Ann Surg Treat Res.  2020 Nov;99(5):275-284. 10.4174/astr.2020.99.5.275.

The pattern of postoperative quality of life following minimally invasive gastrectomy for gastric cancer: a prospective cohort from Korean multicenter robotic gastrectomy trial

• Choi JH
• Han SU
• Yang HK
• Kim YW
• Ryu KW
• Park JM
• An JY
• Kim MC
• Park S
• Song KY
• Oh SJ
• Kong SH
• Suh BJ
• Yang DH
• Ha TK
• Kim HI
• Hyung WJ
• Lee HJ

• KMID: 2508324
• DOI: http://doi.org/10.4174/astr.2020.99.5.275

Abstract

Purpose
Quality of life (QOL) has become important in the trend of emphasizing patient satisfaction. This study aimed to evaluate the QOL in patients who underwent laparoscopic or robotic gastrectomy for gastric cancer.
Methods
A prospective trial was performed involving patients who underwent laparoscopic or robotic gastrectomy for primary gastric cancer at 11 hospitals in Korea. Within this comparative trial, QOL, postoperative pain, and long-term complications were exanimated. The quality-of-life questionnaire (QLQ)-C30 and QLQ-STO22 developed by the European Organization for Research and Treatment of Cancer were used for the QOL survey. We compared the data after dividing it into several types of characteristics as follows; device (robotic or laparoscopic), operation type, pathological stage, and sex. Biased components were extracted by logistic regression analysis. Propensity score matching was applied to the data set with the biased components.
Results
In total, 434 patients (211 for laparoscopic surgery and 223 for robotic surgery) were enrolled, out of which 321 patients who responded to both preoperative and postoperative surveys were selected for analysis. Robotic gastrectomy was not different from laparoscopic gastrectomy with respect to postoperative QOL. Distal gastrectomy showed better scores than total gastrectomy in terms of role functioning, social functioning, fatigue, nausea/vomiting, pain, dyspnea, constipation, financial difficulties, dysphagia, eating restrictions, anxiety, taste, and body image. Male patients showed better scores on the 19 scales compared to female patients.
Conclusion
Robotic and laparoscopic approaches for gastric cancer surgery did not differ from each other with respect to QOL. Distal gastrectomy resulted in better QOL than total gastrectomy.

Keyword

Gastrectomy; Quality of life; Stomach neoplasms

Figure

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  Fig. 1 Quality of life (QOL) survey. (A) The schedule of the QOL survey. Five surveys were completed at the time of preoperative admission, postoperative 1st outpatient department (OPD) visit after discharge, and 3 months, 1 year, and 3 years. The answers were collected from 337, 302, 157, 220, and 165 patients at the respective time points. (B) The response of the survey. Robot multicenter study collected surveys from 434 patients from 11 centers, and 113 patients did not answer both preoperative and postoperative surveys. Accordingly, 321 cases were used as the initial data set for the following analyses.

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  Fig. 2 Quality of life (QOL) of laparoscopic surgery vs. robotic surgery. The QOL questionnaire (QLQ)-C30 and QLQ-STO22 developed by the European Organization for Research and Treatment of Cancer were used. A total of 24 scales are presented in the graph. In the respective scale, the maximum score is 100 and the minimum score is 0. A high score of general health status and 5 functioning scales indicates a good QOL. A high score of 18 symptom scales indicates a poor QOL. LG, laparoscopic gastrectomy; RG, robotic gastrectomy; Preop, preoperative; OPD, outpatient department.

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  Fig. 3 Change of pain score and the use of pain killers. (A) Resting pain score from operation day (OP-day) to discharge (P = 0.614). (B) Movement pain score (P = 0.421). (C) The use of painkiller (frequency, P = 0.824). (D) The use of patient-controlled analgesia (PCA) (volume, P = 0.524). VAS, visual analog scale; LG, laparoscopic gastrectomy; RG, robotic gastrectomy; POD, postoperative day.

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