Skip Navigation
Skip to contents

Cancer Res Treat : Cancer Research and Treatment

OPEN ACCESS

Articles

Page Path
HOME > Cancer Res Treat > Volume 50(3); 2018 > Article
Original Article Impact of Body Mass Index on the Quality of Life after Total Gastrectomy for Gastric Cancer
Ki Bum Park, MD1, Ji Yeon Park, MD1, Seung Soo Lee, MD2, Oh Kyoung Kwon, MD1, Ho Young Chung, MD2, Wansik Yu, MD1,
Cancer Research and Treatment : Official Journal of Korean Cancer Association 2018;50(3):852-860.
DOI: https://doi.org/10.4143/crt.2017.080
Published online: September 13, 2017

1Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea

2Department of Surgery, Kyungpook National University Hospital, Daegu, Korea

Correspondence: Wansik Yu, MD Gastric Cancer Center, Kyungpook National University Medical Center, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea
Tel: 82-53-200-2700 Fax: 82-53-200-2027 E-mail: wyu@knu.ac.kr
• Received: February 16, 2017   • Accepted: September 4, 2017

Copyright © 2018 by the Korean Cancer Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 9,797 Views
  • 322 Download
  • 20 Web of Science
  • 18 Crossref
  • 22 Scopus
prev next
  • Purpose
    We evaluated the impact of postoperative body mass index (BMI) shifts on the quality of life (QoL) following total gastrectomy in patients with gastric cancer.
  • Materials and Methods
    QoL data collected from the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and QLQ-STO22 questionnaires were obtained from 417 patients preoperatively and 1 year after surgery. Patients were divided into two groups based on changes in BMI: group 1 comprised patientswhose BMIrange category dropped, and group 2 included patients who maintained or rose to a higher category compared to their preoperative BMI category.
  • Results
    There were 276 patients in group 1 and 141 in group 2. QoLs with respect to the global health status and functional scales were not significantly different between the groups 1 year after surgery. However, there were significantly greater decreases in QoL in group 1 due to gastrointestinal symptoms, such as nausea and vomiting (p=0.008), appetite loss (p=0.001), and constipation (p=0.038). Of the QLQ-STO22 parameters, dysphagia (p=0.013), pain (p=0.012), reflux symptoms (p=0.017), eating restrictions (p=0.007), taste (p=0.009), and body image (p=0.009) were associated with significantly worse QoL in group 1 than in group 2 1 year after surgery.
  • Conclusion
    Patients have significantly different QoLs depending on the BMI shift after total gastrectomy. Efforts to reduce the gap in QoL should include intensive nutritional support and restoration of dietary behaviors. Appropriate clinical and institutional approaches, plus active medical interventions, are required for maintaining patients’ BMIs after surgery.
Surgical resection of the primary tumor, as well as regional lymph node dissection, constitute the only curative treatment for gastric cancer [1]. Although surgical treatment is the only method to gain disease-free status in patients with gastric cancer, most patients who undergo gastrectomy may experience a deteriorated quality of life (QoL), which is affected by a variety of functional and nutritional problems [2]. Patients who undergo total gastrectomy in particular tend to have greater deterioration of QoL, including poor social functioning, nausea/vomiting, dysphagia, dietary restrictions, reflux, and taste compared to patients who undergo distal gastrectomy [3,4]. The QoL after gastrectomy tends to be lowest during the first year after surgery [5-7]. Additionally, weight loss is unavoidable in patients who undergo gastrectomy; it usually lasts for the duration of the first year after surgery, and most patients do not regain their preoperative body weights [8-10]. Various symptomatic nutritional or functional maladies after gastrectomy might lead to weight loss, and postoperative QoL changes in patients with gastric cancer might be closely connected to such weight loss. Thus, it is crucial to investigate any correlations between QoL and weight changes in patients who underwent total gastrectomy.
Among the diverse tools to assess QoL in patients with gastric cancer, the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30, along with the gastric cancer-specific module (QLQ-STO22), have been used most extensively [11,12]. The entire questionnaire has been translated into Korean and validated [13].
There have been several investigations of QoL changes after gastrectomy in patients with gastric cancer using the EORTC QLQ-C30 and QLQ-STO22. However, most such studies compared QoL changes according to the different types of surgical procedures or the progression of QoL changes throughout the postsurgical survival period [2,6,7]. However, little is known about QoL changes according to body mass index (BMI) shifts during the postoperative period. Therefore, we investigated QoL changes during the first year after surgery in relation to BMI shifts, with the goal of providing better personalized medical care by revealing additional factors that could improve the QoL of patients who underwent a total gastrectomy.
1. Patients
Patients with gastric cancer who underwent curative total gastrectomy between January 2011 and December 2014 at the Kyungpook National University Hospital (KNUH) and the Kyungpook National University Medical Center (KNUMC) were enrolled. We excluded patients who experienced a recurrence within 1 year after surgery as well as those who died of other causes. Ultimately, 417 patients who completed the entire series of QoL assessments during the first year were analyzed.
The BMI was calculated as body weight/height2 (kg/m2), and BMI values were classified as underweight (< 18.50 kg/m2), normal (18.50-22.99 kg/m2), overweight (23.00-24.99 kg/m2), and obese (≥ 25.00 kg/m2) [14]. Fig. 1 shows the baseline BMIs of patients preoperatively and 1 year after surgery. Patients were divided into two groups based on their BMI shifts: group 1 (n=276) included patients whose BMIs were in lower categories compared to their preoperative classifications; group 2 (n=141) comprised patients who had maintained their BMI categories (n=137) or had shifted to a higher range compared to their preoperative BMIs (n=4). We also performed subgroup analysis. Subgroup analysis was classified as follows. Subgroup 1 (n=69) included patients with BMI change from normal to underweight. Subgroup 2 (n=163) included patients with BMI change from obese to normal BMI. Subgroup 3 (n=137) included patients who had maintained their BMI.
2. Surgery
Curative total gastrectomy, D2 lymph node dissection including total omentectomy, and Roux-en-Y esophagojejunostomy were performed in all patients. Reconstruction procedures were performed extracorporeally using circular staplers [15,16]. After surgery, patients were managed according to a clinical protocol that included the intake of drinking water on the third postoperative day, followed by the initiation of a liquid diet on the fourth postoperative day and consumption of a soft diet on the fifth postoperative day. Patients were scheduled to be discharged on the sixth postoperative day.
