title: Assessment of postoperative quality of life following pylorus-preserving gastrectomy and Billroth-I distal gastrectomy in gastric cancer patients: results of the nationwide postgastrectomy syndrome assessment study.
abstract: BACKGROUND
  Pylorus-preserving gastrectomy (PPG) is increasingly being used to treat early gastric cancer in the middle third of the stomach, with the hope of ameliorating postoperative dysfunction and improving quality of life (QOL). We evaluated symptoms of postgastrectomy syndrome (PGS) and QOL by means of a newly developed integrated questionnaire, the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), and compared PPG with Billroth-I distal gastrectomy (DGBI).
  
  
  METHODS
  The PGSAS-45 consists of 45 items, including items from the SF-8 and GSRS instruments, as well as 22 newly selected items. It was designed to assess the severity of PGS and the living status and QOL of gastrectomized patients. The nationwide PGSAS surveillance study enrolled 2,368 gastric cancer patients who underwent various types of gastrectomy. In this study we analyzed 313 PPG patients and 909 DGBI patients.
  
  
  RESULTS
  Body weight loss was -6.9% in the PPG group and -7.9% in the DGBI group (P = 0.052). The PPG group scored better on the diarrhea subscale (PPG; 1.8 vs. DGBI; 2.1, P < 0.0001), dumping subscale (1.8 vs. 2.0, P = 0.003), and frequency of additional meals (1.8 vs. 1.9, P = 0.034). Multiple regression analysis revealed that age and the preservation of the celiac branch of the vagus nerve were independent factors predicting diarrhea and dumping.
  
  
  CONCLUSIONS
  It has been suggested that PPG is superior to DGBI for ameliorating PGS. Preservation of the celiac branch of the vagus nerve is recommended to reduce postoperative disorders regardless of the reconstruction method used.
authors: Department of Surgery, NTT West Osaka Hospital, 2-6-40 Karasugatsuji Tennoji-ku, Osaka, 543-8922, Japan. j.fujita@mhc.west.ntt.co.jp.
authors: Junya
authors: J
authors: Fujita
authors: Division of Gastroenterological Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
authors: Masazumi
authors: M
authors: Takahashi
authors: Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors: Takashi
authors: T
authors: Urushihara
authors: Department of Gastroenterological and Transplant Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors: Kazuaki
authors: K
authors: Tanabe
authors: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors: Yasuhiro
authors: Y
authors: Kodera
authors: Department of Surgery, Kenporen Osaka Central Hospital, Osaka, Japan.
authors: Takeyoshi
authors: T
authors: Yumiba
authors: Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan.
authors: Hideo
authors: H
authors: Matsumoto
authors: Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan.
authors: Akinori
authors: A
authors: Takagane
authors: Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
authors: Chikara
authors: C
authors: Kunisaki
authors: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors: Koji
authors: K
authors: Nakada
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005763:Gastroenterostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000209:etiology*; D011184:Postoperative Period; D011708:Pylorus / Q000601:surgery; D011788:Quality of Life; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires
keywords: DGBI; PGSAS-45; PPG; QOL
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