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Shibata C, Sawada K, Mitamura A, Nakano T. Gastric emptying after distal gastrectomy from physiologic viewpoint: accelerated or delayed? J Smooth Muscle Res 2025; 61:20-28. [PMID: 39924191 PMCID: PMC11807776 DOI: 10.1540/jsmr.61.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 01/23/2025] [Indexed: 02/11/2025] Open
Abstract
Distal gastrectomy is the most frequently performed procedure for gastric cancer. Gastric emptying after distal gastrectomy is generally considered to be accelerated due to resection of the antrum, pylorus, and duodenal bulb. Food residue, however, is frequently observed in the gastric remnant in patients after distal gastrectomy at the time of endoscopy after routine overnight fasting. This observation suggests delayed gastric emptying and conflicts with the general understanding of accelerated gastric emptying after distal gastrectomy. We searched for reports that evaluated the separate gastric emptying of liquids and solids with scintigraphy after distal gastrectomy in humans and also addressed the physiologic changes in gastric emptying after distal gastrectomy. Most all reports showed that gastric emptying of liquids after distal gastrectomy was accelerated compared to healthy controls, especially immediately after feeding. In contrast, some gastric emptying of solids was accelerated early after the meal ingestion, but thereafter emptying of solids remaining in the stomach was delayed beginning about 60 min after the meal in patients after distal gastrectomy. This delayed solid gastric emptying after distal gastrectomy was considered associated with food residue in the remnant stomach. We conclude that gastric emptying after distal gastrectomy was accelerated for liquids and solids soon after the meal ingestion but delayed for solids later than 60 min after the meal ingestion.
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Affiliation(s)
- Chikashi Shibata
- Department of Gastroenterolgic Surgery, Tohoku Medical and
Pharmaceutical University, 1-12-1 Fukumuro, Miyaginoku, Sendai, Miyagi 983-8512,
Japan
| | - Kentaro Sawada
- Department of Gastroenterolgic Surgery, Tohoku Medical and
Pharmaceutical University, 1-12-1 Fukumuro, Miyaginoku, Sendai, Miyagi 983-8512,
Japan
| | - Atsushi Mitamura
- Department of Gastroenterolgic Surgery, Tohoku Medical and
Pharmaceutical University, 1-12-1 Fukumuro, Miyaginoku, Sendai, Miyagi 983-8512,
Japan
| | - Toru Nakano
- Department of Gastroenterolgic Surgery, Tohoku Medical and
Pharmaceutical University, 1-12-1 Fukumuro, Miyaginoku, Sendai, Miyagi 983-8512,
Japan
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Ma F, Guo D, Zhang B, Zhang Y, Peng L, Ma Q, Ji S, Chai J, Hua Y, Chen X, Wang H, Xu S, Luo S. Short and long-term outcomes after proximal gastrectomy with double tract reconstruction for Siewert type III adenocarcinoma of the esophagogastric junction: a propensity score matching study from a 10-year experience in a high-volume hospital. J Gastrointest Oncol 2020; 11:1261-1273. [PMID: 33456999 PMCID: PMC7807272 DOI: 10.21037/jgo-20-475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Total gastrectomy and proximal gastrectomy (PG) are both surgical options for the treatment of Siewert type III adenocarcinoma of the esophagogastric junction (AEG). Currently there is no consensus on selecting which procedure to perform; in particular, there are few reports of long-term outcomes for patients with local advanced AEG. The aim of this study was to validate the usefulness of PG with double-tract reconstruction in Siewert type III AEG. METHODS The clinical data of patients with Siewert type III AEG underwent PG with double-tract reconstruction (PG-DT) or total gastrectomy with Roux-en-Y anastomosis (TG-RY) at our hospital between October 2010 and October 2018. According to the defined inclusion and exclusion criteria, 2,146 cases were enrolled in this study. A 1-to-1 propensity score matching (PSM) was performed to compare the short and long-term outcomes between the 2 groups. RESULTS The operation time was longer in the PG-DT group, and the proportion rates of complications and recovery time was similar in the 2 groups. The rates of maintaining bodyweight and free-fat mass index were significantly higher in patients who underwent PG-DT compared to those who underwent TG-RY. While complications, recovery time and survival are similar between two groups. CONCLUSIONS Regarding short-term outcomes, PG-DT seemed to be superior in terms of maintaining body weight and skeletal muscle compared to TG-RY, while both had similar complications. It was found that PG-DT enabled a potentially longer survival of pathological stage II and III Siewert type III AEG, although the finding was statistically insignificant. These results may help surgeons to determine the appropriate surgical approach and strategy for patients with early and locally advanced Siewert type III AEG.
