QUALITY-OF-LIFE AFTER GASTRECTOMY FOR GASTRIC-CARCINOMA - CONTROLLED-STUDY OF RECONSTRUCTIVE PROCEDURES

The choice of reconstruction after gastrectomy and the significance of remaining reservoir function is a matter of controversy. To broaden t he criteria for choice of treatment, we conducted a prospective random ized clinical trial to determine the impact of various gastrectomy pro cedures on quality of life. Consecutive patients (n = 64) eligible for curative gastric cancer surgery were randomized to have either a tota l (n = 31) or subtotal (n = 13) gastrectomy or a jejunal S-shaped pouc h (n = 20) implanted as a gastric substitute. The quality-of-life eval uation was based on a battery of questionnaires covering both general and specific aspects of life. The patients were rated by one of two ps ychiatrists who were blinded to the patients' group affiliation. Asses sments were made on three occasions: during the week prior to surgery and 3 and 12 months after the surgical intervention. The postoperative complication and mortality rates were similar in all treatment groups , with few serious complications recorded. Irrespective of type of tre atment, the patients suffered from alimentary symptoms and functional limitations in everyday life, whereas their mental well-being improved after surgery. Patients who underwent subtotal gastrectomy had the be st outcome, especially with respect to complaints of diarrhea. Patient s given a gastric substitute after gastrectomy showed no difference fr om those who had only a total gastrectomy. We conclude that despite si gnificant unfavorable consequences that follow gastrectomy, patients r ecover with an improved mental status. A pouch reconstruction after to tal gastrectomy does not improve quality of life, but a subtotal gastr ectomy has advantages that must be considered when the procedure is cl inically feasible.