3. QoL assessments
The Korean versions of the EORTC QLQ-C30 and EORTC QLQ-STO22 were used to assess the QoL. Patients were asked to complete the QLQ-C30 and QLQ-STO22 questionnaires preoperatively and at 1 year after surgery. The QoL assessment was based on the responses to all items in questionnaires as completed by the responders themselves when visiting the outpatient department. If questionnaires were returned with any responses missing, patients were instructed to complete such items. The raw values were linearly transformed into assessment scores ranging from 0 to 100 according to the manual provided by the EORTC. For global health status/QoL and multi-item function scales, a higher score is interpreted as a high QoL and high/healthy level of functioning; however, on symptom scales and single parameters, higher scores reflect additional symptoms/problems. On the EORTC QLQ-STO22, a higher score is interpreted as a low QoL.
4. Statistical analysis
Differences in baseline characteristics between two groups were analyzed with Student’s t test for continuous variables and the chi-square test for categorical variables.
Linear mixed models were used to assess how the surgery affected the changes in QoL between groups and over time. A p-value of < 0.05 was regarded as statistically significant. All statistical analysis was conducted using SPSS software ver. 22 (IBM Corp., Armonk, NY).
5. Ethical statement
The study was approved by the Institutional Review Board of KNUH and KNUMC (approval numbers: 2016-08-025 and 2016-08-019, respectively) and performed in accordance with the principles of the Declaration of Helsinki. The informed consent was waived.
1. Patients characteristics
Table 1 shows the clinicopathological characteristics of the patients. There were no statistical differences in age, sex, comorbidity, previous surgical history, type of surgery, length of hospital stay, number of harvested lymph nodes, and pathological stage between groups 1 and 2.
2. Changes of QoL according to BMI shift
Mean QoL scores preoperatively and 1 year after surgery in the two groups are shown in Table 2. The global health status/QoL was improved after surgery in both groups. Functional scales―except for the emotional scale―showed worse outcomes after surgery in both groups; the mean scores of group 1 were lower than those of group 2 at 1 year after surgery. Moreover, all symptom scales/category scores of group 1 patients were higher compared to their preoperative scores. Group 2 patients showed similar outcomes to group1; however, the mean scores for nausea and vomiting, insomnia, appetite loss, and constipation decreased after surgery. With respect to the EORTC-STO22, the mean scores of all scales and items increased after surgery, but the degree of increase was greater in group 1 than in group 2.
We also plotted the mean QoL score changes between the groups over time. Fig. 2 shows the changes in global health status and functional scales between the two groups; global health status and emotional functioning increased in both groups with no significant difference. Scales other than emotional functioning were lower in both groups after surgery, without significant differences. Fig. 3 shows the changes of symptom scales and categories between the two groups. The QoL due to gastrointestinal symptoms, such as nausea and vomiting (p=0.008), appetite loss (p=0.001), and constipation (p=0.038), decreased significantly more in group 1 than in group 2. Fig. 4 shows the changes in QLQ-STO22 categories in both groups. Of these categories, dysphagia (p=0.013), pain (p=0.012), reflux symptoms (p=0.017), dietary restrictions (p=0.007), taste (p=0.009), and body image (p=0.009) were associated with significantly worse QoLs in group 1 than in group 2.
Comparing between subgroup 1 and subgroup 2, age was significantly older in subgroup 1 than subgroup 2 (62.1±10.7 and 58.3±11.5, respectively) and hospital stay was significantly shorter in subgroup 1 than subgroup 2 (10.6±3.3 and 12.8±10.5, respectively). In the aspect of QoL, the global health status/QoL (p=0.011), physical functioning (p=0.011), and role functioning (p=0.026) were significantly decreased in subgroup 1 than in subgroup 2. Also, when comparing between subgroup 2 and subgroup 3, characteristic of patients were significantly different in depth of invasion (p=0.001), stage (p=0.048), and chemotherapy (p=0.004) between two groups. In the aspect of QoL, nausea and vomiting (p=0.010), appetite loss (p=0.001), constipation (p=0.031), pain (p=0.016), eating restrictions (p=0.026), taste (p=0.015), and body image (p=0.034) showed significantly better QoL in subgroup 3 than in subgroup 2.
The postoperative QoL in patients who undergo a gastrectomy is dependent on various factors, such as the type of reconstruction, extent of gastric resection, and surgical approach [4,17-20]. In terms of the extent of gastric resection, it is expected that patients who undergo total gastrectomy experience significantly worse QoLs than patients who undergo distal gastrectomy during the postoperative period [3,4]. Furthermore, patients who undergo total gastrectomy more often experience impaired nutritional intake due to the absence of the stomach, which limits the amount of food that can be consumed in a single session and results in significant body weight loss [21]. However, the degree of body weight change after total gastrectomy may vary due to patients’ individual factors such as preoperative individual characteristics, pathological characteristics, and the postoperative course. Additionally, the preoperative BMI status may influence nutritional outcomes.
Consistent with previous studies [4,22], our results showed that the overall global health status improved after surgery, and that the functional scale (except emotional function) decreased after surgery regardless of shifts in BMI. As has previously been shown [23], emotional functioning might be related to depression caused by the initial diagnosis of cancer, and patients experience a feeling of relief from depression attributed to their disease over time. Our study showed improvements in emotional functioning after surgery in both groups. Functional scales might be more affected by the psychic domain than the somatic domain compared to symptom scales or QLQ-STO22. Our results showed no significant differences in functional scales regardless of BMI shifts after total gastrectomy.
