title: Quality of life after gastrectomy for adenocarcinoma: a prospective cohort study.
abstract: BACKGROUND
  Gastrectomy remains a major operation with potential for significant deterioration in patients' health-related quality of life (QOL). This study assessed differences in QOL among patients after distal (DG), proximal (PG), or total (TG) gastrectomy.
  
  
  METHODS
  We prospectively enrolled patients undergoing gastrectomy at our institution between 2002 and 2007. Participants completed the European Organization for Research and Treatment of Cancer cancer (QLQ-C30) and gastric (QLQ-STO22) questionnaires preoperatively and at 5 postoperative intervals up to 18 months. We compared changes from baseline in patients based on extent of resection (proximal, distal, or total) using generalized linear models, adjusting for age, stage of disease, and (neo)adjuvant therapy. We converted QOL raw scores to reflect the proportion of patients with clinically significant deterioration based on the minimal important difference.
  
  
  RESULTS
  We included 134 patients: 82 DG, 16 PG, and 36 TG. In the immediate postoperative period, 55% of patients suffered significant impairment in their global QOL. This improved in most patients by 6 months, although 20% to 35% continued to have substantially worse QOL than before surgery. Patients who underwent PG suffered from significantly more clinical reflux [70% vs 35% (DG), 40% (TG)], nausea/vomiting (60% vs 25%, 30%), and global QOL impairment (60% vs 30%, 30%) than patients who underwent DG or TG, whose QOL scores were similar. These differences persisted up to 18 months postoperatively.
  
  
  CONCLUSIONS
  Surgeons should discuss expectations of QOL impairment with their patients before gastrectomy and reassure them that most symptoms resolve by 6 months after operation. Patients who undergo PG suffer from worse QOL impairment than patients who undergo DG or TG.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Karanicolas
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.|Department of Nursing, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Dennis
authors.initials: D
authors.lastname: Graham
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gönen
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Strong
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011446:Prospective Studies; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome