med 2012. [DOI: 10.1309/lm2a3urfem0tsymc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Zhou YY, Xi SH. Combined use of EORTC QLQ-C30 and QLQ-STO22 for assessment of quality of life in patients with gastric cancer after surgery for 3 years. Shijie Huaren Xiaohua Zazhi 2012; 20:1782-1786. [DOI: 10.11569/wcjd.v20.i19.1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the quality of life (QOL) in patients with gastric cancer (GC) after surgery for 3 years with EORTC QLQ-C30 and QLQ-STO22.
METHODS: Ninety-six GC patients who underwent gastrectomy 3 years ago and 90 healthy subjects were recruited into the present study. The mean age was 53.2 ± 8.1 years for GC patients and 54.8 ± 7.9 years for healthy subjects, and 88.5% of patients were diagnosed with stage I GC. There were no differences in age and gender between the two groups. QLQ-C30 and QLQ-STO22 were employed to evaluate the QOL in these subjects.
RESULTS: The QLQ-C30 global QOL was comparable between GC patients and healthy subjects (60.1 ± 18.5 vs 58.3 ± 17.2, P > 0.05). The QOL with regard to cognitive functioning (71.0 ± 11.4 vs 63.6 ± 12.8), emotional functioning (79.4 ± 13.7 vs 71.2 ± 12.6) and fatigue (33.9 ± 10.6 vs 40.9 ± 11.3) of GC patients was superior to that of healthy subjects (all P < 0.05). However, the QOL with regard to nausea and vomiting (17.6 ± 10.4 vs 10.2 ± 8.7), financial difficulties (32.8 ± 14.3 vs 10.1 ± 8.6), reflux (19.4±14.3 vs 11.1±14.7), eating restrictions (15.9 ± 14.6 vs 10.2 ± 7.8) and body image (30.8 ± 16.5 vs 15.7 ± 10.2) was inferior to those of healthy subjects. No marked differences were observed in the scores of other domains/items between the two groups.
CONCLUSION: The QOL of GC patients nearly returns to normal level 3 years after surgery. The QOL related to upper gastrointestinal symptoms is significantly impaired in GC patients compared to healthy subjects.
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van der Schaaf M, Derogar M, Lagergren P. Reference values of oesophago-gastric symptoms (EORTC QLQ-OG25) in a population-based setting. Eur J Cancer 2012; 48:1602-7. [DOI: 10.1016/j.ejca.2011.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 07/14/2011] [Accepted: 10/24/2011] [Indexed: 01/26/2023]
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Abstract
BACKGROUND Attention has recently focused on decreased quality of life (QOL) that occurs in postgastrectomy patients. We verified how gastric emptying function affected QOL. METHODS Subjects were 72 consecutive patients after gastrectomy for cancer, including 25 after distal gastrectomy (DG), 18 after proximal gastrectomy (PG), 16 after pylorus-preserving gastrectomy (PpG), and 13 after total gastrectomy (TG). Using the (13)C breath test method, (13)CO(2) levels in breath were measured over 2 h, and T (max) was determined. Questionnaires (Japanese versions of the Short-Form 36 [SF-36] and Gastrointestinal Symptom Rating Scale [GSRS]) were used to analyze QOL and correlations between questionnaire results and T (max). RESULTS Mean T (max) (min) for each procedure was 15.4 for DG, 21.1 for PG, 41.3 for PpG, and 10.4 for TG. T (max) differed between procedures, but not between survey periods. SF-36 was not correlated with T (max), whereas GSRS showed a difference in diarrhea and total score between procedures, but not between survey periods. In addition, GSRS correlated with T (max) for abdominal pain, indigestion, and total score. The total scores showed a significant symptom aggregation in patients with T (max) less than 21 min. CONCLUSIONS Gastrointestinal symptoms in postgastrectomy patients were associated with the function of the remaining stomach. The (13)C breath test is useful for objectively assessing such symptoms.
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"How do you live without a stomach?": a multiple case study examination of total gastrectomy for palliation or prophylaxis. Palliat Support Care 2012; 9:305-13. [PMID: 21838951 DOI: 10.1017/s1478951511000253] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The number of diagnosed cases of stomach cancer in Western countries is relatively small compared to prevalence rates in Eastern populations. This disparity creates a general lack of information and understanding of the experience of patients treated for this disease in North America. Surgical removal of the stomach, also called total gastrectomy (TG), is presently the only curative treatment available to patients with stomach cancer. Considering the impact such a procedure may have, very little is known about what factors influence an individual's postsurgical quality of life (QL). METHOD This article reviews current literature and examines three unique case studies. Semi-structured interviews were analyzed using content analysis, a qualitative analytic approach for reporting combined subject responses. RESULTS Participants included one 37-year-old man with multiple polyps in his stomach and a family history of stomach cancer, one 18 year-old man with a confirmed CDH1 mutation and a family history of stomach cancer, and one 33-year-old man with confirmed metastatic gastric adenocarcinoma. Subjective patient experience was categorized into: (1) making the decision, (2) treatment impact, and (3) life after TG. Prior to surgery, all patients carefully evaluated their perceived risk compared to the treatment consequences and indicated that a certain event triggered their decision. The largest treatment impacts were learning to eat again and adjusting to the physical changes. Each patient endorsed that their experience made them appreciate and make the most of life. SIGNIFICANCE OF RESULTS This currently represents the only study to investigate the lived experience of TG for prophylaxis or palliation in individuals with and without genetic risk for stomach cancer. Understanding this process will allow all members of the cancer care team, and the patients themselves, to better understand the factors involved in decision making and postoperative adjustment. Fruitful avenues for future research are discussed.
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Munene G, Francis W, Garland SN, Pelletier G, Mack LA, Bathe OF. The quality of life trajectory of resected gastric cancer. J Surg Oncol 2011; 105:337-41. [PMID: 22095440 DOI: 10.1002/jso.22139] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 10/19/2011] [Indexed: 01/05/2023]
Abstract
BACKGROUND Few studies describe quality of life (QoL) outcomes following gastrectomy for gastric cancer using a validated instrument. The gastric cancer module for the Functional Assessment of Cancer Therapy system of QoL measurement tools (FACT-Ga) was utilized to determine the changes in QoL following gastrectomy, and during the disease course. METHODS In 43 patients undergoing gastrectomy for gastric cancer, outcome such as complications, recurrence, and survival were annotated. Karnofsky performance status (KPS) and QoL were determined preoperatively and at each follow-up visit. RESULTS Nineteen (44%) patients and 24 (56%) patients underwent partial gastrectomy (PG) and total gastrectomy (TG), respectively. Complications occurred in 30%, and one mortality (2.3%) occurred. Median survival was 23 months. KPS, FACT-G, and FACT-Ga scores all decreased after surgery, and normalized by 6 months. There was no significant difference in QoL in patients who had a PG or TG, although the type of gastrectomy did affect KPS. QoL dropped on average 4.4 ± 3.6 months prior to death. CONCLUSIONS Surgery adversely affects QoL for up to 6 months. Thereafter, QoL mirrors changes in disease status. More studies are required to document the QoL cost-benefit ratio in gastric cancer, which often is accompanied by short survival benefits.
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Affiliation(s)
- Gitonga Munene
- Department of Surgery, University of Calgary, AB, Canada
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