title: Evaluation of QOL after proximal gastrectomy using a newly developed assessment scale (PGSAS-45).
abstract: BACKGROUND
  Proximal gastrectomy with esophagogastrostomy (PGEG) has been widely applied as a comparatively simple method. In this study, we used a questionnaire survey to evaluate the influence of various surgical factors on post-operative quality of life (QOL) after PGEG.
  
  
  METHODS
  In this post-gastrectomy syndrome assessment study, we analyzed QOL in 2,368 cases. Among these, 193 had undergone proximal gastrectomy and 115 had undergone PGEG. The Post-Gastrectomy Syndrome Assessment Scale (PGSAS)-45 is a questionnaire consisting of 45 items, including the SF-8, the Gastrointestinal Symptom Rating Scale (GSRS), and other symptom items seemed to be specific to post-gastrectomy. The 23 symptom items were composed of seven symptom subscales (SS), including esophageal reflux, abdominal pain, and meal-related distress. These seven SS, total symptom score, ingested amount of food per meal, necessity for additional meals, quality of ingestion SS, ability to work, dissatisfaction with symptoms, dissatisfaction with the meal, dissatisfaction with working, dissatisfaction with daily life SS and change in body weight were evaluated as main outcome measures. In PGEG cases, we evaluated the influence on QOL of various surgical factors, such as procedures to prevent gastroesophageal regurgitation and size of the remnant stomach.
  
  
  RESULTS
  The scores for esophageal reflux and dissatisfaction with the meal were higher in patients who had not undergone an anti-reflux procedure. In most cases, the preserved remnant stomach was more than two-thirds the size of the pre-operative stomach. When comparing patients with a remnant stomach two-thirds the pre-operative size and those with more than three-quarters, the diarrhea SS and necessity for additional meals scores were lower in the group with more than three-quarters. The indigestion, constipation, and abdominal pain subscales, and the total symptom score, were higher in patients who had not undergone pyloric bougie than in those who had.
  
  
  CONCLUSIONS
  These results indicated that QOL was better in patients with a large remnant stomach. Procedures to prevent gastroesophageal reflux, and the use of pyloric bougie as a complementary drainage procedure, were considered effective ways to reduce the deterioration of QOL.
authors.affiliation: Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan, tinada@tcc.pref.tochigi.lg.jp.
authors.forename: Takao
authors.initials: T
authors.lastname: Inada
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.forename: Masami
authors.initials: M
authors.lastname: Ikeda
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Yumiba
authors.forename: Hideo
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Akinori
authors.initials: A
authors.lastname: Takagane
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.forename: Ryoji
authors.initials: R
authors.lastname: Fukushima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yabusaki
authors.forename: Koji
authors.initials: K
authors.lastname: Nakada
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D001835:Body Weight; D003248:Constipation / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D004415:Dyspepsia / Q000209:etiology; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D018530:Gastric Stump / Q000473:pathology*; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D008297:Male; D062407:Meals; D008875:Middle Aged; D009929:Organ Size; D017060:Patient Satisfaction; D011178:Postgastrectomy Syndromes / Q000175:diagnosis / Q000209:etiology*; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires