Table 2. Results of studies reviewed.
| Author, year | Objective |
Comparison group | Follow-up interval | Conclusions | |
|---|---|---|---|---|---|
| HRQOL system | Results | ||||
| Hoksch(20), 2002 | To evaluate the HRQOL during the first post-operative year comparing Longmire’s reconstruction without a pouch and Longmire’s reconstruction with two pouch sizes Disease specific measures: ORTC QLQ-C30 (post-operative vs. pre-operative without pouch): GHS (55.8±1.4 vs. 66.1±2.2), PF (88.0±2.6 vs. 88.1±2.8), RF (62.5±5.2 vs. 93.8±2.2), EF (65.8±4.1 vs. 75.5±3.1), CF (7.9±3.9 vs. 84.4±3.2), SF (63.3±3.6 vs. 93.8±1.7), F (47.7±3.7 vs. 18.7±2.7), N/V (16.7±4.4 vs. 13.5±1.5), P (25.0±4.7 vs. 22.9±3.9), Dy (26.7±6.3 vs. 24.9±5.5), I (26.7±3.8 vs. 31.2±5.6), AL (16.7±3.8 vs. 27.1±5.2), C (6.7±3.9 vs. 10.4±3.1), Di (37.3±7.2 vs. 4.2±2.6), FP (26.7±5.9 vs. 4.2±1.8) Generic instruments: – |
Post-operative vs.pre-operative; IPP vs. IPP 7 vs. IPP 15 | 2-weeks,3-, 6-,12- months | Both preservation of the duodenal passage and the added pouch reconstruction are essential for improving the HRQOL of a patient with a gastrectomy; no difference was found between the two pouch sizes | |
| Shiraishi (21), 2002 | To compare surgical results, hospital charges and HRQOL of three operative procedures: proximal gastrectomy reconstructed by gastric tube, proximal gastrectomy reconstructed by jejunum, and total gastrectomy Disease specific measures: QOL questionnaire (total gastrectomy vs. partial gastrectomy): meals per day (1.71±0.69 vs. 1.22±0.44), body weight (2.29±0.85 vs. 2.22±0.97), appetite (1.71±0.59 vs. 1.78±0.67), diarrhoea (1.71±0.47 vs. 1.56±0.73), vomiting (1.18±0.39 vs. 1.110.33), fatigue (1.82±0.39 vs. 1.67±0.71): for detailed results see original paper Generic instruments: – |
Total gastrectomy vs. proximal gastrectomy | Mean:49.8 months | Operating time, hospital stay and hospital charges for proximal gastrectomy were less than those for total gastrectomy; total HRQOL scores were not significantly different between the two procedures | |
| Spector (15), 2002 | To provide a preliminary description of the HRQOL and symptoms of patients who underwent gastroesophageal surgery for adenocarcinoma of the gastroesophageal junction Disease specific measures: GQLI (total gastrectomy vs. esophagogastrectomy): total (98.0±15.1 vs. 92.5±15.8), symptom (56.7±7.7 vs. 53.6±8.2), emotion (13.0±2.8 vs. 12.3±2.6), function (20.7±4.6 vs. 19.6±7.5), social (9.9±2.9 vs. 8.8±2.6), LAGS (total gastrectomy vs. esophagogastrectomy): total (61.1±5.8 vs. 54.8±9.6) Generic instruments: – |
Total gastrectomy vs. esophagogastrectomy | >3 months | Patients had a relatively high QOL, but experienced difficulties with eating patterns, physical functioning, socialisation and happiness; there were significant differences in HRQOL and symptom frequency between the two procedures, with patients who underwent total gastrectomy faring better | |
| Diaz de Liano(22), 2003 | To assess the HRQOL in patients in the medium to long term in patients who had curative resection for gastric cancer and had no signs of recurrent tumour Disease specific measures: EORTC QLQ-C30 (total gastrectomy vs. proximal gastrectomy): total (31 vs. 24), clinical (39 vs. 39), physical (33 vs. 32), emotional (31 vs. 23), social (29 vs. 25) Generic instruments: – |
Total gastrectomy vs. proximal gastrectomy, D1 lymphadenectomy vs. D2 lymphadenectomy | Mean:49 months | The HRQOL of patients undergoing curative surgery for gastric cancer, regardless of age, is not significantly influenced by the type of gastrectomy, or whether lymphadenectomy is performed | |
| Kono(23), 2003 | To investigate whether or not an improved HRQOL and good clinical course was observed with jejunal pouch reconstruction Disease specific measures: GSRS (no pouch vs. jejunal pouch): 3 months (4.9±1.1 vs. 3.1±0.3, P<0.05), 12 months (4.0±1.1 vs. 3.0±0.3), 48 months (1.0±1.2 vs. 3.5±0.9) Generic instruments: – |
