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. 2018 Mar 15;1(6):165-174.
doi: 10.1002/bjs5.26. eCollection 2017 Dec.

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

K Fujitani  1 , M Ando  2 , K Sakamaki  3 , M Terashima  4 , R Kawabata  5 , Y Ito  6 , T Yoshikawa  7 , M Kondo  8 , Y Kodera  9 , K Yoshida  10
Affiliations

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

K Fujitani et al. BJS Open. .

Abstract

Background: Quality of life (QoL) is a key component in decision-making for surgical palliation, but QoL data in association with surgical palliation in advanced gastric cancer are scarce. The aim of this multicentre observational study was to examine the impact of surgical palliation on QoL in advanced gastric cancer.

Methods: The study included patients with gastric outlet obstruction caused by incurable advanced primary gastric cancer who had no oral intake or liquid intake only. Patients underwent palliative distal/total gastrectomy or bypass surgery at the physician's discretion. The primary endpoint was change in QoL assessed at baseline, 14 days, 1 month and 3 months following surgical palliation by means of the EuroQoL Five Dimensions (EQ-5D™) questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ-STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications.

Results: Some 104 patients (23 distal gastrectomy, 9 total gastrectomy, 70 gastrojejunostomy, 2 exploratory laparotomy) were enrolled from 35 institutions. The mean EQ-5D™ utility index scores remained consistent, with a baseline score of 0·74 and the change from baseline within ± 0·05. Gastric-specific symptoms showed statistically significant improvement from baseline. The majority of patients were able to eat solid food 2 weeks after surgery and tolerated it thereafter. The rate of overall morbidity of grade III or more according to the Clavien-Dindo classification was 9·6 per cent (10 patients) and the 30-day postoperative mortality rate was 1·9 per cent (2 patients).

Conclusion: In patients with gastric outlet obstruction caused by advanced gastric cancer, surgical palliation maintained QoL while improving solid food intake, with acceptable morbidity for at least the first 3 months after surgery. Registration number 000023494 (UMIN Clinical Trials Registry).

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Figures

Figure 1
Figure 1
Changes in EuroQoL Five Dimensions (EQ‐5D™) scores after surgery. The index score ranges from −0·111 to 1·000, with high scores representing good health status
Figure 2
Figure 2
Number of patients with improved or stable EuroQoL Five Dimensions (EQ‐5D™) scores after surgery, compared with number whose scores deteriorated, or who died or had no data available: a all 104 patients, b 32 patients who underwent gastrectomy and c 70 patients who underwent gastrojejunostomy. The EQ‐5D™ scores at each postoperative assessment were considered to have improved or deteriorated if the score changed by at least 0·05 points, and stable if it changed by less than 0·05 points
Figure 3
Figure 3
Changes in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ‐STO22) scores: a dysphagia, b eating restrictions, c reflux, d pain, e anxiety, f dry mouth and g taste. Scores range from 0 to 100, with low scores representing less symptom burden
Figure 4
Figure 4
Changes in oral intake after surgery based on the Gastric Outlet Obstruction Scoring System (0, no oral intake; 1, liquids only; 2, soft solids; 3, low‐residue or full diet): a all 104 patients, b 32 patients who underwent gastrectomy and c 70 patients who underwent gastrojejunostomy
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