Advancing Quality of Life and Nutritional Outcomes: Stomach-Preserving Surgery for Early Gastric Cancer

The secondary analysis of 451 participants from the Sentinel Node Oriented Tailored Approach (SENORITA) randomized clinical trial revealed that stomach-preserving surgery could be a favorable treatment option for early-stage gastric cancer.

“The stomach-preserving group showed little changes in quality-of-life (QoL) scores and nutritional indicators, which returned to their preoperative values,” the researchers reported. “The stomach-preserving group had significantly better QoL and nutritional outcomes than the standard group.”

The SENORITA RCT evaluated nutritional outcomes and quality of life between the laparoscopic standard gastrectomy (LSG) and laparoscopic sentinel node navigation surgery (LSNNS). However, no study has reported QoL and nutritional outcomes of patients who underwent stomach-preserving surgery among the LSNNS group.

To fill this knowledge gap, Bang Wool Eom, Center of Gastric Cancer, National Cancer Center, Goyang, Republic of Korea, and colleagues aimed to compare long-term nutritional outcomes and QoL between patients who underwent stomach-preserving surgery and those who underwent standard gastrectomy and to identify factors associated with poor QoL outcomes in patients who underwent stomach-preserving surgery.

For this purpose, the research team conducted a secondary analysis of the SENORITA trial, a randomized clinical trial comparing LSNNS with LSG. It enrolled patients from 7 tertiary or general hospitals across the Republic of Korea from 2013 to 2016, with follow-up through 5 years. Among trial participants, the analysis included patients who underwent actual laparoscopic standard gastrectomy in the LSG group and those who underwent stomach-preserving surgery in the LSNNS group. It excluded patients who did not complete the baseline or any follow-up questionnaire.

The main outcomes were overall European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30) and stomach module (STO22) scores, hemoglobin, body mass index, protein, and albumin levels.

The study included 194 and 257 patients who underwent stomach-preserving surgery and standard gastrectomy, respectively (mean age, 55.6 years; 55.2% were males).

The study led to the following findings:

• The stomach-preserving group had better QoL scores at three months postoperatively in terms of physical function (87.2 versus 83.9), appetite loss (13.1 versus 19.4), dyspnea (5.9 versus 11.2), dysphagia (8.0 versus 12.7), anxiety (29.0 versus 35.2), eating restriction (10.9 versus 18.2), taste change (7.4 versus 13.0), and body image (19.5 versus 27.2).
• At one year postoperatively, the stomach-preserving group had significantly higher body mass index (23.9 versus 22.1, calculated as weight in kilograms divided by height in meters squared) and hemoglobin (14.3 versus 13.3 g/dL), albumin (4.3 versus 4.25 g/dL), and protein (7.3 versus 7.1 g/dL) levels compared to the standard group.
• Multivariable analyses showed that tumor location (greater curvature, lower third) was favorably associated with global health status (β, 10.5), reflux (β, −8.4), and eating restriction (β, −5.7) at three months postoperatively in the stomach-preserving group.
• Segmental resection was associated with a risk of eating restriction (β, 15.1) and diarrhea (β, 40.6) at 3 years postoperatively.

The study showed that stomach-preserving surgery after sentinel node evaluation was tied to better long-term QoL and nutritional outcomes than standard gastrectomy.

“These findings may help facilitate decision-making regarding treatment for patients with early-stage gastric cancer,” the researchers concluded.

Reference:

Eom BW, Yoon HM, Kim Y, et al. Quality of Life and Nutritional Outcomes of Stomach-Preserving Surgery for Early Gastric Cancer: A Secondary Analysis of the SENORITA Randomized Clinical Trial. JAMA Surg. Published online May 29, 2024. doi:10.1001/jamasurg.2024.1210