With respect to symptom scales/categories and the QLQ-STO22, previous studies showed that patients who underwent total gastrectomy experienced nausea and vomiting, dysphagia, reflux symptoms, eating restrictions, dry mouth, and taste to a greater extent than those who underwent distal gastrectomy [3,4]. A poorer QoL after total gastrectomy might be affected by the surgical procedure itself, but the degree to which the QoL worsens might be different depending on BMI shifts. Deteriorating QoL scales/categories were related to gastrointestinal symptoms and eating problems, such as nausea and vomiting, appetite loss, constipation, dysphagia, reflux symptoms, dietary restrictions, and taste. These symptoms are related to various conditions, such as preoperative patient characteristics, surgical methods, pathological characteristics, and the postoperative course. As our study design was to adjust for various conditions and other potential confounding factors, the differences in QoL between the two groups may be related to symptoms of body weight loss. Hence, patients who shifted to lower BMI categories after total gastrectomy ought to receive medical intervention to improve their gastrointestinal symptoms and eating problems. Moreover, it is important to reassure patients who fear eating because of dysphagia or who restrict their diets, and to assist them in changing their eating habits post-surgery to including smaller amounts of food while increasing the frequency of their meals.
Our data showed that body image was significantly poorer in patients whose BMIs fell after total gastrectomy. The EORTC QLQ-STO22 questionnaire included the query “Have you felt physically less attractive as a result of your disease or treatment?” Patients might regard weight loss as negatively contributing to their body image; this is true even if patients are in the normal BMI range after surgery. We posit that this might be related to concern about weight loss, which is one of the symptoms of malnourishment. Thus, patients who have a worse body image because of weight loss should be accurately assessed in order to clarify their BMI range. Additionally, it is critical that surgeons provide precise body composition data to patients, and identify those patients who have shifted to the underweight BMI category while reporting on their poorer body image score after surgery. Nutritional education and medical support are required for these patients. Moreover, reassuring patients regarding their body image is more important in those who shift to a normal or above normal BMI category after surgery.
Most patients who undergo total gastrectomy experience a BMI shift after surgery. The degrees of such shifts vary among patients with different characteristics. Our data regarding QoL differences according to BMI shifts after surgery might be clinically significant, as most patients who underwent total gastrectomy were in the underweight or normal BMI ranges. Approximately 20% of the patients were in the underweight BMI category after total gastrectomy; these patients ought to receive active medical intervention to overcome nutritional deficits and deteriorated QoL. The majority of patients were in the normal BMI range after total gastrectomy, including those who shifted to this group and those who maintained their BMI categories. However, even patients with normal BMI ranges after surgery may have different QoL statuses. Therefore, patients whose BMIs shifted to a normal range after surgery should receive reassurance concerning their QoL instead of symptom control and nutritional education; the latter is more important in patients who are underweight after surgery.
The subgroup analysis also supports the results of our study. When comparing subgroup 1 between subgroup 2, global health status/QoL and functional scales showed significantly better QoL in subgroup 2 than in subgroup 1. However, there were no significant differences between two groups in symptoms scale and STO 22. These results might be affected by the significant low age in subgroup 2 than in subgroup 1. In subgroup 2 and subgroup 3 analysis, subgroup 3 showed significant better QoL of similar items in our initial results than in subgroup 2. From the 2 subgroup analyses, it could be concluded that maintaining the BMI after surgery showed better QoL than decreased BMI after surgery. Some of the obese patients might experience relief of symptoms related to overweight because of loss of weight. Also, in a healthy population, they can experience a better QoL by reducing their weight. However, in cancer patients, patients with decreased weight after surgery might believe that patients’ preoperative weight is considered to be a healthy weight, and it seems to have worse QoL than whose weight is maintained. Differences in the QoL due to weight changes may require a different approach to healthy population and cancer patients, as well as, maintaining BMI after surgery is crucial to patients who underwent gastrectomy for gastric cancer.
Notably, we did not observe a causal relationship between body weight loss and QoL changes post-surgery. Although our study design was to observe QoL change according to BMI shifting after surgery, poorer QoL might have an inverse correlation with body weight. In the first postsurgical year, significant changes in body weight and QoL might influence each other; therefore, it is difficult to determine a clear correlation or causal relationship between them. Since BMI is an objective index of body weight, we classified the patients by BMI shifts after surgery rather than by body weight loss. Further study is required to clarify the interrelationship between nutritional parameters (including body weight and BMI) and QoL after surgery.
As the distributions of BMI in Asian populations are distinctly left-shifted compared to those in Western populations, the results of our study should be validated in Western countries. However, we focused on the BMI shifts, not actual distributions, to study correlations with QoL changes.
In this study, there was significant difference in the percentage of patients who received adjuvant chemotherapy between the two groups. Adjuvant chemotherapy might affect to QoL. However, as postoperative 1 year is considered to be the time since the end of the adjuvant chemotherapy, the impact of adjuvant chemotherapy on QoL might be not significant. Also, there are few studies on the effect of adjuvant chemotherapy on QoL in patients with gastric cancer. Further study is needed to explore the impact of the adjuvant chemotherapy after gastrectomy on QoL.
In conclusion, patients have significantly different QoLs depending on their BMI shifts after total gastrectomy. Efforts to reduce such declinations in QoL should include intensive nutritional support and the restoration of dietary behaviors. Appropriate clinical and institutional approaches, as well as active medical interventions, are required for maintaining BMI after surgery. Moreover, patients should be well informed that their QoL may change after surgery, and surgeons should make an effort to reassure patients postoperatively.

