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Optimal Roux-en-Y reconstruction after distal gastrectomy for early gastric cancer as assessed using the newly developed PGSAS-45 scale

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Abstract

Purpose

The optimal surgical procedure for distal gastrectomy with Roux-en-Y reconstruction (DGRY) remains to be determined. Recently, a self-report assessment instrument, the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), was compiled to evaluate symptoms, the living status and the quality of life of patients who have undergone gastrectomy. We used this scale to evaluate procedures used for DGRY.

Methods

The subjects included 475 patients who underwent DGRY for stage IA/IB gastric cancer. We evaluated whether the size of the remnant stomach, length of the Roux limb, reconstruction route and anastomotic procedure affected the patients’ symptoms, living status and quality of life assessed using the PGSAS-45.

Results

Patients with a residual stomach of more than half had significantly worse esophageal reflux scores than the patients with a smaller residual stomach (P = 0.0462); a residual stomach of one-third or one-fourth was favorable. A shorter length of the Roux limb was shown to be preferable to a longer Roux limb based on the results of the PGSAS-45. In addition, antecolic reconstruction and the anastomotic procedure using a linear stapler were found to be more favorable.

Conclusions

The size of the remnant stomach and the length and route of the Roux limb significantly influence the patient-reported DGRY outcomes.

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Acknowledgments

This study was supported by grants from Jikei University and the Japanese Society for Gastro-surgical Pathophysiology. We thank all patients who participated in this study, as well as the staff members at the participating hospitals for their cooperation.

Author information

Authors and Affiliations

  1. Department of Frontier Surgery, Center for Frontier Medical Engineering, Chiba University, Graduate School of Medicine, 1-33, Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan

    Hiroshi Kawahira

  2. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yasuhiro Kodera

  3. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Naoki Hiki

  4. Division of Gastroenterological Surgery, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan

    Masazumi Takahashi

  5. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan

    Seiji Itoh

  6. Department of Surgery, Jikei University School of Medicine, Tokyo, Japan

    Norio Mitsumori & Koji Nakada

  7. Division of Gastroenterological Surgery, Saitama Cancer Center, Ina, Japan

    Yoshiyuki Kawashima

  8. Department of Surgery, Kochi Medical School, Kochi, Japan

    Tsutomu Namikawa

  9. Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan

    Takao Inada

Authors
  1. Hiroshi Kawahira
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  2. Yasuhiro Kodera
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  3. Naoki Hiki
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  4. Masazumi Takahashi
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  5. Seiji Itoh
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  6. Norio Mitsumori
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  7. Yoshiyuki Kawashima
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  8. Tsutomu Namikawa
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  9. Takao Inada
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  10. Koji Nakada
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Corresponding author

Correspondence to Hiroshi Kawahira.

Additional information

For the Japan Postgastrectomy Syndrome Working Party.

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Cite this article

Kawahira, H., Kodera, Y., Hiki, N. et al. Optimal Roux-en-Y reconstruction after distal gastrectomy for early gastric cancer as assessed using the newly developed PGSAS-45 scale. Surg Today 45, 1307–1316 (2015). https://doi.org/10.1007/s00595-015-1111-9

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  • DOI: https://doi.org/10.1007/s00595-015-1111-9

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