No pouch vs. jejunal pouch | 3-, 12-, 48-months | Jejunal pouch reconstruction provided a better HRQOL than Roux-en-Y construction without pouch both at short-term and long-term periods in early gastric cancer | |
| Kahlke(24), 2004 | To determine the impact of the intensity of pre-operative symptoms on post-operative survival and QOL Disease specific measures: EORTC QLQ-C30 (post-operative vs. pre-operative): PF (72 vs. 82), RF (66 vs. 70), EF (62 vs. 55), CF (78 vs. 81), SF (70 vs. 48), F (50 vs. 40), N/V (21 vs. 16), P (29 vs. 34), Dy (22 vs. 20), I (31 vs. 28), AL (42 vs. 38), C (16 vs. 25), Di (29 vs. 21), FP (a28 vs. 15) Generic instruments: – |
Post-operative vs.pre-operative, major vs. minor symptoms | 3 months | The intensity of pre-operative symptoms influences post-operative survival, with a significantly lower survival rate for patients with major symptoms; HRQOL is partially influenced by pre-operative symptoms, with a trend to a better HRQOL in patients with major pre-operative symptoms | |
| Hjermstad (25), 2006 | To compare the HRQOL of patients treated at the Norwegian Radium Hospital with reference values from the general population Disease specific measures: STO-22 (total gastrectomy vs. partial gastrectomy vs. no gastric surgery): dysphagia (16 vs. 5 vs. 1), emotional (41 vs. 18 vs. 14), pain (26 vs. 14 vs. 12), dietary restrictions (36 vs. 7 vs. 5), upper GI symptoms (24 vs. 19 vs. 13), dry mouth (43 vs. 28 vs. 19), body image (32 vs. 2 vs. 0), hair loss (30 vs. 5 vs. 15), worries about hair (8 vs. 0 vs. 0) Generic instruments: – |
General population, total gastrectomy vs. partial gastrectomy vs. no gastric surgery | Mean:8.9 years | If surgery is necessary due to bleeding, perforation or localised relapse, stomach-preserving surgery will certainly reduce the treatment related symptoms and improve HRQOL for some of the patients | |
| Ikenaga (26), 2006 | To evaluate the long-term HRQOL of patients who underwent laparoscopically assisted distal gastrectomy (LADG) compared with that of patients who underwent conventional open gastrectomy Disease specific measures: 15 question HRQOL survey (open surgery vs. laparoscopic surgery): for results see original paper Generic instruments: – |
Open vs. laparoscopic gastrectomy | Mean:2.9 years | When compared with open gastrectomy, LADG did not unequivocally contribute to better long-term HRQOL; satisfaction with surgery was greater in patients who underwent LADG; a few complications were that impair the HRQOL were observed in the LADG group that were not seen in patients who underwent open surgery | |
| Samarasam (27), 2006 | To assess the feasibility and the survival advantage of resectional operation, in relation to the tumour load, the effectiveness of palliation of pre-operative symptoms following surgery for advanced gastric cancer, and the improvement in HRQOL following operation for gastric cancer Disease specific measures: QOL survey (resectional vs. non-resectional surgery): normal activities (83% vs. 29%), normal diet (83% vs. 24%), vomiting (6% vs. 52%), haematemesis (0% vs. 14%), melaena (6% vs. 52%) Generic instruments: – |
Resectional vs. non-resectional surgery | >6 months | In advanced gastric cancer, there is a significant survival advantage in patients who undergo gastrectomy; The HRQOL is undoubtedly better if a resectional operation is carried out |
|
| Huang(28), 2007 | To determine whether clinical stages, reconstructive surgical procedures, and preservation of the stomach would affect the HRQOL for disease-free patients who had survived surgical treatment Disease specific measures: EORTC QLQ-C30 (total gastrectomy vs. proximal gastrectomy): PF (83 vs. 87), RF (75 vs. 100), EF (71 vs. 83), CF (83 vs. 83), SF (83 vs. 83), F (39 vs. 33), N/V (17 vs. 0), P (17 vs. 17), Dy (0 vs. 0), I (33 vs. 0), AL (33 vs. 0), C (33 vs. 0), Di (33 vs. 33), FP (0 vs. 0), dysphagia (11 vs. 0), stomach pain (17 vs. 13), reflux (11 vs. 6), eating restriction (25 vs. 8), anxiety (33 vs. 22), dry mouth (33 vs. 0), body image (0 vs. 0), taste change (0 vs. 0), hair loss (0 vs. 0) Generic instruments: – |