Conflict of interest relevant to this article was not reported.

Fig. 1.
Body mass index shift after total gastrectomy.
crt-2017-080f1.gif
Fig. 2.
Changes in the quality of life (QoL) according to body mass index shifts 1 year after total gastrectomy, as assessed by the global health status/QoL and functional scales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. GH, global health status; PF2, physical functioning; RF2, role functioning; EF, emotional functioning; CF, cognitive functioning; SF, social functioning.
crt-2017-080f2.gif
Fig. 3.
Changes in the quality of life according to body mass index shifts 1 year after total gastrectomy, as assessed by symptom scales/items of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. FA, fatigue; NV, nausea and vomiting; PA, pain; DY, dyspnea; SL, insomnia; AP, appetite loss; CO, constipation; DI, diarrhea; FI, financial difficulties. *p < 0.05.
crt-2017-080f3.gif
Fig. 4.
Changes in the quality of life according to body mass index shifts 1 year after total gastrectomy, as assessed by symptom scales/items of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire STO22. XDG, dysphagia; Xpain, pain; XRflx, reflux symptoms; XEatR, eating restrictions; Anx, anxiety; DM, having a dry mouth; T, taste; BI, body image; HL, hair loss. *p < 0.05.
crt-2017-080f4.gif
Table 1.
Characteristics of patients
Characteristic Group 1 (n=276) Group 2 (n=141) p-value
Age (yr) 59.2±11.1 58.7±11.9 0.664
Sex
 Female 81 (29.3) 41 (29.1) 0.954
 Male 195 (70.7) 100 (70.9)
Comorbidity
 Cardiovascular 37 (13.4) 16 (11.3) 0.108
 Cerebrovascular 4 (1.4) 1 (0.7)
 Diabetes 14 (5.1) 3 (2.1)
 Hepatic 4 (1.4) 2 (1.4)
 Renal 1 (0.4) 0
 Pulmonary 0 3 (2.1)
 Thyroid 3 (1.1) 2 (1.4)
 Combined disease 14 (5.1) 2 (1.4)
Previous operation history
 Gastrectomy 3 (1.1) 7 (5.0) 0.060
 Lower anterior resection 2 (0.7) 0
 Hysterectomy 1 (0.4) 0
Type of surgery
 OTG 253 (91.7) 128 (90.8) 0.668
 LATG 22 (8.0) 11 (7.8)
 OTG with Whipple’s operation 1 (0.4) 2 (1.4)
Hospital stay (day) 12.4±9.9 11.3±4.8 0.107
Depth of invasion
 T1a 72 (26.1) 22 (15.6) 0.001
 T1b 92 (33.3) 40 (28.4)
 T2 25 (9.1) 19 (13.5)
 T3 52 (18.8) 22 (15.6)
 T4a 35 (12.7) 38 (27.0)
Lymph node metastasis
 N0 205 (74.3) 90 (63.8) 0.040
 N1 19 (6.9) 19 (13.5)
 N2 27 (9.8) 12 (8.5)
 N3 25 (9.1) 20 (14.2)
Stage
 IA 156 (56.5) 59 (41.8) 0.085
 IB 26 (9.4) 16 (11.3)
 IIA 28 (10.1) 15 (10.6)
 IIB 15 (5.4) 14 (9.9)
 IIIA 15 (5.4) 8 (5.7)
 IIIB 21 (7.6) 14 (9.9)
 IIIC 15 (5.4) 15 (10.6)
Harvested lymph nodes 44.6±17.3 46.6±20.1 0.280
Chemotherapy
 Yes 61 (22.1) 51 (36.2) 0.002
 No 215 (77.9) 90 (63.8)

Values are presented as number (%) or mean±standard deviation. Stage grouping by 7th edition of the American Joint Committee on Cancer classification. OTG, open total gastrectomy; LATG, laparoscopic assisted total gastrectomy.

