Improved Long-Term Quality of Life in Patients with Laparoscopy-Assisted Distal Gastrectomy with Jejunal Pouch Interposition for Early Gastric Cancer

Although laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) offers more advantages than open distal gastrectomy, it does not eliminate the postgastrectomy syndrome, which can negatively impact quality of life (QoL). In this paper, we investigate jejunal pouch interposition (JPI) during LADG and evaluate its potential for long-term use.

Between April, 2004 and April, 2005, 28 patients underwent LADG with JPI (LA-JPI), and an equal number underwent LADG with Billroth-II gastrojejunostomy (LA-B-II). Of these, 25 patients with LA-JPI and 28 with LA-B-II, surviving more than 4 years, were enrolled. We compared clinicopathological characteristics, surgical outcomes, and the patients’ QoL.

There were no differences in clinicopathological characteristics and surgical outcomes except longer operation time of LA-JPI group than LA-B-II group (P < 0.001). The gastrofiberscopy, performed 4 years after surgery, demonstrated significant higher incidence of bile reflux gastritis in LA-B-II group(P = 0.03). In terms of QoL metrics, we identified a significantly lower incidence rate of appetite change, heartburn, and reductions in physical strength and daily activity levels in the LA-JPI group. In addition, satisfaction with the operative procedure and postoperative life were higher. Although the number of meals per day did not differ, we noted a significantly greater food intake with each meal compared with the preoperative metric (P = 0.04) and reduced body weight loss (P = 0.003) was observed in the LA-JPI group.

These long-term follow-up results suggest that LA-JPI might alleviate postgastrectomy syndrome and that this could help improve the QoL in patients with EGC.