Assessment of Quality of Life and Function after Proximal Gastrectomy
According to Reconstructive Procedures

Eiji Nomura, Masami Niki, Keizou Fujii, Kanji Nishiguchi, Hideaki Mabuchi, Masaaki Okuzawa, Masayuki Ohta and Nobuhiko Tanigawa

Department od General and Gastroenterological Surgery, Osaka Medical College

To investigate the usefulness of reconstructive procedures after proximal gastrectomy, we examined the extent of gastrectomy and the models of jejunal interposition. Assessment of the quality of life and a functional evaluation was examined in patients who had undergone 4 kinds of reconstructive procedures after proximal gastrectomies including total gastrectomy. At 1 year after the operation, the postoperative physical condition of the patients was evaluated by comparisons among 2/3 proximal gastrectomies reconstructed by the jejunal interposition group (2/3-PG group, n=5), 4/5 proximal gastrectomies reconstructed by the jejunal interposition group (4/5-PG group, n=7), 4/5 proximal gastrectomies reconstructed by the jejunal pouch interposition group (Pouch group, n=7), and total gastrectomies reconstructed by the jejunal interposition group (TG group, n=12). In the 2/3-PG and Pouch groups, the postoperative/preoperative ratios of meal intake were higher, and the changes in acetaminophen concentration, blood sugar and insulin levels were lower than those in the other groups. In particular, the postoperative/preoperative ratios of body weight were the highest in the 2/3 PG group than in the other grouos. In the Pouch group, the remnant stomach was observed by endoscopy in all cases, while 2 cases in the Pouch group showed finding of esophagitis. Postoperative QOL in the 4/5 PG and TG groups was inferior to that in the other two groups, and the results of functional evaluation in the 4/5 PG group resembled those in the TG group. In proximal gastrectomy, the extent of the distal stomach should be preserved, and when the remnant stomach is small, the reserve function should be increased with a jejunal pouch.

Key words
gastric cancer, proximal gastrectomy, jejunal interposition, quality of life

Reprint requests
Eiji Nomura Department of General and Gastroenterological Surgery, Osaka Medical College2-7 Daigaku-machi, Takatsuki city, 569-8686 JAPAN

Accepted
October 26, 1999

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