Quality of life after gastrectomy by laparoscopic and open approach. Own experience and review of the literature

Introduction. Gastrectomy is a surgical method for the treatment of gastric cancer patients, which is associated with the deterioration of the patient’s quality of life (QoL). This article assesses factors that have an impact on QoL, investigates the role of reconstructive operations and surgical accesses in the treatment outcomes. The clinical cases and patients’ follow-ups are also presented in this article.

Objective. The aim of our work is the assessment of the EORTC QLQ-STO22 questionnaire efficiency and its correlation with the status of patients.

Methods. In the three years from 2016 to 2019, operations were performed in 60 patients (37 male and 23 female). All the patients underwent total gastrectomy with D2 lymphadenectomy, with the use of laparascopic or open surgery. In the basic group (27 patients, 17 male, 10 female), laparascopic operation was performed. In the control group (33 patients, 20 male, 13 female), open surgery was performed. Each group was further subdivided into subgroups, in which anastomosis was performed either manually or mechanically: 19 and 9 patients in the first group, 24 and 9 patients in the second group, correspondingly. The assessment of the patients’ quality of life was conducted before the surgical intervention, 1, 3, 6 months and 1 year post-surgery. The control of the patients’ status in the form of a questionnaire was done via telephone or e-mail contacts.

Results. The literature review has shown a high importance of a correctly chosen method for the reconstruction. The manual methods in both groups showed better results regarding QoL of patients. In 1 month after surgery, in the laparascopic group the results were as follows: 77.5±7.2 (manual) and 72.0±2.5 (mechanical). In the group of open surgery: 69.6±5.5 (manual) and 61.0±3.1 (mechanical). 3 months post-surgery, in the laparascopic group the results were the following: 79.2±1.6 (manual) and 73.1±3.5 (mechanical). In the group of open surgery: 70.5±5.5 (manual) and 60.2±3.2 (mechanical). In 6 months, in the laparascopic group the results were as follows: 71.1±4.2 (manual) and 68.6±2.6 (mechanical). In the group of open surgery: 68.2±4.2 (manual) and 61.0±2.1 (mechanical). 1 year after surgery, in the laparascopic group the results were the following: 60.1±7.2 (manual) and 64.7±5.2 (mechanical). In the group of open surgery: 67.1±3.3 (manual) and 62.7±1.0 (mechanical).

Discussion. Such factors as comorbidities, staging of tumor, type of surgical intervention, volume of lymphadenectomy, type of reconstruction, postoperative complications, adjuvant and neoadjuvant chemotherapy have an impact on QoL.

Conclusion. The EORTC QLQ-C30 questionnaires of the STO22 module give an opportunity for clinicians and researchers to assess the patient’s status and analyze QoL in patients after gastrectomy with different methods of reconstruction and surgical access. The advantage of a reservoir formation in the reconstructive operation has been proven. Laparoscopic interventions have a number of advantages but should not be applied in the elderly and weakened patients.