Long-Term Nutritional Outcomes of Near-Total Gastrectomy in Gastric Cancer Treatment: a Comparison with Total Gastrectomy Using Propensity Score Matching Analysis원문보기
Purpose: This study sought to examine whether near total gastrectomy (nTG) confers a longterm nutritional benefit when compared with total gastrectomy (TG) for the treatment of gastric cancer. Materials and Methods: Patients who underwent nTG or TG for gastric cancer were included (n=570). Using the...
Purpose: This study sought to examine whether near total gastrectomy (nTG) confers a longterm nutritional benefit when compared with total gastrectomy (TG) for the treatment of gastric cancer. Materials and Methods: Patients who underwent nTG or TG for gastric cancer were included (n=570). Using the 1:2 matched propensity score, 25 patients from the nTG group and 50 patients from the TG group were compared retrospectively for oncologic outcomes, including long-term survival and nutritional status. Results: The length of the proximal resection margin, number of retrieved lymph nodes and tumor nodes, metastasis stage, short-term postoperative outcomes, and long-term survival were not significantly different between the groups. The body mass index values, and serum total protein and hemoglobin levels of the patients decreased significantly until postoperative 6 months, and then recovered slightly over time (P<0.05); however, there was no difference in the levels between the groups. The prognostic nutritional index values and serum albumin levels decreased significantly until postoperative 6 months and then recovered (P<0.05); the levels decreased more in the nTG group than in the TG group (P<0.05). The mean corpuscular volumes and serum transferrin levels increased significantly until postoperative 1 year and then recovered slightly over time (P<0.05); however, there was no difference between the groups. Serum vitamin $B_{12}$, iron, and ferritin levels of the patients did not change significantly over time, and no difference existed between the groups. Conclusions: A small remnant stomach after nTG conferred no significant nutritional benefits over TG.
Purpose: This study sought to examine whether near total gastrectomy (nTG) confers a longterm nutritional benefit when compared with total gastrectomy (TG) for the treatment of gastric cancer. Materials and Methods: Patients who underwent nTG or TG for gastric cancer were included (n=570). Using the 1:2 matched propensity score, 25 patients from the nTG group and 50 patients from the TG group were compared retrospectively for oncologic outcomes, including long-term survival and nutritional status. Results: The length of the proximal resection margin, number of retrieved lymph nodes and tumor nodes, metastasis stage, short-term postoperative outcomes, and long-term survival were not significantly different between the groups. The body mass index values, and serum total protein and hemoglobin levels of the patients decreased significantly until postoperative 6 months, and then recovered slightly over time (P<0.05); however, there was no difference in the levels between the groups. The prognostic nutritional index values and serum albumin levels decreased significantly until postoperative 6 months and then recovered (P<0.05); the levels decreased more in the nTG group than in the TG group (P<0.05). The mean corpuscular volumes and serum transferrin levels increased significantly until postoperative 1 year and then recovered slightly over time (P<0.05); however, there was no difference between the groups. Serum vitamin $B_{12}$, iron, and ferritin levels of the patients did not change significantly over time, and no difference existed between the groups. Conclusions: A small remnant stomach after nTG conferred no significant nutritional benefits over TG.
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제안 방법
A Kaplan-Meier survival curve was used to analyze the survival rates. A repeated measures analysis of variance and the Greenhouse-Geisser method were used to compare postoperative changes in body weight, PNI, and nutritional parameters between the groups. All statistical analyses were performed using SPSS for Windows (ver.
Finally, gastric hormones and postgastrectomy syndromes such as dumping and stasis were not analyzed in the present study. Despite these limitations, to the best of our knowledge, the present study is the first to analyze the long-term nutritional outcomes and variable nutritional parameters between nTG and TG using propensity score matching.
The present study has several limitations. First, the study analyzed a small sample size, was retrospective, and was conducted at a single center. Thus, we used propensity score matching analysis to minimize these biases.
Propensity score matching was conducted to adjust for differences between the groups in the clinicopathological characteristics that were directly related to nutritional outcomes. Propensity scores were obtained using binary logistic regression with covariates of age, sex, ECOG, BMI, surgical approach, depth of invasion, LN metastasis, and pathological stage. Subsequently, the nTG group was 1:2 matched to the TG group based on the top 50 propensity scores.
The demographics, clinical and pathological characteristics, operative details, short-term postoperative outcomes, long-term survival data, and nutrition data, which were collected retrospectively from the hospital's gastric cancer patient registry, were compared between the two groups. The nutritional parameters, including BMI, prognostic nutritional index (PNI), serum levels of albumin and total protein, hemoglobin, and mean corpuscular volume (MCV) of the patients were collected preoperatively and at 6 months, 1 year, and 2 years after surgery. Serum levels of vitamin B12, iron, ferritin, and transferrin were determined at 6 months, 1 year, and 2 years after surgery.
대상 데이터
Overall, 570 patients were included in this study; of these, 75 well-matched patients were selected. Their clinicopathological characteristics are shown in Table 1.
Patients who underwent curative radical TG or nTG for gastric cancer from 2009 to 2014 at Seoul St. Mary's Hospital were included in the present study.
Patients with stage IV gastric cancer who had a synchronous malignancy were excluded. The 570 enrolled patients included 25 patients who underwent nTG (nTG group) and 545 patients who underwent TG (TG group). The demographics, clinical and pathological characteristics, operative details, short-term postoperative outcomes, long-term survival data, and nutrition data, which were collected retrospectively from the hospital's gastric cancer patient registry, were compared between the two groups.
데이터처리
Student's t-test and Mann-Whitney U test were used to compare continuous variables.
이론/모형
Student's t-test and Mann-Whitney U test were used to compare continuous variables. A Kaplan-Meier survival curve was used to analyze the survival rates. A repeated measures analysis of variance and the Greenhouse-Geisser method were used to compare postoperative changes in body weight, PNI, and nutritional parameters between the groups.
Overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan-Meier curves to compare the long-term oncologic outcomes between the groups. No difference was detected in the OS and DFS rates according to the extent of gastrectomy between the groups (P=0.
The preoperative clinical characteristics of the patients were classified according to the criteria of the Eastern Cooperative Oncology Group (ECOG). Pathological stage was classified according to the Seventh American Joint Cancer Committee tumor, node, metastasis (TNM) classification system [14]. Postoperative complications within 30 postoperative days were classified according to the Clavien-Dindo system.
성능/효과
Their clinicopathological characteristics are shown in Table 1. After the matching, there was no significant difference between the groups in terms of clinicopathological characteristics, such as age, sex, BMI, ECOG, and comorbidities. Tumor diameter and location were not matched.
In conclusion, compared with TG, nTG with a small remnant stomach during the treatment of upper- or middle-third gastric cancer confers no nutritional benefit. However, further welldesigned long-term prospective studies in this regard are warranted.
The operative details and short-term postoperative outcomes are shown in Table 2. No differences were found in the surgical approach, combined resection, extent of LN dissection, operation time, estimated blood loss, duration to flatus and soft diet, hospital stay, and complications within 30 postoperative days. However, there was a difference in the reconstruction method, because TG and nTG entail fundamentally different anastomotic procedures (P=0.
In the present study, BMI and serum total protein level decreased until 6 months after gastrectomy and then recovered slightly, with statistical significance; however, no significant differences were observed between the groups. The PNI and serum albumin level decreased until 6 months after gastrectomy and then recovered slightly; in addition, more recovery was observed in the TG group than in the nTG group, with statistical significance. These results indicate that compared with TG, nTG with a small remnant stomach conferred no significant nutritional benefits.
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