RESUMO
PURPOSE: Patients who have undergone gastrectomy have unique symptoms that are not appropriately assessed using currently available tools. This study developed and validated a symptom-focused quality of life (QoL) questionnaire for patients who have received gastrectomy for gastric cancer. MATERIALS AND METHODS: Based on a literature review, patient interviews, and expert consultation by the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS), the initial item pool was developed. Two large-scale developmental studies were then sequentially conducted for exploratory factor analyses for content validity and item reduction. The final item pool was validated in a separate cohort of patients and assessed for internal consistency, test-retest reliability, construct validity, and clinical validity. RESULTS: The initial questionnaire consisted of 46-items in 12 domains. Data from 465 patients at 11 institutions, followed by 499 patients at 13 institutions, were used to conduct item reduction and exploratory factor analyses. The final questionnaire (KOQUSS-40) comprised 40 items within 11 domains. Validation of KOQUSS-40 was conducted on 413 patients from 12 hospitals. KOQUSS-40 was found to have good model fit. The mean summary score of the KOQUSS-40 was correlated with the EORTC QLQ-C30 and STO22 (correlation coefficients, 0.821 and 0.778, respectively). The KOQUSS-40 score was also correlated with clinical factors, and had acceptable internal consistency (> 0.7). Test-retest reliability was greater than 0.8. CONCLUSION: The KOQUSS-40 can be used to assess QoL of gastric cancer patients after gastrectomy and allows for a robust comparison of surgical techniques in clinical trials.
Assuntos
Gastrectomia/efeitos adversos , Síndromes Pós-Gastrectomia/diagnóstico , Qualidade de Vida , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Pós-Gastrectomia/etiologia , Síndromes Pós-Gastrectomia/psicologia , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Neoplasias Gástricas/complicações , Neoplasias Gástricas/psicologia , Inquéritos e Questionários/estatística & dados numéricosRESUMO
BACKGROUND: Proximal gastrectomy (PG) has become an increasingly preferred procedure for early cancer in the upper third of the stomach, owing to reportedly superior quality of life (QOL) after PG when compared with total gastrectomy. However, various methods of reconstruction have currently been proposed. We compared the postoperative QOL among the three different reconstruction methods after PG using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire. METHODS: Post Gastrectomy Syndrome Assessment Study (PGSAS), a nationwide multi-institutional survey, was conducted to evaluate QOL using the PGSAS-45 among various types of gastrectomy. Of the 2,368 eligible data from the PGSAS survey, data from 193 patients who underwent PG were retrieved and used in the current study. The PGSAS-45 consists of 45 items including 22 original gastrectomy specific items in addition to the SF-8 and GSRS. These were consolidated into 19 main outcome measures pertaining postgastrectomy symptoms, amount of food ingested, quality of ingestion, work, and level of satisfaction for daily work, and the three reconstruction methods (n = 193; 115 esophago-gastrostomy [PGEG], 34 jejunal interposition [PGJI], and 44 jejunal pouch interposition [PGJPI]) were compared using PGSAS-45. RESULTS: Size of the remnant stomach was significantly larger in PGEG, and significantly smaller in PGJI and PGJPI (P < 0.05). There was no difference in other patient background factors among the groups. EGJPI tended to be superior to PGEG in several of the 19 main outcome with marginal significance (P = 0.047-0.076). CONCLUSION: PGJPI appears to be the most favorable of the three reconstruction methods after PG especially when the size of remnant stomach is rather small. TRIAL REGISTRATION NUMBER: UMIN-CTR #000002116 entitled as "A study to observe correlation between resection and reconstruction procedures employed for gastric neoplasms and development of postgastrectomy syndrome".
