Quality of life: A critical outcome for all surgical treatments of gastric cancer

Abstract

Surgery represents the main curative therapeutic modality for gastric cancer, and it is occasionally considered for palliation as well as prophylaxis. Most frequently, surgical outcomes are conveyed in terms of oncological outcomes such as recurrence and survival. However, quality of life (QoL) is also important and should be considered when making treatment decisions - including the extent of and approach to surgery. Measurement of QoL usually involves the application of questionnaires. While there are multiple QoL questionnaires validated for use in oncology patients, there are very few that have been validated for use in those with gastric cancer. In this review, we discuss and compare the current status of QoL questionnaires in gastric cancer. More importantly, the impact of surgery for treatment, palliation and prophylaxis of gastric cancer on QoL will be described. These data should inform the surgeon on the optimal approach to treating gastric cancer, taking into account oncological outcomes. Knowledge gaps are also identified, providing a roadmap for future studies.

Keywords: Gastric cancer; Oncology; Palliation; Quality of life; Surgery.

Figure 1

A model to conceptualize the effects of gastric procedures on quality of life. For any given situation, surgery will have a quality of life (QoL) “cost” which is proportional to the magnitude of the reduction in QoL and the duration of this impaired QoL. Ideally, QoL should be restored to preoperative levels in individuals undergoing prophylactic gastrectomy (line A). In patients undergoing curative procedures, QoL should be return to baseline within a short period (line B). In patients undergoing a palliative procedure, QoL should be improved soon after surgery, with little QoL “cost” (line C).

Figure 2

Resection and reconstruction options for distal (A) and proximal gastric cancers (B).