J. Svedlund et al., Long term consequences of gastrectomy for patients' quality of life: The impact of reconstructive techniques, AM J GASTRO, 94(2), 1999, pp. 438-445
Objective: During recent years considerable interest has been focused on qu
ality of life as an additional therapeutic outcome measure in the surgical
treatment of gastric carcinoma. However, the long term consequences of gast
rectomy and the impact on quality of life of different reconstructive techn
iques are still a matter of controversy. To broaden the criteria for choice
of treatment, we conducted a prospective randomized clinical trial to dete
rmine the impact of various gastrectomy procedures on quality of life durin
g a 5-yr follow-up period. Methods: Consecutive patients (n = 64) eligible
for curative gastric cancer surgery were randomized to have either total (n
= 31) or subtotal (n = 13) gastrectomy or a jejunal S-shaped pouch (n = 20
) as a gastric substitute after total gastrectomy. Assessments of quality o
f life were made on seven occasions during a 5-yr period: within 1 wk befor
e surgery, 3 and 12 months after the surgical intervention, and then once/y
r, All patients were interviewed by one of two psychiatrists, who rated the
ir symptoms and introduced standardized self-report questionnaires covering
both general and specific aspects of life. The raters were blinded for the
patients' group affiliations. Results: Survival rates were similar in all
treatment groups. Patients who had a total gastrectomy continued to suffer
from alimentary symptoms, especially indigestion and diarrhea, during the e
ntire follow-up period. However, patients who underwent subtotal gastrectom
y had a significantly better outcome already during the first postoperative
yr, Patients given a gastric substitute after gastrectomy improved with th
e passage of time and had an even better outcome in the long run. Conclusio
ns: To optimize the rehabilitation after gastrectomy, patients' quality of
life must be taken into consideration. When subtotal gastrectomy is clinica
lly feasible, this procedure has advantages in the early postoperative peri
od. However, a pouch reconstruction after total gastrectomy should be consi
dered in patients having a favorable tumor status suggesting a fair chance
of long term survival. (Am J Gastroenterol 1999;94:438-445. (C) 1999 by Am,
Cell. of Gastroenterology).