Longitudinal assessment of quality-of-life after gastrectomy for gastric cancer: a prospective study.

Abstract

Background: The longitudinal recovery process for postoperative quality of life (QOL) after gastrectomy remains incompletely understood. We prospectively evaluated temporal changes in QOL using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) and investigated predictors of poor postoperative QOL.

Methods: This prospective observational study enrolled 433 patients who underwent gastrectomy for primary gastric cancer between 2015 and 2020. Patients completed the PGSAS-45 questionnaire preoperatively and at 1 month, 6 months, 1 year, and > 5 years after surgery. Longitudinal changes in QOL were analyzed, and multivariable logistic regression was performed to identify predictors of poor postoperative QOL at 1 year after surgery.

Results: All PGSAS-45 domains except the mental component summary (MCS) were significantly deteriorated at 1 month after surgery. Most domains recovered substantially between 1 and 6 months and changed little thereafter. MCS was the only domain that improved beyond the preoperative level. Independent predictors of poor total symptom score were major postoperative complications (Clavien-Dindo grade ≥ III; odds ratio [OR] 4.78, p = 0.013) and preoperative MCS < 46 (OR 2.45, p = 0.001). Preoperative physical component summary (PCS) < 46 (OR 2.01, p = 0.028) independently predicted poor quality of ingestion, while preoperative MCS < 46 (OR 2.81, p < 0.001) independently predicted greater dissatisfaction with daily life.

Conclusions: Postoperative QOL recovered predominantly within the first 6 months after gastrectomy and remained largely stable thereafter. Preoperative PCS and MCS, together with major postoperative complications, were important determinants of postoperative QOL.