Defining Recovery After Gastrectomy: Insights from Longitudinally Collected Patient-Reported Outcomes

BACKGROUND: Longitudinal patient-reported outcomes (PROs) can capture symptom burden and functional recovery, but benchmarks across gastrectomy, including the impact of bodyweight loss on quality of life, remain unclear. METHODS: We prospectively collected PRO data (October 2020-January 2025) from patients undergoing gastrectomy who completed the MD Anderson Symptom Inventory at eight time points, from preoperative through postoperative month (POM) 6. Symptom and interference composite scores were calculated as the mean of the top five symptoms and top three interference items identified at postoperative day (POD) 3. Recovery was defined as achieving mild scores (≤3) on both composites. Logistic regression identified factors associated with recovery at POM 1. Bodyweight changes from preoperative baseline were assessed at POM 1, 3, and 6, and their associations with the "enjoyment-of-life" score were examined using Spearman correlation. RESULTS: We analyzed patients who underwent total (TG, n = 44), distal (DG, n = 44), proximal (PrG, n = 22), and partial gastrectomy (n = 14). Symptom burden was greatest around POD 3 across groups. TG patients showed persistently elevated scores in multiple symptoms even at POM 6. Recovery rates at POM 1, 3, and 6 were 63, 72, and 75% after TG and 79, 90, and 96% after other gastrectomies. In multivariable analysis, open TG was independently associated with failure to recover (odds ratio 0.28 [reference: robotic DG]; p = 0.048), whereas robotic TG was not (odds ratio 0.8; p = 0.742). TG and PrG patients experienced 15% BW loss through POM6; however, the enjoyment-of-life score showed no association with BW. CONCLUSIONS: Using PRO-based recovery definition, TG was associated with delayed recovery, and postoperative course varied among gastrectomy types.