Factors that minimize postgastrectomy symptoms following pylorus-preserving gastrectomy: assessment using a newly developed scale (PGSAS-45).
BACKGROUND
Pylorus-preserving gastrectomy (PPG) is sometimes performed as a function-preserving surgery for the treatment of early gastric cancer. The aim of this study was to use an integrated assessment scale for postgastrectomy syndrome to determine the appropriate indicators and optimal methods for PPG.


METHODS
The Postgastrectomy Syndrome Assessment Study (PGSAS) is a multicenter survey based on an integrated questionnaire (PGSAS-45) consisting of 45 items. Questionnaire responses were retrieved from a total of 2,520 patients, each of whom had undergone one of six different types of gastrectomy procedures; 313 responses from patients who had received PPG were analyzed here.


RESULTS
The size of the proximal gastric remnant (less than one-quarter, about one-third, or more than one-half of the original size) significantly influenced the change in body weight, the scores for dissatisfaction at the meal, and dissatisfaction for daily life subscale (P = 0.030, P = 0.005, P = 0.034, respectively). The nausea score in patients who underwent hand-sewn anastomosis was significantly lower than in those who underwent anastomosis with a linear stapler (P = 0.006). The scores for diarrhea subscale, increased passage of stools, and sense of foods sticking differed significantly depending on the length of the preserved pyloric cuff (P = 0.047, P = 0.021, P = 0.046, respectively).


CONCLUSIONS
The results suggest that preservation of a sufficient proximal gastric remnant is recommended when utilizing PPG as function-preserving surgery.
Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan, tsutomun@kochi-u.ac.jp.
Tsutomu
T
Namikawa
Naoki
N
Hiki
Shinichi
S
Kinami
Hiroshi
H
Okabe
Takashi
T
Urushihara
Hiroshi
H
Kawahira
Norimasa
N
Fukushima
Yasuhiro
Y
Kodera
Takeyoshi
T
Yumiba
Atsushi
A
Oshio
Koji
K
Nakada
D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D018530:Gastric Stump / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D011178:Postgastrectomy Syndromes / Q000517:prevention & control*; D011379:Prognosis; D011708:Pylorus / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires