Quality-of-life after curative surgery for gastric cancer: a comparison between total gastrectomy and subtotal gastric resection

Quality-of-Life has become an increasingly important factor for long term survivors after surgery for gastric cancer. Quality-of Life also includes social and psychological aspects. Many gastric carcinomas are located in the distal two thirds of the stomach. In these cases, a subtotal gastric resection may be adequate if a proximal safety margin of 5 cm in intestinal type tumors according to Laurén and 10 cm in diffuse type cancers respectively can be achieved. On the other hand total gastrectomy "de principe" has been advocated for all gastric malignancies because of high local recurrence rates after subtotal resection. The aim of the present study was to assess the Quality-of-Life in long term survivors after resection for gastric cancer comparing subtotal gastric resection with total gastrectomy.

One hundred ninety-five patients were examined with the Gastrointestinal Quality-of-Life-Index (GLQI). Hard clinical data such as postoperative weight loss, frequency of daily meals and bowel emptying were evaluated. One hundred five patients were submitted for total gastrectomy and in 90 patients a subtotal gastric resection was performed. None of the patients had clinical, radiological or endoscopic evidence of recurrence.

After subtotal gastric resection, patients achieved statistically significant better scores concerning disease/therapy-related symptoms, physical functions resulting in a better overall score (p < 0.02). Following subtotal resection, patients had a significantly lower weight loss compared to patients after total gastrectomy (p < 0.02), a smaller number of daily meals (p < 0.001) and a lower frequency of bowel emptying/day (p = 0.031). There was no statistically significant difference in emotional status or social activities showing a similar acceptance of disease and therapy in both groups.

In those cases where an adequate proximal safety margin can be achieved by a subtotal gastric resection, this procedure is preferable to a total gastrectomy. However preservation of the gastric stump should never be allowed to compromise oncological radicality.