Table 2.
Comparison of QoL changes according to BMI shifting
Variable Group 1 (n=276)
Group 2 (n=141)
Preoperative Postoperative p-value Preoperative Postoperative p-value
EORTC QLQ-C30
 Global health status/QoLa) 61.7 64.4 0.744 61.0 66.5 0.416
 Functional scalesa)
  Physical functioning 86.3 79.8 0.495 87.3 81.1 0.436
  Role functioning 90.8 79.6 0.389 89.2 81.4 0.381
  Emotional functioning 79.6 80.9 0.199 82.3 82.7 0.328
  Cognitive functioning 89.2 82.4 0.631 88.4 84.2 0.296
  Social functioning 83.8 82.6 0.415 83.6 81.6 0.645
 Symptom scales/itemsb)
  Fatigue 21.6 32.2 0.802 22.1 30.5 0.393
  Nausea and vomiting 9.0 16.2 0.071 12.4 11.8 0.035
  Pain 11.8 15.5 0.967 11.7 12.2 0.058
  Dyspnea 12.2 15.0 0.602 11.1 13.0 0.372
  Insomnia 15.7 17.5 0.607 17.0 15.1 0.332
  Appetite loss 14.4 20.2 0.025 20.0 13.0 0.003
  Constipation 12.4 15.5 0.112 16.1 13.2 0.307
  Diarrhea 13.4 26.9 0.588 12.3 22.5 0.080
  Financial difficulties 18.7 21.1 0.271 15.8 19.4 0.521
EORTC QLQ-STO22b)
 Dysphagia scale 6.6 16.9 0.140 8.5 14.6 0.118
 Pain scale 15.2 22.2 0.125 18.0 18.5 0.120
 Reflux symptoms scale 11.1 17.9 0.078 13.9 15.4 0.190
 Eating restrictions scale 8.7 22.9 0.008 13.0 21.1 0.362
 Anxiety scale 26.1 36.3 0.773 26.8 32.4 0.092
 Having a dry mouth 18.4 25.8 0.623 19.6 23.2 0.320
 Taste 6.4 15.1 0.165 9.0 10.9 0.051
 Body image 19.3 37.4 0.225 22.9 32.9 0.113
 Hair loss 18.9 29.5 0.552 21.5 27.1 0.558

Values are presented as mean score. Group 1: Patients whose BMIs were in lower categories compared to their preoperative classifications. Group 2: Patients who had maintained their BMI categories or had shifted to a higher range compared to their preoperative BMIs. QoL, quality of life; BMI, body mass index; EORTC QLQ, European Organization for Research and Treatment Quality of Life Questionnaire.

a) A higher score represents a better QoL,

b) A higher score represents a worse QoL.

  • 1. Wu CW, Lo SS, Shen KH, Hsieh MC, Lui WY, P'eng FK. Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg. 2000;24:465–72. ArticlePubMed
  • 2. Kim AR, Cho J, Hsu YJ, Choi MG, Noh JH, Sohn TS, et al. Changes of quality of life in gastric cancer patients after curative resection: a longitudinal cohort study in Korea. Ann Surg. 2012;256:1008–13. ArticlePubMed
  • 3. Lee SS, Chung HY, Kwon OK, Yu W. Long-term quality of life after distal subtotal and total gastrectomy: symptom- and behavior-oriented consequences. Ann Surg. 2016;263:738–44. ArticlePubMed
  • 4. Park S, Chung HY, Lee SS, Kwon O, Yu W. Serial comparisons of quality of life after distal subtotal or total gastrectomy: what are the rational approaches for quality of life management? J Gastric Cancer. 2014;14:32–8. ArticlePubMedPMC
  • 5. Kong H, Kwon OK, Yu W. Changes of quality of life after gastric cancer surgery. J Gastric Cancer. 2012;12:194–200. ArticlePubMedPMC
  • 6. Karanicolas PJ, Graham D, Gonen M, Strong VE, Brennan MF, Coit DG. Quality of life after gastrectomy for adenocarcinoma: a prospective cohort study. Ann Surg. 2013;257:1039–46. ArticlePubMedPMC
