Quality of Life after Curative Surgery in Patients with Gastric Cancer: Comparison between a Subtotal Gastrectomy and a Total Gastrectomy

Yu, Wansik; Lee, Chang Hwan; Chung, Ho Young

Abstract

PURPOSE: Quality of life (QOL) assessment should be applied in surgical settings to compare treatment options. We compared QOL after a subtotal versus a total gastrectomy for gastric cancer to identify which resection would produce a better QOL for the patient.
PATIENTS AND METHODS
We studied 362 patients with no evidence of recurrent disease after curative surgery for gastric cancer. The QOL was measured by assessing patient health perceptions according to the Spitzer index and Troidl score and by treatment-specific symptoms according to Korenaga and others with some modifications. High scores reflect a better QOL.
RESULTS
The mean score of the Spitzer index was 8.87+/-1.36 after a subtotal gastrectomy and 8.80+/-1.23 after a total gastrectomy. More than 80% of the patients in both groups maintained good quality of life when measured by the Spitzer index. The mean Troidl score was 10.41+/-2.12 after a subtotal gastrectomy and 9.79+/-2.16 after a total gastrectomy (p=0.033). Swallowing difficulty was more frequent after a total gastrectomy (p=0.002). There was a statistically significant difference in the meal size (p=0.044). Other variables of the Troidl score revealed no statistically significant differences. Dizziness was significantly more frequent after a total gastrectomy than after a subtotal gastrec tomy (p=0.009).
Conclusion
We conclude that in terms of postoperative quality of life, a subtotal gastrectomy has advantages over a total gastrectomy. In those cases where an adequate proximal safety margin can be achieved by a subtotal gastrectomy, that procedure is preferable to a total gastrectomy.