Quality of life of gastric cancer patients after radical surgery depending on the status of the duodenal passage

Purpose of the study. To assess the impact of preservation of the duodenal passage on the quality of life (QOL) after total gastrectomy (TGE) in patients with gastric cancer (GC).

Patients and methods. The study included 55 patients with GC who underwent TGE: group I (n = 29) included patients with preservation of the duodenal passage (PDP) using the double tract reconstruction method; Group II (n = 26) included those with standard Roux-en-Y reconstruction. QOL was assessed using the EORTC QLQ-C30 questionnaire with the QLQ-STO22 module for GC patients.

Results. Changes in QOL in patients 3 months after TGE were expressed in a statistically significant decrease in scores of all functional scales (QL, PF, RF, EF, CF and SF), and an increase in the scores ​​of symptom scales (FA, NV, PA, DY, SL, AL, CO, DI, FI), to the same extent for both groups. After 6 months, an increase in the scores ​​of functional scales was noted; statistically significant differences between the groups were identified on the QL, RF, CF and SF scales in favor of the group with PDP. In the group with PDP, a more significant decrease in the level of most symptomatic scales was also noted. After 12 months, a statistically significant advantage remained on functional and symptomatic scales for patients in the group with PDP. Assessment of QOL using the scales of the QLQ-STO22 module showed similar trends: after a sharp increase in symptom values ​​at 3 months after surgery, equally pronounced in both groups, there was a decrease at 6 months, more pronounced in the group with PDP. At 12 months postoperatively, the overall trend towards an advantage in the PDP group continued.

Conclusion. The dynamics of QOL recovery in patients with GC after surgical treatment depends on the status of the duodenal passage: in the group of patients with PDP, faster positive dynamics are observed on all scales of functioning and symptoms than in patients without duodenal passage. Preservation of duodenal passage during surgical treatment of GC has a positive effect on the dynamics of recovery of the QOL of patients with GC, providing a positive contribution to improving the results of antitumor treatment.

1. Franciosi V, Maglietta G, Degli Esposti C, et al. Early palliative care and quality of life of advanced cancer patients-a multicenter randomized clinical trial. Ann Palliat Med. 2019;8(4):381-389. https://doi.org/10.21037/apm.2019.02.07

2. Hu Y, Zaydfudim VM. Quality of Life After Curative Resection for Gastric Cancer: Survey Metrics and Implications of Surgical Technique. J Surg Res. 2020 Jul;251:168-179. https://doi.org/ 10.1016/j.jss.2020.02.005

3. Jung JH, Lee SS, Chung HY. Quality of life changes in elderly patients after gastrectomy: perspective of an aged Asian society in the 2010s. Ann Surg Treat Res. 2022 Apr;102(4):214-222. https://doi.org/10.4174/astr.2022.102.4.214.

4. Park KB, Park JY, Lee SS, Chung HY, Kwon OK. Chronological changes in quality of life and body composition after gastrectomy for locally advanced gastric cancer. Ann Surg Treat Res. 2020 May;98(5):262-269. https://doi.org/10.4174/astr.2020.98.5.262.

5. Tabernero J, Alsina M, Shitara K, et al. Health-related quality of life associated with trifluridine/tipiracil in heavily pretreated metastatic gastric cancer: results from TAGS. Gastric cancer Off J Int Gastric Cancer Assoc Japanese Gastric Cancer Assoc. 2020;23(4):689-698. https://doi.org/10.1007/s10120-020-01053-9

6. Conroy T, Marchal F, Blazeby JM. Quality of life in patients with oesophageal and gastric cancer: an overview. Oncology 2006; 70: 391-402 [PMID: 17259744 DOI: 10.1159/000099034]

7. Haraldstad K, Wahl A, Andenæs R, et al. A systematic review of quality of life research in medicine and health sciences. Qual Life Res. 2019;28(10):2641-2650. doi:10.1007/s11136-019-02214-9

8. Raina SK. State of The Globe: Health-Related Quality of Life as Health Status Measure: Time to Move On. J Glob Infect Dis. 2019;11(3):89-90. doi:10.4103/jgid.jgid_163_18.

9. Alkhaffaf B, Blazeby JM, Bruce IA, Morris RL. Patient priorities in relation to surgery for gastric cancer: qualitative interviews with gastric cancer surgery patients to inform the development of a core outcome set. BMJ Open. 2020;10(2):e034782. doi:10.1136/bmjopen-2019-034782

10. Hiramatsu Y, Kikuchi H, Takeuchi H. Function-Preserving Gastrectomy for Early Gastric Cancer. Cancers (Basel). 2021;13(24). doi:10.3390/cancers13246223

11. Mao X, Xu X, Zhu H, Ji C, Lu X, Wang B. A comparison between pylorus-preserving and distal gastrectomy in surgical safety and functional benefit with gastric cancer: a systematic review and meta-analysis. World J Surg Oncol. 2020;18(1):160. doi:10.1186/s12957-020-01910-y

12. Nunobe S, Hiki N. Function-preserving surgery for gastric cancer: current status and future perspectives. Transl Gastroenterol Hepatol. 2017;2:77. doi:10.21037/tgh.2017.09.07

13. Tsujiura M, Nunobe S. Functional and nutritional outcomes after gastric cancer surgery. Transl Gastroenterol Hepatol. 2020 Apr 5;5:29. doi: 10.21037/tgh.2019.11.10. PMID: 32258533; PMCID: PMC7063493.

14. van Amelsfoort RM, Walraven I, Kieffer J, et al. Quality of Life Is Associated With Survival in Patients With Gastric Cancer: Results From the Randomized CRITICS Trial. J Natl Compr Canc Netw. 2022;20(3):261-267. doi:10.6004/jnccn.2021.7057

15. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee MC, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw KCA, Sullivan M, Takeda F. The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute 1993; 85: 365-376.

16. Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A, on behalf of the EORTC Quality of Life Group. The EORTC QLQ-C30 Scoring Manual (3rd Edition). Published by: European Organisation for Research and Treatment of Cancer, Brussels 2001.

17. Blazeby JM, Conroy T, Bottomley A, Vickery C, Arraras J, Sezer O, Moore J, Koller M, Turhal NS, Stuart R, Van Cutsem E, D'haese S, Coens C; European Organisation for Research and Treatment of Cancer Gastrointestinal and Quality of Life Groups. Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-STO 22, to assess quality of life in patients with gastric cancer. Eur J Cancer. 2004 Oct;40(15):2260-8. https://doi.org/10.1016/j.ejca.2004.05.023. PMID: 15454251.