  • 7. Yu W, Park KB, Chung HY, Kwon OK, Lee SS. Chronological changes of quality of life in long-term survivors after gastrectomy for gastric cancer. Cancer Res Treat. 2016;48:1030–6. ArticlePubMedPMCPDF
  • 8. Curran FT, Hill GL. Failure of nutritional recovery after total gastrectomy. Br J Surg. 1990;77:1015–7. ArticlePubMed
  • 9. Braga M, Molinari M, Zuliani W, Foppa L, Gianotti L, Radaelli G, et al. Surgical treatment of gastric adenocarcinoma: impact on survival and quality of life: a prospective ten year study. Hepatogastroenterology. 1996;43:187–93. PubMed
  • 10. Liedman B, Andersson H, Berglund B, Bosaeus I, Hugosson I, Olbe L, et al. Food intake after gastrectomy for gastric carcinoma: the role of a gastric reservoir. Br J Surg. 1996;83:1138–43. ArticlePubMed
  • 11. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76. ArticlePubMedPDF
  • 12. Vickery CW, Blazeby JM, Conroy T, Arraras J, Sezer O, Koller M, et al. Development of an EORTC disease-specific quality of life module for use in patients with gastric cancer. Eur J Cancer. 2001;37:966–71. ArticlePubMed
  • 13. Yun YH, Park YS, Lee ES, Bang SM, Heo DS, Park SY, et al. Validation of the Korean version of the EORTC QLQ-C30. Qual Life Res. 2004;13:863–8. ArticlePubMed
  • 14. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63. ArticlePubMed
  • 15. Lee MS, Lee JH, Park DJ, Lee HJ, Kim HH, Yang HK. Comparison of short- and long-term outcomes of laparoscopic-assisted total gastrectomy and open total gastrectomy in gastric cancer patients. Surg Endosc. 2013;27:2598–605. ArticlePubMed
  • 16. Wada N, Kurokawa Y, Takiguchi S, Takahashi T, Yamasaki M, Miyata H, et al. Feasibility of laparoscopy-assisted total gastrectomy in patients with clinical stage I gastric cancer. Gastric Cancer. 2014;17:137–40. ArticlePubMed
  • 17. Bae JM, Kim S, Kim YW, Ryu KW, Lee JH, Noh JH, et al. Health-related quality of life among disease-free stomach cancer survivors in Korea. Qual Life Res. 2006;15:1587–96. ArticlePubMed
  • 18. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7. ArticlePubMed
  • 19. Namikawa T, Oki T, Kitagawa H, Okabayashi T, Kobayashi M, Hanazaki K. Impact of jejunal pouch interposition reconstruction after proximal gastrectomy for early gastric cancer on quality of life: short- and long-term consequences. Am J Surg. 2012;204:203–9. ArticlePubMed
  • 20. Misawa K, Fujiwara M, Ando M, Ito S, Mochizuki Y, Ito Y, et al. Long-term quality of life after laparoscopic distal gastrectomy for early gastric cancer: results of a prospective multiinstitutional comparative trial. Gastric Cancer. 2015;18:417–25. ArticlePubMed
  • 21. Kiyama T, Mizutani T, Okuda T, Fujita I, Tokunaga A, Tajiri T, et al. Postoperative changes in body composition after gastrectomy. J Gastrointest Surg. 2005;9:313–9. ArticlePubMed
  • 22. Kobayashi D, Kodera Y, Fujiwara M, Koike M, Nakayama G, Nakao A. Assessment of quality of life after gastrectomy using EORTC QLQ-C30 and STO22. World J Surg. 2011;35:357–64. ArticlePubMed
  • 23. Park JY, Eom BW, Jo MJ, Yoon HM, Ryu KW, Kim YW, et al. Health-related quality of life after robot-assisted distal gastrectomy in early gastric cancer. World J Surg. 2014;38:1112–20. ArticlePubMed

Figure & Data

REFERENCES

    Citations

    Citations to this article as recorded by  
    • Nutritional Experiences of Patients Undergoing Total Gastrectomy Surgery
      Derya Şayır, Kevser Karacabay
      Gastroenterology Nursing.2024; 47(3): 203.     CrossRef
    • Exploring the Association between Health-Related Physical Fitness and Quality of Life in Patients with Cancer: A Cross-Sectional Study
      Anita Borsati, Diana Giannarelli, Lorenzo Belluomini, Christian Ciurnelli, Alessio Colonna, Irene D’Amico, Arianna Daniele, Nicole Del Bianco, Linda Toniolo, Ilaria Trestini, Daniela Tregnago, Jessica Insolda, Marco Sposito, Massimo Lanza, Michele Milella
      Healthcare.2024; 12(16): 1643.     CrossRef
    • Research Progress on the Relationship between Nutritional Support and Postoperative Quality of Life in Patients with Gastric Cancer
      思孟 张
      Advances in Clinical Medicine.2024; 14(09): 765.     CrossRef
    • U-shaped association between body mass index and health-related quality of life impairment in Korean cancer survivors: a nationwide representative cross-sectional survey
      Jong Eun Park, Kyoung Eun Yeob, So Young Kim, Chul-Woung Kim, Hye Sook Han, Jong Hyock Park
      Journal of Cancer Survivorship.2023; 17(5): 1522.     CrossRef
    • The Predictive Value of a New Inflammatory-Nutritional Score for Quality of Life after Laparoscopic Distal Gastrectomy for Gastric Cancer
      Simeng Zhang, Ruiqing Liu, Maoshen Zhang, JiLin Hu, Shuai Xiang, Zinian Jiang, Dongsheng Wang
      Nutrition and Cancer.2023; 75(4): 1165.     CrossRef
    • Quality of Life in Patients Undergoing Surgery for Upper GI Malignancies
      Grigorios Christodoulidis, Marina-Nektaria Kouliou, Konstantinos-Eleftherios Koumarelas, Dimitris Giakoustidis, Thanos Athanasiou
      Life.2023; 13(9): 1910.     CrossRef
    • The effect of body mass index on quality of life in modified single stoma cutaneous ureterostomy or ileal conduit after radical cystectomy
      Wan‐Jin Zhang, Xu‐Yun Huang, Bin Lin, Wen‐Cai Zheng, Zhi‐Bin Ke, Xiao‐Dan Lin, Jia‐Yin Chen, Hai Cai, Yun‐Zhi Lin, Ye‐Hui Chen, Qing‐Shui Zheng, Yong Wei, Xue‐Yi Xue, Xiao‐Dong Li, Ning Xu
      Cancer Medicine.2023; 12(22): 20930.     CrossRef
    • Long-term health-related quality of life in patients with gastric cancer after total or distal gastrectomy: A propensity score-matched cohort study
      Jianhong Yu, Zaozao Wang, Hong Yang, Chenghai Zhang, Jiadi Xing, Ming Cui, Hui Liu, Yu Wu, Xiangqian Su
      International Journal of Surgery.2023;[Epub]     CrossRef
    • Factors connected with anxiety and other neuropsychiatric symptoms in advanced gastric cancer
      Pawel Bryniarski, Magdalena Bryniarska, Maciej Jezioro, Daniel Andrysiak, Iwona Filipczak-Bryniarska
      Acta Neuropsychiatrica.2022; 34(1): 10.     CrossRef
    • Relationship Between Symptom Distress and Fatigue Characteristics in Patients with Gastric Cancer During 1 Month after Gastrectomy
      Hui-Ying Yang, Yun-Hsiang Lee, Jin-Ming Wu, I-Rue Lai, Shiow-Ching Shun
      Clinical Nursing Research.2022; 31(3): 463.     CrossRef
    • Risk of fracture following gastric surgery for benign and malignant conditions: A study level pooled analysis of population-based cohort studies
      Qiuping Zou, Chao Wei, Zhuo Shao, Hao Wang, Zhihong Xiao, Lixing Cao, Zubing Mei, Wei Zhao, Zhi Jiang, Zhiqiang Chen
      Frontiers in Oncology.2022;[Epub]     CrossRef
    • Health-related quality of life after gastric cancer treatment in Brazil: Narrative review and reflections
      Rodrigo Nascimento Pinheiro, Samantha Mucci, Renato Morato Zanatto, Olavo Magalhães Picanço Junior, Alexandre Ferreira Oliveira, Gaspar de Jesus Lopes Filho
      World Journal of Clinical Cases.2021; 9(17): 4123.     CrossRef
    • Influencing Factors and Effects of Treatment on Quality of Life in Patients With Gastric Cancer—A Systematic Review
      Sophia Kristina Rupp, Andreas Stengel
      Frontiers in Psychiatry.2021;[Epub]     CrossRef
    • Nutritional status, sarcopenia, gastrointestinal symptoms and quality of life after gastrectomy for cancer – A cross-sectional pilot study
      Sedegheh Gharagozlian, Tom Mala, Hilde Kristin Brekke, Lisa C. Kolbjørnsen, Åslaug A. Ullerud, Egil Johnson
      Clinical Nutrition ESPEN.2020; 37: 195.     CrossRef
    • Advantages of Distal Subtotal Gastrectomy over Total Gastrectomy in the Quality of Life of Long-Term Gastric Cancer Survivors
      Oh Kyoung Kwon, Byunghyuk Yu, Ki Bum Park, Ji Yeon Park, Seung Soo Lee, Ho Young Chung
      Journal of Gastric Cancer.2020; 20(2): 176.     CrossRef
    • Chronological changes in quality of life and body composition after gastrectomy for locally advanced gastric cancer
      Ki Bum Park, Ji Yeon Park, Seung Soo Lee, Ho Young Chung, Oh Kyoung Kwon
      Annals of Surgical Treatment and Research.2020; 98(5): 262.     CrossRef
    • Health-related quality of life in curatively-treated patients with esophageal or gastric cancer: A systematic review and meta-analysis
      Héctor G. van den Boorn, Charlotte I. Stroes, Aeilko H. Zwinderman, Wietse J. Eshuis, Maarten C.C.M. Hulshof, Faridi S. van Etten-Jamaludin, Mirjam A.G. Sprangers, Hanneke W.M. van Laarhoven
      Critical Reviews in Oncology/Hematology.2020; 154: 103069.     CrossRef
    • Impact of body mass index on quality of life after distal gastrectomy for gastric cancer
      Ki Bum Park, Byunghyuk Yu, Ji Yeon Park, Oh Kyoung Kwon, Wansik Yu
      Annals of Surgical Treatment and Research.2019; 96(5): 250.     CrossRef

    • PubReader PubReader
    • ePub LinkePub Link
    • Cite
      CITE
      export Copy Download
      Close
      Download Citation
      Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

