Large-scale investigation into dumping syndrome after gastrectomy for gastric cancer.
BACKGROUND
The aim of this study was to investigate early and late dumping syndromes in a large number of patients after gastrectomy for gastric cancer.


METHODS
Responses to questions on a visual analogue scale survey completed by 1,153 gastrectomy patients were analyzed for associations between clinical factors and occurrence of dumping syndrome. Types of gastrectomy included distal gastrectomy with Billroth I or with Roux-Y reconstruction, pylorus preserving gastrectomy, proximal gastrectomy, and total gastrectomy.


RESULTS
Based on the visual analogue scale rating of symptomatic discomfort, patients were categorized into 1 of 2 groups: symptom-free or symptomatic. Incidences of early or late dumping syndrome in all patients were 67.6% and 38.4%, respectively. Patients in whom early dumping syndrome developed were significantly more likely to experience late dumping syndrome than those in whom it did not develop (p < 0.001). According to multivariate analyses, factors that decreased the risk for developing early dumping syndrome were reduced weight loss (p < 0.01), old age (p < 0.01), pylorus preserving gastrectomy (p < 0.01), distal gastrectomy with Roux-Y reconstruction (p < 0.01), and distal gastrectomy with Billroth I (p = 0.019). In addition, factors that decreased the risk of developing late dumping syndrome were reduced weight loss (p = 0.03), being male (p < 0.01), pylorus preserving gastrectomy (p < 0.01), and distal gastrectomy with Roux-Y reconstruction (p < 0.01). No other clinical factors (lymph node dissection, vagal nerve preservation, and postoperative period) showed a substantial association with the occurrence of dumping syndrome in multivariate analyses.


CONCLUSIONS
Substantially more patients suffered from early dumping syndrome than late dumping syndrome after gastrectomy. Two clinical factors, surgical procedures and amount of body weight loss, associated significantly with the occurrence of both early and late dumping syndrome.
Mine
Shinji
S
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan. shinji.mine@jfcr.or.jp
Sano
Takeshi
T
Tsutsumi
Kenji
K
Murakami
Yoshitaka
Y
Ehara
Kazuhisa
K
Saka
Makoto
M
Hara
Kazuo
K
Fukagawa
Takeo
T
Udagawa
Harushi
H
Katai
Hitoshi
H
D015984:Causality; D018572:Disease-Free Survival; D004377:Dumping Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011159:Population Surveillance; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires