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Annals of Surgical Oncology

, Volume 22, Issue 3, pp 772–779 | Cite as

Functional Outcomes and Quality of Life After Proximal Gastrectomy with Esophagogastrostomy Using a Narrow Gastric Conduit

  • Ulrich Ronellenfitsch
  • Sara Najmeh
  • Amin Andalib
  • Rushika M. Perera
  • Mathieu C. Rousseau
  • David S. Mulder
  • Lorenzo E. Ferri
Gastrointestinal Oncology

Abstract

Background

The best surgical approach for tumors of the proximal stomach remains controversial. For proximal gastrectomy (PG), the evidence regarding quality of life (QoL) and functional outcomes is controversial. Moreover, there are limited data from non-Asian settings.

Methods

All patients who underwent PG from September 2005 to July 2013 were identified from an institutional database. Demographic, perioperative and pathologic characteristics were retrieved. Symptom scores (0 = best/4 = worst) for reflux symptoms, dysphagia and validated QoL metrics (FACT scale, where a higher score is better) were assessed during early and late follow-up. Eligible patients for analysis were those with no evidence of recurrence.

Results

Of 465 upper gastrointestinal cancer resections, 50 were PG for adenocarcinoma (42; 84 %), neuroendocrine carcinoma (5; 10 %) or other pathologies (3; 6 %). R0 resection was achieved in 44 (89.8 %) of 49 patients with malignant tumors. Median lymph node collection was 32 (range 7–57). QoL scores did not differ from preoperative to early follow-up but increased compared to both at late follow-up [preoperative, 125 (interquartile range 105–140); early follow-up, 122.5 (97–142); late follow-up, 147 (132–159); p < 0.05]. At early and late follow-up, 9 (21.4 %) of 42 and 10 (33.3 %) of 30 patients reported reflux symptoms, but most were mild. Endoscopic signs of esophagitis were found in 7 (29 %) of 24 patients, but only two of these reported reflux symptoms. Conversely only three of eight patients with reflux symptoms had esophagitis on endoscopy.

Conclusions

Global QoL is not reduced early after PG, and increases compared to baseline at late follow-up. Although reflux symptoms are reported by a quarter of patients, most are mild, and there is little correlation with esophagitis. PG should remain a viable option in the management of proximal gastric tumors.

Keywords

Esophagitis Total Gastrectomy Reflux Symptom Proximal Stomach Proximal Gastrectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

UR was supported by a fellowship within the Postdoc-Program of the German Academic Exchange Service (DAAD).

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Ulrich Ronellenfitsch
    • 1
    • 2
  • Sara Najmeh
    • 2
  • Amin Andalib
    • 2
  • Rushika M. Perera
    • 2
  • Mathieu C. Rousseau
    • 2
  • David S. Mulder
    • 2
  • Lorenzo E. Ferri
    • 2
  1. 1.Department of Surgery, Medical Faculty Mannheim of the University of HeidelbergUniversity Medical Centre MannheimMannheimGermany
  2. 2.Division of Thoracic Surgery, McGill University Health CentreMontreal General HospitalMontrealCanada

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