Assuntos
Gastrectomia/métodos , Procedimentos de Cirurgia Plástica/métodos , Síndromes Pós-Gastrectomia/psicologia , Qualidade de Vida , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Feminino , Coto Gástrico/patologia , Humanos , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/psicologiaRESUMO
Laparoscopic sleeve gastrectomy (LSG) is an effective treatment modality for obesity. Commonest delayed complication post LSG is gastroesophageal reflux disease (GER). The prevalence of GER among obese patients is higher than normal individuals. Such patients need long term Proton pump inhibitors (PPI) or antireflux procedures to manage reflux. Antireflux mucosectomy (ARMS) uses techniques of endoscopic mucosal resection to treat reflux for PPI refractory GER. However, it can be technically challenging to perform ARMS with a restricted stomach in patients who have undergone LSG. A 40-year-old female, hypertensive who had previously undergone LSG was treated for GER by a multidimensional approach with ARMS utilizing hypotensive anesthesia. The patient underwent the procedure successfully without any complication. She was discharged and at follow up visit, her reflux symptoms had improved and endoscopy was unremarkable. We describe this unusual case which was treated effectively with ARMS.
Assuntos
Ressecção Endoscópica de Mucosa/métodos , Gastrectomia , Refluxo Gastroesofágico , Obesidade Mórbida/cirurgia , Síndromes Pós-Gastrectomia , Qualidade de Vida , Adulto , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/psicologia , Refluxo Gastroesofágico/cirurgia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Síndromes Pós-Gastrectomia/diagnóstico , Síndromes Pós-Gastrectomia/fisiopatologia , Síndromes Pós-Gastrectomia/psicologia , Síndromes Pós-Gastrectomia/cirurgia , Resultado do TratamentoRESUMO
AIM: To investigate the detrimental impact of loss of reservoir capacity by comparing total gastrectomy (TGRY) and distal gastrectomy with the same Roux-en-Y (DGRY) reconstruction. The study was conducted using an integrated questionnaire, the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, recently developed by the Japan Postgastrectomy Syndrome Working Party. METHODS: The PGSAS-45 comprises 8 items from the Short Form-8, 15 from the Gastrointestinal Symptom Rating Scale, and 22 newly selected items. Uni- and multivariate analysis was performed on 868 questionnaires completed by patients who underwent either TGRY (n = 393) or DGRY (n = 475) for stage I gastric cancer (52 institutions). Multivariate analysis weighed of six explanatory variables, including the type of gastrectomy (TGRY/DGRY), interval after surgery, age, gender, surgical approach (laparoscopic/open), and whether the celiac branch of the vagus nerve was preserved/divided on the quality of life (QOL). RESULTS: The patients who underwent TGRY experienced the poorer QOL compared to DGRY in the 15 of 19 main outcome measures of PGSAS-45. Moreover, multiple regression analysis indicated that the type of gastrectomy, TGRY, most strongly and broadly impaired the postoperative QOL among six explanatory variables. CONCLUSION: The results of the present study suggested that TGRY had a certain detrimental impact on the postoperative QOL, and the loss of reservoir capacity could be a major cause.
Assuntos
Gastrectomia/efeitos adversos , Síndromes Pós-Gastrectomia/psicologia , Qualidade de Vida , Neoplasias Gástricas/cirurgia , Fatores Etários , Idoso , Anastomose em-Y de Roux , Feminino , Gastrectomia/métodos , Humanos , Japão , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Síndromes Pós-Gastrectomia/etiologia , Período Pós-Operatório , Fatores Sexuais , Estômago/inervação , Estômago/cirurgia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Nervo Vago/cirurgiaAssuntos
Anastomose em-Y de Roux/psicologia , Gastrectomia/métodos , Gastrectomia/psicologia , Síndromes Pós-Gastrectomia/diagnóstico , Síndromes Pós-Gastrectomia/psicologia , Qualidade de Vida/psicologia , Neoplasias Gástricas/cirurgia , Atividades Cotidianas/psicologia , Anastomose em-Y de Roux/métodos , Peso Corporal , Avaliação da Deficiência , Síndrome de Esvaziamento Rápido/diagnóstico , Síndrome de Esvaziamento Rápido/psicologia , Humanos , Jejuno/transplante , Estadiamento de Neoplasias , Satisfação do Paciente , Neoplasias Gástricas/patologia , Neoplasias Gástricas/psicologia , Inquéritos e QuestionáriosAssuntos