Total gastrectomy vs. proximal gastrectomy | Mean:17 months | Patients with gastric adenocarcinoma who successfully survive treatment enjoy similar levels of global health, functional status, and symptom-free daily life, regardless of their original disease stage; proximal gastric preservation may have marginal advantages to improve patients’ HRQOL by improving role function and reducing nausea/vomiting and appetite loss post-operatively | |
| Kim(29), 2008 | To evaluate laparoscopy assisted distal gastrectomy compared with open distal gastrectomy with regard to the HRQOL during the early post-operative period, up to 0-days, and the surgical outcome including morbidity and mortality Disease specific measures: EORTC QLQ-C30 (open vs. laparoscopic gastrectomy): mean change GHS (−15.43 vs. −6.43), RF (−23.48 vs. −8.14), PF (−8.03 vs. −2.47), EF (5.31 vs. 12.2), F (14.58 vs. 6.26), AL (2.27 vs. −0.27), P (8.78 vs. 5.94), I (2.38 vs. −3.23) Generic instruments: – |
Open vs.Laparoscopic gastrectomy | 1-, 3-, 6-, 12-months | Minimal invasive treatment for early gastric cancer can be safely and effectively implemented with LADG, based on our analysis of the early post-operative period | |
| Tyrvainen (30), 2008 | To evaluate HRQOL in the long-term survivors after total gastrectomy for gastric carcinoma, in comparison with the age and sex adjusted normal population Disease specific measures: - Generic instruments: SF-36 (cases vs. controls): GH (56 vs. 53), PF (80 vs. 60), MH (77 vs. 75), SF (83 vs. 79), VT (67 vs. 60), BP (68 vs. 66), RP (70 vs. 57), RE (67 vs. 64), 15D (cases vs. controls): inadequate data |
Age and sex matched | 9 years | Patients who survived for long-term after total gastrectomy for gastric carcinoma have some problems with sleeping, eating, ability to defecate or urinate and with distress; mental health, physical and social functioning, energy and vitality do not differ from their normal population controls | |
| Wu(31), 2008 | To examine HRQOL of gastric cancer patients receiving D1 or D3 surgery Disease specific measures: Spitzer HRQOL Index (post-operative vs. pre-operative): activity (2.01 vs. 1.94), daily living (2.00 vs. 1.99), health (1.87 vs. 1.69), support (1.96 vs. 1.93), outlook (1.91 vs. 1.60) Generic instruments: – |
Post-operative vs.pre-operative, D3 vs. D1 surgery | 6 months, 1-, 2-, 3-, 4-, 5-yrs | D1 and D3 patients showed no significant difference in HRQOL; the results suggest that changes of HRQOL are largely due to scope of gastrectomy and disease status, rather than the extent of lymph node dissection | |
| Tokunaga (32), 2009 | To compared the esophagogastrostomy (EG) and jejunal interposition (JI) reconstruction methods after proximal gastrectomy using a questionnaire survey to identify which is superior regarding subjective symptoms Disease specific measures: QOL survey (EG vs. JI): nausea (3% vs. 9%, P=0/237), vomiting (3% vs. 11%, P=0.145), heartburn (8% vs. 9%, P=0.600), regurgitation (8% vs. 7%, P=0.578), abdominal fullness (3% vs. 22%, P=0.008), discomfort (11% vs. 22%, P=0.130), abdominal distension (11% vs. 16%, P=0.367), continuous fullness (3% vs. 18%, P=0.028), continuous nausea (3% vs. 9%, P=0.237), belching (5% vs. 11%, P=0.292), epigastric discomfort (11% vs. 24% P=0.086), hiccup (0% vs. 13%, P=0.022) Generic instruments: – |
Esophagogastrostomy vs. jejunal interposition | NR | EG is a better reconstruction method compared to a JI after a proximal gastrectomy when evaluating subjective symptoms | |
