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Quality of Life After Gastrectomy for Adenocarcinoma: A Prospective Cohort Study

Karanicolas, Paul J. MD, PhD*; Graham, Dennis NP, DNSc†,‡; Gönen, Mithat PhD§; Strong, Vivian E. MD; Brennan, Murray F. MD; Coit, Daniel G. MD

doi: 10.1097/SLA.0b013e31828c4a19
Original Articles

Background: Gastrectomy remains a major operation with potential for significant deterioration in patients' health-related quality of life (QOL). This study assessed differences in QOL among patients after distal (DG), proximal (PG), or total (TG) gastrectomy.

Methods: We prospectively enrolled patients undergoing gastrectomy at our institution between 2002 and 2007. Participants completed the European Organization for Research and Treatment of Cancer cancer (QLQ-C30) and gastric (QLQ-STO22) questionnaires preoperatively and at 5 postoperative intervals up to 18 months. We compared changes from baseline in patients based on extent of resection (proximal, distal, or total) using generalized linear models, adjusting for age, stage of disease, and (neo)adjuvant therapy. We converted QOL raw scores to reflect the proportion of patients with clinically significant deterioration based on the minimal important difference.

Results: We included 134 patients: 82 DG, 16 PG, and 36 TG. In the immediate postoperative period, 55% of patients suffered significant impairment in their global QOL. This improved in most patients by 6 months, although 20% to 35% continued to have substantially worse QOL than before surgery. Patients who underwent PG suffered from significantly more clinical reflux [70% vs 35% (DG), 40% (TG)], nausea/vomiting (60% vs 25%, 30%), and global QOL impairment (60% vs 30%, 30%) than patients who underwent DG or TG, whose QOL scores were similar. These differences persisted up to 18 months postoperatively.

Conclusions: Surgeons should discuss expectations of QOL impairment with their patients before gastrectomy and reassure them that most symptoms resolve by 6 months after operation. Patients who undergo PG suffer from worse QOL impairment than patients who undergo DG or TG.

In this prospective cohort study including 134 patients undergoing gastrectomy for cancer, 55% suffered significant impairment in their global quality of life. Patients who underwent proximal gastrectomy suffered from significantly more clinical reflux, nausea/vomiting, and global quality of life impairment than patients who underwent distal or total gastrectomy. These differences persisted up to 18 months postoperatively.

*Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Departments of Surgery

Nursing

§Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.

Reprints: Daniel G. Coit, MD, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY. E-mail: coitd@mskcc.org.

Paul J. Karanicolas and Dennis Graham contributed equally to this study and are co-first authors.

Disclosure: The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.