Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, 2-15-3, kawagishicho, chuoku, Niigata, 951-8566, Japan.
Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
World J Surg. 2020 Oct;44(10):3433-3440. doi: 10.1007/s00268-020-05629-5.
Proximal gastrectomy (PG) has become an increasingly preferred procedure for early cancer in the upper third of the stomach, owing to reportedly superior quality of life (QOL) after PG when compared with total gastrectomy. However, various methods of reconstruction have currently been proposed. We compared the postoperative QOL among the three different reconstruction methods after PG using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire.
Post Gastrectomy Syndrome Assessment Study (PGSAS), a nationwide multi-institutional survey, was conducted to evaluate QOL using the PGSAS-45 among various types of gastrectomy. Of the 2,368 eligible data from the PGSAS survey, data from 193 patients who underwent PG were retrieved and used in the current study. The PGSAS-45 consists of 45 items including 22 original gastrectomy specific items in addition to the SF-8 and GSRS. These were consolidated into 19 main outcome measures pertaining postgastrectomy symptoms, amount of food ingested, quality of ingestion, work, and level of satisfaction for daily work, and the three reconstruction methods (n = 193; 115 esophago-gastrostomy [PGEG], 34 jejunal interposition [PGJI], and 44 jejunal pouch interposition [PGJPI]) were compared using PGSAS-45.
Size of the remnant stomach was significantly larger in PGEG, and significantly smaller in PGJI and PGJPI (P < 0.05). There was no difference in other patient background factors among the groups. EGJPI tended to be superior to PGEG in several of the 19 main outcome with marginal significance (P = 0.047-0.076).
PGJPI appears to be the most favorable of the three reconstruction methods after PG especially when the size of remnant stomach is rather small.
UMIN-CTR #000002116 entitled as "A study to observe correlation between resection and reconstruction procedures employed for gastric neoplasms and development of postgastrectomy syndrome".
由于近端胃切除术（PG）在治疗胃上部早期癌症方面具有较好的生活质量（QOL），因此与全胃切除术相比，PG 已成为一种越来越受欢迎的手术方法。然而，目前已经提出了各种重建方法。我们使用胃切除术后综合征评估量表-45（PGSAS-45）问卷比较了 PG 后三种不同重建方法的术后 QOL。
进行了胃切除术后综合征评估研究（PGSAS），这是一项全国性多机构调查，使用 PGSAS-45 评估各种胃切除术的 QOL。在 PGSAS 调查的 2368 份合格数据中，检索了 193 名接受 PG 的患者的数据，并将其用于本研究。PGSAS-45 由 45 个项目组成，包括 22 个原始胃切除术特异性项目以及 SF-8 和 GSRS。这些项目被合并为 19 个主要的术后症状、摄入食物量、摄入质量、工作以及日常工作满意度的测量指标，比较了三种重建方法（n=193；115 例食管胃吻合术[PGEG]、34 例空肠间置术[PGJI]和 44 例空肠袋间置术[PGJPI]）。
PGEG 的残胃大小明显较大，PGJI 和 PGJPI 的残胃大小明显较小（P<0.05）。各组间其他患者背景因素无差异。PGJPI 在几个主要结果中的表现优于 PGEG，具有边缘显著意义（P=0.047-0.076）。
PGJPI 似乎是 PG 后三种重建方法中最有利的方法，特别是当残胃大小较小的情况下。
UMIN-CTR #000002116，题为“胃肿瘤切除和重建方法与胃切除术后综合征发展相关性的研究”。
