QUALITY-OF-LIFE AFTER SUBTOTAL AND TOTAL GASTRECTOMY FOR GASTRIC-CARCINOMA

Objective: To compare quality of life after subtotal gastrectomy (STG) and total gastrectomy of various types, in view of the fact that, wit h T1 and T2 gastric carcinoma of intestinal type in the distal third o f the stomach, subtotal gastrectomy is similar to total gastrectomy re garding the extent of lymphadenectomy and prognosis. Patients and meth ods: Quality of life was measured by standardised questionnaires given to 36 patients after subtotal gastrectomy (22 men, 14 women; mean age 63 [27-79] years): general physical complaints (GPC); contentment wit h life (CL); psychosocial stress (PSS). The results were compared with those previously obtained in 58 patients with total gastrectomy (46 m en, 12 women; mean age 63.4 [39-74] years) and oesophagojejunostomy (O JPP) (n = 29) or oesophagojejunoplication and pouch (OJPP) (n = 29). R esults: Weight loss of patients after OJPP was not significantly diffe rent from that of patients after STG, but it was significantly higher after OJS (13.5 +/- 8.6 kg; P < 0.0006). Patients with STG had signifi cantly more general complaints (P < 0.05) and greater discontent with life (P < 0.05) than those with OJPP Specific analysis of gastric comp laints showed greatest dissatisfaction with gastrointestinal functions in patients after STG (P < 0.0004), less also after OJS compared with OJPP (P < 0.01). Conclusions: Subtotal gastrectomy for gastric carcin oma has no advantages over total gastrectomy with oesophagojejunoplica tion and pouch as regards weight loss, gastrointestinal complaints, ps ychosocial stress and general contentment. The poor quality of life se ems to have its functional correlate in increased intestino-oesophagea l reflux with incompetent cardia and after Billroth II reconstruction.