Assistência ao Convalescente/métodos , Gastrectomia , Excisão de Linfonodo , Recidiva Local de Neoplasia/terapia , Equipe de Assistência ao Paciente , Síndromes Pós-Gastrectomia/terapia , Neoplasias Gástricas/cirurgia , Quimioterapia Adjuvante , Progressão da Doença , Humanos , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/psicologia , Estadiamento de Neoplasias , Cuidados Paliativos , Síndromes Pós-Gastrectomia/diagnóstico , Síndromes Pós-Gastrectomia/psicologia , Desnutrição Proteico-Calórica/terapia , Qualidade de Vida/psicologia , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologiaRESUMO
UNLABELLED: This prospective longitudinal study on gastric carcinoma patients with gastrectomy was designed to answer the question about changes in several determinants of the quality of life (QL) at various times before and after surgery and to obtain evidence for specific approaches of therapeutic intervention. METHODS AND PATIENTS: 36 patients were given a questionnaire structured according to Eypasch et al. (self- assessment) before surgery, at discharge from the hospital, and after 3 and 6 months. The dual structure of the questions makes it possible to determine whether a single item is present at all (prevalence) and to what extent it impairs the quality of life (no impairment/some/moderate/strong impairment--corresponding to 0-3). The data were evaluated per domain of QL as well as item-related. RESULTS: Postoperatively, 14 patients had to be excluded from the study because of non-radical surgery, complications, recurrences, etc. After 6 months the items of all QL-determinants showed the lowest prevalence with the exception, however, of the somatic determinants, the items of which showed a prevalence of 27 % preoperatively, 64 % at discharge from the hospital, 58 % after 3 months, and 46 % after 6 months. The average degree of QL-impairment increased continuously from 1.17 preoperatively to 1.61 after 6 months. Preoperatively the psychic domain was predominantly impaired, postoperatively the somatic domain. CONCLUSION: Analysis of the subjective quality of life can reveal care deficits. Gastrectomy-associated symptoms seem to influence the quality of life considerably in the first 6 months after surgery. More attention has to be paid to the sequelae of surgery. The high pre- and postoperative frequency of psychic impairment makes it desirable to provide special psychooncological offers of care.
Assuntos
Gastrectomia/psicologia , Equipe de Assistência ao Paciente , Síndromes Pós-Gastrectomia/psicologia , Qualidade de Vida/psicologia , Encaminhamento e Consulta , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Síndromes Pós-Gastrectomia/terapia , Estudos Prospectivos , Autoavaliação (Psicologia) , Papel do Doente , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/terapia , Neoplasias Gástricas/psicologia , Inquéritos e QuestionáriosAssuntos
Adaptação Psicológica , Gastrectomia/psicologia , Síndromes Pós-Gastrectomia/psicologia , Papel do Doente , Neoplasias Gástricas/cirurgia , Mecanismos de Defesa , Feminino , Seguimentos , Gastrectomia/reabilitação , Humanos , Masculino , Inventário de Personalidade , Síndromes Pós-Gastrectomia/reabilitação , Qualidade de Vida , Neoplasias Gástricas/psicologia , Neoplasias Gástricas/reabilitaçãoRESUMO
Rehabilitation needs and problems in 227 gastric cancer patients. In an investigation on needs of rehabilitation in gastric cancer we evaluated postgastrectomy problems in 227 gastrectomized patients. The average weight loss was 5% prior to operation and there was a further weight loss of 16% in the follow-up 18 months after the operation due to the postgastrectomy syndrome. The most frequent complaints of gastrectomized patients were inappetence (32%), reflux oesophagitis (25.1%), eructation (54.2%), diarrhea (22%), flatulence (36.5%), dumping syndrome (20.4%). 176 patients (78%) observed an indigestion of certain food since the operation. Postgastrectomy syndromes were more frequent in totally than in partially gastrectomized patients.
Assuntos
Gastrectomia/reabilitação , Neoplasias Gástricas/cirurgia , Feminino , Seguimentos , Gastrectomia/métodos , Gastrectomia/psicologia , Humanos , Masculino , Síndromes Pós-Gastrectomia/psicologia , Qualidade de Vida , Neoplasias Gástricas/reabilitação , Redução de PesoRESUMO
Psychic status was evaluated in 250 radically operated patients with gastric cancer at different stages of treatment (inpatient hospital-health resort-outpatient hospital) and adequate therapy was administered. Timely correction of depression proved a component of complex treatment of postresection disorders in gastric cancer patients.