Quality of life after minimally invasive and open surgery for gastric cancer: a comparative study based on patient-reported outcomes

Background. In modern gastric cancer surgery, the assessment of quality of life (QoL) through Patient-Reported Outcomes (PRO) is becoming a key criterion for treatment effectiveness. Of particular interest is the differentiated assessment of the impact of surgical access and reconstruction technique on the dynamics of various aspects of QoL in the postoperative period. Aim: to conduct a comparative analysis of the dynamics of QoL, functional, and oncological outcomes after laparoscopic and open extended gastrectomy, with special attention to the recovery timeline of specific parameters depending on the surgical technique. Material and methods. This prospective comparative study included patients who underwent laparoscopic extended gastrectomy (LEG, n = 63) with an original intracorporeal anastomosis technique and open extended gastrectomy (OEG, n = 114) for gastric adenocarcinoma. Intra- and postoperative parameters, complications (Clavien – Dindo), post-gastrectomy syndromes, nutritional status, and survival were assessed. Quality of life was evaluated using a set of PRO instruments (EORTC QLQ-C30, QLQ-STO22, SF-36) preoperatively and at 1, 3 and 6 months after surgery. Results. The groups were comparable in baseline characteristics. The LEG group had a longer operation time (185 ± 45 vs. 173 ± 55 min, p = 0.032), lower blood loss (55 ± 45 vs. 160 ± 55 ml, p = 0.007), and a shorter postoperative hospital stay (9.5 ± 3.2 vs. 12.3 ± 4.1 days, p 0.001). The rate of complications ≥ IIIa was comparable (6.9% vs. 11%, p = 0.335), and 30-day mortality was similar between the groups (1.7% vs. 2%, p = 0.892). The most pronounced differences in QoL dynamics between the groups were chronological. As early as 1 month post-surgery, the LEG group showed significantly better scores on global health and physical functioning scales (EORTC QLQ-C30), as well as less pronounced symptoms of pain, nausea/vomiting, and fatigue (p 0.01). By the 3rd month, these differences remained significant for almost all main functional scales and symptoms of the general questionnaire. However, the maximum and statistically most significant differences by the 6th postoperative month were formed specifically in the spectrum of specific symptoms assessed by the QLQ-STO22 module (dysphagia, reflux, eating restrictions), as well as in nutritional status indicators (p 0.001). SF-36 data confirmed a faster recovery of the physical component of health in the first 3 months after LEG. At 6 months, the LEG group showed a statistically significant reduction in the frequency and severity of post-gastrectomy syndromes (5 patients (8.6%) vs. 28 patients (27.9%), p = 0.014), which directly correlated with better QLQ-STO22 scores and nutritional status. 24-month overall (83.7% vs. 79.2%, p = 0.41) and relapse-free (75.8% vs. 71.5%, p = 0.49) survival rates showed no significant differences. Conclusion. Laparoscopic extended gastrectomy with an original anastomosis technique provides a clinically significant improvement in QoL, characterized by a two-phase dynamic: an initial rapid reduction in postoperative symptoms associated with less traumatic access is followed by a more pronounced long-term advantage in nutritional status and reduction of specific gastrointestinal symptoms, which is due to the reconstruction technique. The obtained data emphasize the importance of assessing QoL at different time points and substantiate the advantages of the minimally invasive approach and improved reconstruction technique for comprehensive patient recovery.