title: Optimal Roux-en-Y reconstruction after distal gastrectomy for early gastric cancer as assessed using the newly developed PGSAS-45 scale.
abstract: OBJECTIVE
  The optimal surgical procedure for distal gastrectomy with Roux-en-Y reconstruction (DGRY) remains to be determined. Recently, a self-report assessment instrument, the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), was compiled to evaluate symptoms, the living status and the quality of life of patients who have undergone gastrectomy. We used this scale to evaluate procedures used for DGRY.
  
  
  METHODS
  The subjects included 475 patients who underwent DGRY for stage IA/IB gastric cancer. We evaluated whether the size of the remnant stomach, length of the Roux limb, reconstruction route and anastomotic procedure affected the patients' symptoms, living status and quality of life assessed using the PGSAS-45.
  
  
  RESULTS
  Patients with a residual stomach of more than half had significantly worse esophageal reflux scores than the patients with a smaller residual stomach (P = 0.0462); a residual stomach of one-third or one-fourth was favorable. A shorter length of the Roux limb was shown to be preferable to a longer Roux limb based on the results of the PGSAS-45. In addition, antecolic reconstruction and the anastomotic procedure using a linear stapler were found to be more favorable.
  
  
  CONCLUSIONS
  The size of the remnant stomach and the length and route of the Roux limb significantly influence the patient-reported DGRY outcomes.
authors: Department of Frontier Surgery, Center for Frontier Medical Engineering, Chiba University, Graduate School of Medicine, 1-33, Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan. hk@faculty.chiba-u.jp.
authors: Hiroshi
authors: H
authors: Kawahira
authors: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors: Yasuhiro
authors: Y
authors: Kodera
authors: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: Naoki
authors: N
authors: Hiki
authors: Division of Gastroenterological Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
authors: Masazumi
authors: M
authors: Takahashi
authors: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
authors: Seiji
authors: S
authors: Itoh
authors: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors: Norio
authors: N
authors: Mitsumori
authors: Division of Gastroenterological Surgery, Saitama Cancer Center, Ina, Japan.
authors: Yoshiyuki
authors: Y
authors: Kawashima
authors: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors: Tsutomu
authors: T
authors: Namikawa
authors: Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
authors: Takao
authors: T
authors: Inada
authors: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors: Koji
authors: K
authors: Nakada
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D059026:Diagnostic Self Evaluation; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000175:diagnosis*; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013528:Surgical Staplers; D016896:Treatment Outcome; D055815:Young Adult
keywords: Gastrectomy; Postgastrectomy syndrome; Roux-en-Y
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