title: Functional outcomes and quality of life after proximal gastrectomy with esophagogastrostomy using a narrow gastric conduit.
abstract: BACKGROUND
  The best surgical approach for tumors of the proximal stomach remains controversial. For proximal gastrectomy (PG), the evidence regarding quality of life (QoL) and functional outcomes is controversial. Moreover, there are limited data from non-Asian settings.
  
  
  METHODS
  All patients who underwent PG from September 2005 to July 2013 were identified from an institutional database. Demographic, perioperative and pathologic characteristics were retrieved. Symptom scores (0 = best/4 = worst) for reflux symptoms, dysphagia and validated QoL metrics (FACT scale, where a higher score is better) were assessed during early and late follow-up. Eligible patients for analysis were those with no evidence of recurrence.
  
  
  RESULTS
  Of 465 upper gastrointestinal cancer resections, 50 were PG for adenocarcinoma (42; 84%), neuroendocrine carcinoma (5; 10%) or other pathologies (3; 6%). R0 resection was achieved in 44 (89.8%) of 49 patients with malignant tumors. Median lymph node collection was 32 (range 7-57). QoL scores did not differ from preoperative to early follow-up but increased compared to both at late follow-up [preoperative, 125 (interquartile range 105-140); early follow-up, 122.5 (97-142); late follow-up, 147 (132-159); p < 0.05]. At early and late follow-up, 9 (21.4%) of 42 and 10 (33.3%) of 30 patients reported reflux symptoms, but most were mild. Endoscopic signs of esophagitis were found in 7 (29%) of 24 patients, but only two of these reported reflux symptoms. Conversely only three of eight patients with reflux symptoms had esophagitis on endoscopy.
  
  
  CONCLUSIONS
  Global QoL is not reduced early after PG, and increases compared to baseline at late follow-up. Although reflux symptoms are reported by a quarter of patients, most are mild, and there is little correlation with esophagitis. PG should remain a viable option in the management of proximal gastric tumors.
authors.affiliation: Department of Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Centre Mannheim, Mannheim, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ronellenfitsch
authors.forename: Sara
authors.initials: S
authors.lastname: Najmeh
authors.forename: Amin
authors.initials: A
authors.lastname: Andalib
authors.forename: Rushika M
authors.initials: RM
authors.lastname: Perera
authors.forename: Mathieu C
authors.initials: MC
authors.lastname: Rousseau
authors.forename: David S
authors.initials: DS
authors.lastname: Mulder
authors.forename: Lorenzo E
authors.initials: LE
authors.lastname: Ferri
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018278:Carcinoma, Neuroendocrine / Q000473:pathology / Q000601:surgery; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery; D004946:Esophagostomy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery