Systematic review on quality of life outcomes after gastrectomy for gastric carcinoma.
BACKGROUND
Despite advances in chemotherapy and radiotherapy, gastrectomy is the only curative intervention for gastric carcinoma. This study reviews post-operative health-related quality of life (HRQOL) after gastrectomy.


METHODS
A literature search was conducted on PubMed for all studies published after January 2000 matching strict eligibility criteria. Bibliographies of included studies were also reviewed. Quality appraisal and data tabulation were performed using pre-determined forms. Results were synthesised by narrative review according to PRISMA guidelines with full tabulation of results of all included studies.


RESULTS
A total of 21 studies (3,575 patients) were included. Post-operative HRQOL improvements were demonstrated across most or all domains in different HRQOL instruments. Patients experienced declines in HRQOL 1 month after surgery, but reached at least pre-operative levels with recovery by 1 year. The greatest improvements were demonstrated in the emotional health domain with favourable functional benefits. Partial gastrectomy appears to be superior to total gastrectomy in physical, emotional and functional health domains. However, patients remain susceptible to gastrointestinal symptoms following surgery, which negatively impact upon HRQOL. Post-operative complications did not appear to affect HRQOL. Most studies were prospective, but data is heterogeneous.


CONCLUSIONS
Gastrectomy results in significant HRQOL benefits across a broad range of health domains. This is critical outcome of surgery and an important consideration in pre-operative decision making.
1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ; 2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, NSW, Australia ; 4 Department of Surgery, Wollongong Hospital, Kogarah, NSW, Australia ; 5 Surgical Skills Network, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Bernard
B
Shan
1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ; 2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, NSW, Australia ; 4 Department of Surgery, Wollongong Hospital, Kogarah, NSW, Australia ; 5 Surgical Skills Network, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Leonard
L
Shan
1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ; 2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, NSW, Australia ; 4 Department of Surgery, Wollongong Hospital, Kogarah, NSW, Australia ; 5 Surgical Skills Network, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
David
D
Morris
1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ; 2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, NSW, Australia ; 4 Department of Surgery, Wollongong Hospital, Kogarah, NSW, Australia ; 5 Surgical Skills Network, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Sanjeev
S
Golani
1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ; 2 Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, NSW, Australia ; 4 Department of Surgery, Wollongong Hospital, Kogarah, NSW, Australia ; 5 Surgical Skills Network, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Akshat
A
Saxena
Gastrectomy; gastric carcinoma; quality of life (QOL)