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Affiliation(s)
- Fei Ma
- Department of General Surgery, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Dandan Guo
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bin Zhang
- Department of General Surgery, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Yonglei Zhang
- Department of General Surgery, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Liangqun Peng
- Department of General Surgery, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Ma
- Department of General Surgery, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Sheqing Ji
- Department of General Surgery, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Junhui Chai
- Department of General Surgery, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Yawei Hua
- Department of General Surgery, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaobing Chen
- Department of Medical Oncology, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Wang
- Department of Medical Oncology, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuning Xu
- Department of Medical Oncology, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Suxia Luo
- Department of Medical Oncology, the Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
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Pouch Versus No Pouch Following Total Gastrectomy: Meta-analysis of Randomized and Non-randomized Studies. Ann Surg 2019; 269:1041-1053. [DOI: 10.1097/sla.0000000000003082] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Nutritional Results of Roux-en-Y Pouch Reconstruction After Total Gastrectomy for Gastric Cancer. Int Surg 2018. [DOI: 10.9738/intsurg-d-17-00042.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective:
The aim of the present study was to describe the nutritional advantage of pouch reconstruction.
Summary of background data:
Roux-en-Y (RY) pouch reconstruction might improve patients' quality of life compared with RY reconstruction without a pouch after total gastrectomy for gastric cancer.
Methods:
Clinical records were retrospectively reviewed in 9 and 30 patients with gastric cancer for stages I to III diseases in the pouch and RY groups, respectively, and perioperative and nutritional results were studied. Nutritional results were studied for hemoglobin, serum albumin, total lymphocyte count, and prognostic nutritional index for 5 years postoperatively.
Results:
Intraoperative blood loss did not differ between 2 groups, and operative time in the pouch group was prolonged compared with the RY group. All parameters we studied for nutritional results did not differ between the pouch and RY groups in patients with stages I to III diseases. When nutritional results were investigated in patients with stage I diseases, the total lymphocyte count at 2 years and prognostic nutritional index at 2 and 3 years postoperatively were greater in the pouch group than RY group, but the increase was not obvious at 4 to 5 years after the operation, and serum albumin and hemoglobin did not differ between 2 groups.
Conclusions:
These results indicate that the nutritional advantage of pouch reconstruction is very limited after total gastrectomy because the nutritional benefits of pouch reconstruction were observed in 2 of 4 parameters in patients with stage I at 2 and 3 years postoperatively.
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Takahashi M, Goto S, Ueno T, Shima K, Inoue K, Douchi D, Nishina O, Naito H. Extreme dilatation of the interposed jejunal pouch after proximal gastrectomy associated with portal venous gas: A case report. Int J Surg Case Rep 2017; 37:244-247. [PMID: 28715720 PMCID: PMC5514623 DOI: 10.1016/j.ijscr.2017.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 12/31/2022] Open
Abstract
Dilatation of the interposed jejunal pouch developed after proximal gastrectomy. Shock state with portal venous gas was restored after conservative therapy. The pouch dilatation recurred soon after resuming oral ingestion. Resection of the pouch with R-Y esophagojejunostomy relieved the patient. Surgical intervention should be considered for refractory pouch dilatation. Introduction The jejunal pouch interposition (JPI) after proximal gastrectomy (PG) was proposed as a reconstructive procedure to provide a gastric reservoir substitute and prevent postgastrectomy syndrome. However, food residue remaining in some of the pouches resulted in the adverse effect of abdominal bloating, thereby body weight loss. Here, we report a rare case with an extreme dilation of the interposed jejunal pouch (JP) 8 years after PG, requiring pouch resection. Presentation of case A 65-year-old-man who had undergone PG with an inverted U-shaped JPI for early gastric cancer 8 years previously, suffered from shock after right hip joint implantation. Abdominal enhanced CT scan revealed an extremely dilated JP accompanied by portal venous gas. After 5 months of conservative therapy, he underwent resection of the JP and gastric remnant with Roux-en-Y esophagojejunostomy reconstruction. After the operation, the patient has remained in good health for over 3 years. Discussion and conclusion Long-term operative outcome following pouch operation for gastric cancer still remains controversial. Surgical intervention should be considered when we encounter patients who have refractory pouch dilatation after surgery for gastric cancer.