| Avery(33), 2010 | To examine HRQOL and survival in patients with potentially curable gastric cancer Disease specific measures: EORTC QLQ-C30 (post-operative vs. pre-operative): GHS (69 vs. 68), PF (80 vs. 85), RF (76 vs. 70), SF (71 vs. 72), EF (73 vs. 71), CF (82 vs. 85), N/V (54 vs. 36), P (69 vs. 39), F (81 vs. 68), AL (38 vs. 50), Di (54 vs. 14), I (54 vs. 39); EORTC QLQ-STO22 (post-operative vs. pre-operative): dysphagia (36 vs. 44), eating restrictions (76 vs. 59), reflux (68 vs. 67), dry mouth (60 vs. 56) Generic instruments: – |
Post-operative vs.pre-operative | 6 weeks, 3-, 6-, 9-, 12-, 18-, 24-months | Gastrectomy for cancer has a temporary negative impact on most aspects of HRQOL that typically recovers within the first post-operative year in patients surviving at least2 years | |
| Kobayashi (34), 2011 | To evaluate the HRQOL after gastrectomy using EORTC instruments and to compare various aspects of HRQOL among surgical procedures Disease specific measures: EORTC QLQ-C30 (post-operative vs. pre-operative): inadequate data; EORTC QLQ-STO22 (post-operative vs. pre-operative): inadequate data Generic instruments: – |
Post-operative vs. pre-operative; total gastrectomy vs. distal gastrectomy vs. laparoscopy-assisted distal gastrectomy | 1-, 3-, 6-, 12-months | EORTC QLQ-C30 and STO22 detected differences in several aspects of HRQOL among patients treated by the three surgical procedures; the laparoscopic approach resulted in superior short-term outcomes, whereas TG continued to affect the HRQOL in several items12 months after surgery | |
| Jakstaite (35), 2012 | To evaluate the HRQOL in relation to age, sex, clinical stage, post-operative complication, and adjuvant chemotherapy in patients who underwent curative total gastrectomy with D2 lymphadenectomy and Omega type esophagojejunostomy for gastric adenocarcinoma Disease specific measures: EORTC QLQ-C30 (stages 1-2 vs. stage 3): GHS (63.7 vs. 46.6), PF (70.6 vs. 55.7), RF (73.5 vs. 52.9), EF (68.1 vs. 60.3), CF (81.4 vs. 68.6), SF (75.5 vs. 61.8) Generic instruments: – |
Male vs. female, stages 1-2 vs. stage 3 | 6-18 months | The global HRQOL and the social functioning was better in patients after 65 years and over, compared to patients under the age of 65 after total gastrectomy | |
| Kim(36), 2012 | To examine changes of HRQOL in Korean patients with gastric cancer after curative resection Disease specific measures: EORTC QLQ-C30 (post-operative vs. pre-operative): GHS (70.5±18.5 vs. 61.6±21.9, P<0.01), PF (86.8±11.8 vs. 86.5±13.3, P=0.92), RF (85.3±18.2 vs. 88.7±17.5, P=0.01), EF (84.7±16.2 vs. 74.5±20.7, P<0.01), CF (83.7±16.5 vs. 86.8±15.7, P=0.03), SF (87.8±18.8 vs. 79.0±25.0, P<0.01); EORTC QLQ-STO22 (post-operative vs. pre-operative): dysphagia (10.2±11.7 vs. 6.4±10.5, P<0.01), chest and abdominal pain (15.0±14.8 vs. 15.7±14.9, P=0.46), reflux (8.7±12.4 vs. 10.7±14.0, P=0.03), eating restriction (14.6±20.4 vs. 8.5±12.9, P<0.01), anxiety (30.9±23.0 vs. 32.7±22.1, P=0.14): see original article for full results Generic instruments: – |
Post-operative vs.pre-operative | 3-, 12-months | Global HRQOL and emotional functioning improved over time in both groups; patients in the subtotal gastrectomy group were more likely to report better HRQOL than those in the total gastrectomy group, although both showed similar changes in QOL | |
| Kunisaki (37), 2012 | To compare early and long-term surgical outcomes via a statistically generated case-control study between laparoscopy assisted gastrectomy (LAG) and open gastrectomy (OG) for curatively resected gastric cancer, therefore confirming the feasibility of LAG for gastric cancer Disease specific measures: QOL survey (open vs. laparoscopic gastrectomy): body weight ratio (0.83±0.24 vs. 0.88±0.24, P=0.55), volume of food (0.74±0.18 vs. 0.79±0.20, P=0.59), heart burn (26% vs. 17%, P=0.10), abdominal discomfort (25% vs. 19%, P=0.25), diarrhoea (16% vs. 10%, P=0.22), early-dumping syndrome (8% vs. 5%, P=0.39), late-dumping syndrome (7% vs. 5%, P=0.55), wound pain (11% vs. 3%, P=0.03); performance status (open vs. laparoscopic gastrectomy): 1 (87% vs. 90%), 2 (11% vs. 9%), 3 (2% vs. 1%) Generic instruments: – |
