Symptoms, nutritional outcomes and quality of life after total gastrectomy with Roux-en-Y reconstruction: results of a cross-sectional study conducted on 80 long-term survivors

Impaired functional outcomes are common issues after total gastrectomy, although seldom explored at a long distance from surgery. The primary aim of this study was to investigate the long-term postoperative functional and nutritional results after Roux-en-Y total gastrectomy (RYTG). Patients with gastric neoplasms or CDH1 mutation undergoing RYTG between 2000 and 2021, with a minimum follow-up of 12 months, were interviewed to assess their functional and nutritional status and to measure their quality of life (QoL) with the GIQLI, EORTC-QLQ20 and EORTC-STO22 questionnaires. Statistical analysis was used to present these results and assess variables associated with body weight variation (BWV), dumping syndrome and QoL. Eighty patients were selected out of 265 RYTGs performed. The mean BWV was - 19.4% ± 9.4. The prevalence of dumping syndrome was 27.5%, the prevalence of food intake disturbances and reflux were 33.8% and 46.2%, respectively. The prevalence of anemia was 27.5%. A higher preoperative BMI and a longer follow-up time were associated with BWV. The only predictor of dumping syndrome was a lower age at surgery. Patients with dumping reported significantly lower GIQLI score [median 132 (IQR 123-138) vs 111 (82-123), p < 0.001], and a lower GIQLI score was associated with higher preoperative BMI, with the interaction between dumping syndrome and BWV, and with food intake disturbances. RYTG is associated with a long-term decrease in body weight and a high rate of compromised functional outcomes, with a possible significant effect on QoL. To prevent these occurrences, alternative reconstruction methods to RYTG could be considered.