      Format:
      • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
      • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
      Include:
      • Citation for the content below
      Impact of Body Mass Index on the Quality of Life after Total Gastrectomy for Gastric Cancer
      Cancer Res Treat. 2018;50(3):852-860.   Published online September 13, 2017
      Close
    • XML DownloadXML Download
    Impact of Body Mass Index on the Quality of Life after Total Gastrectomy for Gastric Cancer
    Image Image Image Image
    Fig. 1. Body mass index shift after total gastrectomy.
    Fig. 2. Changes in the quality of life (QoL) according to body mass index shifts 1 year after total gastrectomy, as assessed by the global health status/QoL and functional scales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. GH, global health status; PF2, physical functioning; RF2, role functioning; EF, emotional functioning; CF, cognitive functioning; SF, social functioning.
    Fig. 3. Changes in the quality of life according to body mass index shifts 1 year after total gastrectomy, as assessed by symptom scales/items of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. FA, fatigue; NV, nausea and vomiting; PA, pain; DY, dyspnea; SL, insomnia; AP, appetite loss; CO, constipation; DI, diarrhea; FI, financial difficulties. *p < 0.05.
    Fig. 4. Changes in the quality of life according to body mass index shifts 1 year after total gastrectomy, as assessed by symptom scales/items of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire STO22. XDG, dysphagia; Xpain, pain; XRflx, reflux symptoms; XEatR, eating restrictions; Anx, anxiety; DM, having a dry mouth; T, taste; BI, body image; HL, hair loss. *p < 0.05.
    Impact of Body Mass Index on the Quality of Life after Total Gastrectomy for Gastric Cancer
    Characteristic Group 1 (n=276) Group 2 (n=141) p-value
    Age (yr) 59.2±11.1 58.7±11.9 0.664
    Sex
     Female 81 (29.3) 41 (29.1) 0.954
     Male 195 (70.7) 100 (70.9)
    Comorbidity
     Cardiovascular 37 (13.4) 16 (11.3) 0.108
     Cerebrovascular 4 (1.4) 1 (0.7)
     Diabetes 14 (5.1) 3 (2.1)
     Hepatic 4 (1.4) 2 (1.4)
     Renal 1 (0.4) 0
     Pulmonary 0 3 (2.1)
     Thyroid 3 (1.1) 2 (1.4)
     Combined disease 14 (5.1) 2 (1.4)
    Previous operation history
     Gastrectomy 3 (1.1) 7 (5.0) 0.060
     Lower anterior resection 2 (0.7) 0
     Hysterectomy 1 (0.4) 0
    Type of surgery
     OTG 253 (91.7) 128 (90.8) 0.668
     LATG 22 (8.0) 11 (7.8)
     OTG with Whipple’s operation 1 (0.4) 2 (1.4)
    Hospital stay (day) 12.4±9.9 11.3±4.8 0.107
    Depth of invasion
     T1a 72 (26.1) 22 (15.6) 0.001
     T1b 92 (33.3) 40 (28.4)
     T2 25 (9.1) 19 (13.5)
     T3 52 (18.8) 22 (15.6)
     T4a 35 (12.7) 38 (27.0)
    Lymph node metastasis
     N0 205 (74.3) 90 (63.8) 0.040
     N1 19 (6.9) 19 (13.5)
     N2 27 (9.8) 12 (8.5)
     N3 25 (9.1) 20 (14.2)
    Stage
     IA 156 (56.5) 59 (41.8) 0.085
     IB 26 (9.4) 16 (11.3)
     IIA 28 (10.1) 15 (10.6)
     IIB 15 (5.4) 14 (9.9)
     IIIA 15 (5.4) 8 (5.7)
     IIIB 21 (7.6) 14 (9.9)
     IIIC 15 (5.4) 15 (10.6)
    Harvested lymph nodes 44.6±17.3 46.6±20.1 0.280
    Chemotherapy
     Yes 61 (22.1) 51 (36.2) 0.002
     No 215 (77.9) 90 (63.8)
    Variable Group 1 (n=276)
    Group 2 (n=141)
    Preoperative Postoperative p-value Preoperative Postoperative p-value
    EORTC QLQ-C30
     Global health status/QoLa) 61.7 64.4 0.744 61.0 66.5 0.416
     Functional scalesa)
      Physical functioning 86.3 79.8 0.495 87.3 81.1 0.436
      Role functioning 90.8 79.6 0.389 89.2 81.4 0.381
      Emotional functioning 79.6 80.9 0.199 82.3 82.7 0.328
      Cognitive functioning 89.2 82.4 0.631 88.4 84.2 0.296
      Social functioning 83.8 82.6 0.415 83.6 81.6 0.645
     Symptom scales/itemsb)
      Fatigue 21.6 32.2 0.802 22.1 30.5 0.393
      Nausea and vomiting 9.0 16.2 0.071 12.4 11.8 0.035
      Pain 11.8 15.5 0.967 11.7 12.2 0.058
      Dyspnea 12.2 15.0 0.602 11.1 13.0 0.372
      Insomnia 15.7 17.5 0.607 17.0 15.1 0.332
      Appetite loss 14.4 20.2 0.025 20.0 13.0 0.003
      Constipation 12.4 15.5 0.112 16.1 13.2 0.307
      Diarrhea 13.4 26.9 0.588 12.3 22.5 0.080
      Financial difficulties 18.7 21.1 0.271 15.8 19.4 0.521
    EORTC QLQ-STO22b)
     Dysphagia scale 6.6 16.9 0.140 8.5 14.6 0.118
     Pain scale 15.2 22.2 0.125 18.0 18.5 0.120
     Reflux symptoms scale 11.1 17.9 0.078 13.9 15.4 0.190
     Eating restrictions scale 8.7 22.9 0.008 13.0 21.1 0.362
     Anxiety scale 26.1 36.3 0.773 26.8 32.4 0.092
     Having a dry mouth 18.4 25.8 0.623 19.6 23.2 0.320
     Taste 6.4 15.1 0.165 9.0 10.9 0.051
     Body image 19.3 37.4 0.225 22.9 32.9 0.113
     Hair loss 18.9 29.5 0.552 21.5 27.1 0.558
    Table 1. Characteristics of patients

    Values are presented as number (%) or mean±standard deviation. Stage grouping by 7th edition of the American Joint Committee on Cancer classification. OTG, open total gastrectomy; LATG, laparoscopic assisted total gastrectomy.

    Table 2. Comparison of QoL changes according to BMI shifting

    Values are presented as mean score. Group 1: Patients whose BMIs were in lower categories compared to their preoperative classifications. Group 2: Patients who had maintained their BMI categories or had shifted to a higher range compared to their preoperative BMIs. QoL, quality of life; BMI, body mass index; EORTC QLQ, European Organization for Research and Treatment Quality of Life Questionnaire.

    A higher score represents a better QoL,

    A higher score represents a worse QoL.


    Cancer Res Treat : Cancer Research and Treatment
    Close layer
    TOP