title: Evaluation of postgastrectomy symptoms after distal gastrectomy with Billroth-I reconstruction using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45).
abstract: BACKGROUND
  Distal gastrectomy with Billroth-I reconstruction (DGBI) is the most commonly used treatment approach for gastric cancer patients in Japan. The aim of this study was to assess and elucidate the effect of different surgical DGBI techniques on postgastrectomy syndrome (PGS) using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45).
  
  
  METHODS
  The newly created PGSAS-45 composed of 45 questions was used in this study. The scale was distributed to 2,922 patients who underwent gastrectomy >1 year prior. Completed forms were returned by 2,520 patients (86 %), of which 909 underwent DGBI. The effects of performing the Kocher maneuver, differences in the size of the gastric remnant and differences the anastomosis technique had on the main outcome measures of PGSAS-45 were analyzed.
  
  
  RESULTS
  Patients for whom the Kocher maneuver was performed experienced significantly worse meal-related distress and poorer quality of ingestion. Additionally, a less satisfactory physical and mental component summary from the SF-8 was reported. Patients with larger gastric remnants showed significantly better scores on the diarrhea subscale, a slightly better trend for the need for additional meals and dissatisfaction with eating. Regarding the anastomosis technique, there was no difference between the hand-sewn, circular stapler (CS) and linear stapler end-to-end anastomosis, and there was also no difference between the end-to-end and side-to-end anastomosis with the CS.
  
  
  CONCLUSIONS
  The Kocher maneuver may increase meal-related distress, reduce the quality of ingestion and impart a negative effect on quality of life (QOL). The larger gastric remnants may cause reduction in diarrhea and an improvement in meal-related scores.
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan, misawakzn@aichi-cc.jp.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Misawa
authors.forename: Masanori
authors.initials: M
authors.lastname: Terashima
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Uenosono
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ota
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hata
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Noro
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yajima
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Nitta
authors.forename: Koji
authors.initials: K
authors.lastname: Nakada
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D018530:Gastric Stump; D005763:Gastroenterostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000209:etiology*; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires
references.citation: Gastric Cancer. 2013 Jan;16(1):1-27
references.pmid: 22729699
references.citation: Gastric Cancer. 2011 Jun;14(2):113-23
references.pmid: 21573742
references.citation: Ann Surg Oncol. 2014 Jun;21 Suppl 3:S370-8
references.pmid: 24590434
references.citation: Aust N Z J Surg. 1973 May;42(4):345-8
references.pmid: 4532514
references.citation: Hepatogastroenterology. 2004 May-Jun;51(57):906-11
references.pmid: 15143944
references.citation: Am Surg. 1999 Oct;65(10):905-7
references.pmid: 10515531
references.citation: Med Care. 1992 Jun;30(6):473-83
references.pmid: 1593914
references.citation: Gastric Cancer. 2015 Jan;18(1):147-58
references.pmid: 24515247
references.citation: Dig Dis Sci. 1988 Feb;33(2):129-34
references.pmid: 3123181
references.citation: J Natl Cancer Inst. 1993 Mar 3;85(5):365-76
references.pmid: 8433390
references.citation: Surg Today. 2007;37(2):122-6
references.pmid: 17243030
references.citation: Gastroenterol Clin North Am. 1994 Jun;23(2):261-79
references.pmid: 8070912
references.citation: Surg Annu. 1981;13:139-61
references.pmid: 7025276
references.citation: Eur J Cancer. 1998 May;34(6):810-5
references.pmid: 9797690
references.citation: Psychooncology. 2008 May;17(5):474-9
references.pmid: 17847126
references.citation: Gastric Cancer. 2011 Aug;14(3):279-84
references.pmid: 21519869
references.citation: Qual Life Res. 2003 Dec;12(8):1003-12
references.pmid: 14651418
references.citation: Eur J Cancer. 2004 Oct;40(15):2260-8
references.pmid: 15454251