The Quality of Life as a Criterion for the Effective Surgical Treatment of the Gastric Cardia Disease

Abstract

The aim of the study was to assess the quality of life (QoL) in patients exposed to proximal resection of the stomach in various modifications. Materials and methods. The study included 97 patients who underwent surgical treatment of the gastric cardia disease; of them, 87.6% having malignant neoplasms. The patients were exposed to proximal gastric resection using isoperistaltic jejunogastroplasty (Merendino-Dillard-modified) (50 patients, main group I) and conventional proximal gastric resection using direct esophagogastroanastomosis (47 patients, control group II). The Russian language versions of the Medical Outcomes Study 36-item Short-Form Health Survey (MOS SF-36 scale) (psychometric parameters) and Gastrointestinal Symptom-Rating Scale (GSRS) (gastrointestinal parameters) were used to assess health-related quality of life (HRQoL) in the patients before surgery and 12 and 24 months after it.Results. The results obtained demonstrated deterioration in the quality of life of patients both in physical (on average, by 36,51,8 scores or 31,4%) and psychological (on average, by 34,31,8 scores or 34,3%) health parameters according to MOS SF-36 scale before surgical treatment. In the postoperative period, in 12 and especially in 24 months, there was an improvement in physical and psychological health parameters above 70 scores; the patients of group I recovered faster and averaged 84,84,1 scores (significantly closer to the population norm - 86,52,7 scores), and in patients of group II this parameter was 75,33,1. As assessed using the GSRS questionnaire, there were the least disturbances in the digestive system functioning after proximal gastric resection with the Merendino-Dillard-modified gastroplasty (in 12,0% of cases), compared to esophago-gastrostomy (in 30,0% of cases); the results are relevant (rxy=0,6970,009; p0,01). Proximal gastric resection with the Merendino-Dilard-modified digestive tract reconstruction creates more optimal conditions for the rapid rehabilitation of functional parameters, which positively affects the quality of life of patients. Conclusion. The results obtained reflect the impact of the gastric cardia disease and its symptoms on the health and vital activity of patients before surgery and demonstrate how significant and effective the surgical treatment is.