Differences in patient-reported symptoms following radical gastrectomy: a propensity score-matched cohort study

Surgery is not only the mainstay of treatment for gastric cancer but also the key to improving postoperative quality of life for patients. Patient-reported symptoms following radical gastrectomy tend to be diverse and descriptive. This study aims to describe patient self-reported outcomes and compare the differences between total gastrectomy (TG), distal gastrectomy (DG), and proximal gastrectomy (PG).

This was a retrospective comparative cohort study that included 578 patients. All these patients were diagnosed with gastric cancer and underwent gastrectomy. The included patients were divided into the TG group, DG group, and PG group. All these data were collected and registered prospectively during the patient's postoperative follow-up process. The analyzed data in this study included food intake, weight loss, sleep disorders, and the most common digestive symptoms, at the postoperative first week (1W), the first postoperative month (1M), the third postoperative month (3M), and the sixth postoperative month after discharge (6M). These data were retrospectively compared in these three groups. Propensity score matching (PSM) was used to decrease selection bias. A 0.02 caliper width was used.

After PSM, TG, DG, and PG were compared with each other. Compared with DG and TG, food intake recovered more quickly in PG at 1W (P < 0.05). Food intake in most patients recovered to the normal diet at 3M. 46% of patients (263/578) experienced sleep disorders at 1W. No matter if it is TG, DG, or PG, easy to wake was the main complaint of patients with the insomnia symptom. Compared with TG and PG, weight loss was lowest in DG (P < 0.05). Incidence of digestive symptoms was lowest in DG (P < 0.05). In three groups (TG, DG, and PG), abdominal distention was the most reported discomfort. Compared with DG, the incidence of eating obstruction sensation was higher in TG (P = 0.04) and in PG (P = 0.01).

Compared with DG and PG, weight loss was maximum, and the incidence of digestive symptoms was highest in TG. The study found that sleep disorders and abdominal distension were the most common complaints after gastrectomy. Some drugs should be given to relieve these symptoms, and further research is needed to improve the quality of life for these patients.