Quality of life after esophagogastrostomy plus gastrojejunostomy reconstruction following proximal gastrectomy: a comparative study of three surgical procedures

Objective: We have previously reported a novel reconstruction method, esophagogastrostomy plus gastrojejunostomy (EGJ), after curative proximal gastrectomy for proximal gastric cancer (PGC). The aim of this study was to evaluate the quality of life (QOL) after EGJ reconstruction in patients with PGC by comparing with other two surgical procedures during a one-year postoperative period. Methods: We investigated a total of 43 PGC patients who underwent radical gastrectomy and had no evidence of recurrence or metastasis 1 year after surgery. Of these patients, 17 were treated with proximal gastrectomy followed by esophagogastrostomy (EG) reconstruction, 12 with total gastrectomy and Roux-en Y (RY) reconstruction and 14 with proximal gastrectomy followed by EGJ reconstruction procedure. The Chinese versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Cancer (QLQ-C30) and the site-specific module for gastric cancer (QLQ STO22) were used to assess changes of QOL based on three different reconstruction methods. Questionnaires were completed at the baseline (before surgery) and 1, 6 and 12 months postoperatively. Results: The mean scores for most of the functional and symptom scales deteriorated significantly at 1 month after surgery and gradually improved afterwards. Global health status, appetite loss and reflux symptoms showed significant differences among three groups at the same follow-up interval. EGJ patients suffered from the least reflux symptoms, which apparently influenced global health status of the EG group. Meanwhile, Up to 75% of RY patients at 1 month and 41.7% at 6 months post-operativelycomplained of serious appetite loss symptom and resulted in poor QOL when compared with the other two groups. Conclusions: Our study showed that EGJ patients had better QOL during a 1-year period after surgery by not only resolving the syndrome of reflux esophagitis but also preserving the distal stomach as well as duodenal passage.