Supplementary Material for: Comparative Study on the Difference in Functional Outcomes at Discharge between Proximal and Total Gastrectomy

Several studies have regarded proximal gastrectomy (PG) as optimal compared to total gastrectomy (TG) for upper stomach cancer. In addition to the traditional outcomes of complication and mortality, change in functional status should be considered as another relevant outcome in aging generations. However, there has been no community-based appraisal of functional outcomes between PG and TG. Using an administrative database, we compared functional outcomes between PG and TG. Among 12,508 patients who survived for ≥15 years and underwent open gastrectomy between 2008 and 2010, we examined patient characteristics, comorbidities, functional status estimated by the Barthel index (BI) at admission and discharge, complications, ICU care, ventilation administration, blood transfusion, operating room time, resumption of oral intake, length of stay and total charges. With reference to distal gastrectomy (DG), we performed multivariate analyses to assess the impacts of PG and TG on complications and BI deterioration. A total of 434 PGs and 4,941 TGs were observed in 148 and 295 hospitals, respectively. Patient characteristics, care process, resumption of oral intake, operating room time, length of stay and total charges were also significantly different among the three gastrectomy types. PG, TG and DG were not associated with complications or functional deterioration. Patient characteristics, preoperative blood transfusion and longer operating room time were significantly associated with more complications and BI deterioration. Since patient case mix and longer operating room time were associated with poor outcomes, physicians should recognize the role of PG and might optimally challenge and complete gastrectomies within the appropriate indications.

多项研究认为，相较于全胃切除术（total gastrectomy, TG），近端胃切除术（proximal gastrectomy, PG）是上胃癌的优选术式。除传统关注的并发症与死亡率外，老年人群的功能状态变化亦应作为另一重要结局指标加以考量。然而目前尚无基于社区的评估，对比分析近端胃切除术与全胃切除术的功能结局。
本研究依托行政数据库，对比探讨PG与TG的功能结局。研究纳入2008至2010年间接受开放性胃切除术且术后生存≥15年的12508例患者，对患者基线特征、合并症、入院及出院时通过巴氏指数（Barthel Index, BI）评估所得的功能状态、并发症发生情况、重症监护治疗、通气支持、输血需求、手术时长、经口进食恢复时间、住院时长及总医疗费用进行了系统性采集与分析。以远端胃切除术（distal gastrectomy, DG）作为参照组，本研究开展多变量分析，以评估PG与TG对并发症发生及BI评分恶化的影响。
本研究共纳入148家医院的434例PG患者，以及295家医院的4941例TG患者。三种胃切除术式的患者基线特征、诊疗流程、经口进食恢复时间、手术时长、住院时长及总医疗费用均存在显著差异。分析结果显示，PG、TG与DG均未与并发症发生或功能恶化存在独立关联。患者基线特征、术前输血及更长的手术时长，与更高的并发症发生率及BI评分恶化显著相关。
鉴于患者病例组合与更长手术时长与不良诊疗结局相关，临床医师应正视PG的临床应用价值，并可在适宜适应证范围内优化开展并完成胃切除术。