Open vs. laparoscopic gastrectomy | Mean:36.1±22.9 months | Laparoscopy assisted gastrectomy for gastric cancer may be both feasible and safe, offering advantages over open gastrectomy according to the surgical learning curve | |
| Lee(38), 2012 | To compare the HRQOL of a laparoscopy assisted distal gastrectomy group (LADG) and an open distal subtotal gastrectomy (ODSG) group after the early post-operative period and before reaching 5 years post-operatively, when patients are considered to be disease-free Disease specific measures: EORTC QLQ-C30 (ODSG vs. LADG): GHS (57.4±18.2 vs. 56.0±19.0, P=0.73), PF (88.9±15.1 vs. 81.3±19.5, P=0.054), RF (93.0±14.9 vs. 82.9±22.7, P=0.026), EF (90.6±17.4 vs. 81.7±23.4, P=0.065), CF (89.6±15.2 vs. 81.0±20.7, P=0.034), SF (89.3±19.8 vs. 81.0±21.8, P=0.079); EORTC QLQ-STO22 (ODG vs. LDAG): dysphagia (7.9±9.9 vs. 12.4±14.7, P=0.127), pain (15.2±15.0 vs. 15.2±12.7, P=0.987), reflux (12.1±19.4 vs. 11.7±14.2, P=0.925), eating restrictions (6.4±10.1 vs. 13.6±12.8, P=0.009), anxiety (13.1±17.0 vs. 22.2±20.7, P=0.033): see original article for full results Generic instruments: – |
ODSG vs. LADG | 6 months to 5 years | Patients who have undergone LADG may experience unexpected reversal of HRQOL by experiencing lower HRQOL compared to those who have undergone ODSG until long-term survival is achieved | |
| Namikawa (39), 2012 | To evaluate short- and long-term post-operative outcomes of jejunal pouch interposition after proximal gastrectomy compared with conventional RY construction after total gastrectomy for cancer Disease specific measures: EORTC QLQ-C30 (no pouch vs. jejunal pouch): GHS (63.5±28.8 vs. 56.7±19.9, P=0.968), PF (70.0±27.8 vs. 87.3±9.1, P=0.161), RF (76.2±31.7 vs. 95.0±11.2, P=0.118), EF (89.6±7.9 vs. 79.2±9.0, P=0.112), CF (58.2±25.2 vs. 66.7±22.2, P=0.214), SF (86.6±29.9 vs. 86.7±13.1, P=0.877); EORTC QLQ-STO22 (no pouch vs. jejunal pouch): eating solid food (1.6±0.9 vs. 1.4±0.8, P=0.271), eating soft food (1.1±0.4 vs. 1.1±0.3, P=0.356), drinking liquids (1.4±0.7 vs. 1.5±0.5, P=0.964), discomfort when eating (1.5±0.9 vs. 1.7±0.5, P=0.820), pain in stomach area (1.6±0.9 vs. 1.6±0.7, P=0.517), discomfort in stomach area (1.8±0.9 vs. 1.8±0.6, P=0.627), abdominal bloating (1.8±1.0 vs. 1.5±0.7, P=0.265), reflux (1.8±1.0 vs. 1.7±0.8, P=0.708), acid indigestion (1.7±1.1 vs. 1.9±0.7, P=0.921): see original article for full results Generic instruments: – |
No pouch vs. jejunal pouch | 1-, 5-years | Compared to RY reconstruction, JPI reconstruction after proximal gastrectomy achieves better food intake and improves the patient’s HRQOL in the early period after gastrectomy | |
HRQOL, health related quality of life; NA, not applicable; NR, not recorded; P, prospective; PR, participation rate; HRQOL, quality of life; R, retrospective; RR, response rate; DOI, depth of invasion; GC, gastric cancer; GQLI, gastroenterology quality of life index; GSRS, gastrointestinal symptom rating scale; LAGS, life after gastric surgery; SF-36, medical outcomes survey short form 36 questions; BP, bodily pain; GH, general health; MCS, mental component summary score; MH, mental health; PCS, physical component summary score; PF, physical functioning; RE, role emotional; RP, role physical; SF, social functioning; VT, vitality; ECOG, eastern cooperative oncology group performance status rating; EORTC QLQ-C30, European organisation for research and treatment of cancer quality of life questionnaire-cancer specific; AL, appetite loss; C, constipation; CF, cognitive function; Di, diarrhoea; Dy, dyspnoea; EF, emotional function; F, fatigue; FP, financial problems; GHS, global health status; I, insomnia; N/V, nausea/vomiting; P, pain; PF, physical function; RF, role function: SF, social function; EORTCQLQ-STO22, European organisation for research and treatment of cancer quality of life questionnaire-colon specific.