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Affiliation(s)
- Michinaga Takahashi
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Shinji Goto
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Tatsuya Ueno
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Kentaro Shima
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Koetsu Inoue
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Daisuke Douchi
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Orie Nishina
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Hiroo Naito
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
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Namikawa T, Munekage E, Munekage M, Maeda H, Kitagawa H, Nagata Y, Kobayashi M, Hanazaki K. Reconstruction with Jejunal Pouch after Gastrectomy for Gastric Cancer. Am Surg 2016. [DOI: 10.1177/000313481608200611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The construction of a gastric substitute pouch after gastrectomy for gastric cancer has been proposed to help ameliorate postprandial symptoms and nutritional performance. Adequate reconstruction after gastrectomy is an important issue, because postoperative patient quality of life (QOL) primarily depends on the reconstruction method. To this end, jejunal pouch (JP) reconstructions were developed to improve the patient's eating capacity and QOL by creating large reservoirs with improved reflux barriers to prevent esophagitis and residual gastritis. It is important that such reconstructions also preserve blood and extrinsic neural integrity for maintaining pouch function, because JP motility is associated directly with QOL. Some problems remain to be resolved with the JP reconstructions method including gastrointestinal motility, which plays a major role in food transfer, digestion, and absorption of nutrients. Further studies including basic research and larger prospective randomized control trials are also needed to obtain definitive results. With persistent innovations in surgical techniques, JP after gastrectomy could become a safe and preferable reconstructive modality to improve patient QOL after gastrectomy.
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Affiliation(s)
| | - Eri Munekage
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | | | - Hiromichi Maeda
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Japan
| | | | - Yusuke Nagata
- Department of Surgery, Izumino Hospital, Kochi, Japan
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Risk-reduction surgery in pediatric surgical oncology: A perspective. J Pediatr Surg 2016; 51:675-87. [PMID: 26898681 DOI: 10.1016/j.jpedsurg.2016.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE A small percentage of pediatric solid cancers arise as a result of clearly identified inherited predisposition syndromes and nongenetic lesions. Evidence supports preemptive surgery for children with genetic [multiple endocrine neoplasia type 2 (MEN2), familial adenomatous polyposis syndrome (FAP), hereditary nonpolyposis colorectal cancer (HNPCC), and hereditary diffuse gastric cancer (HDGC) and nongenetic [thyroglossal duct cysts (TGDC), congenital pulmonary airway malformations (CPAM), alimentary tract duplication cysts (ATDC), and congenital choledochal cysts (CCC)] developmental anomalies. Our aim was to explore the utility of risk reduction surgery to treat and prevent cancer in children. METHODS A systematic review of the available peer-reviewed literature on PubMed was performed using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) search strategy, where possible. Search items included "risk reduction surgery", "hereditary cancer predisposition syndrome", "multiple endocrine neoplasia type 2", "familial adenomatous polyposis", "hereditary nonpolyposis colorectal cancer", "hereditary diffuse gastric cancer", "thyroglossal duct cysts", congenital pulmonary airway malformations", "alimentary tract duplication cysts", "malignant transformation", and "guidelines". RESULTS We identified 67 articles that met the inclusion criteria describing the indications for prophylactic surgery in surgical oncology. For the genetic predisposition syndromes, 7 studies were related to professional endorsed guidelines, 7 were related to surgery for MEN2, 11 were related to colectomy for FAP, 6 were related to colectomy for HNPCC, and 12 related to gastrectomy for HDGC. Articles for the nongenetic lesions included 5 for techniques related to TGDC resection, 9 for surgery for CPAMs, and 10 for resection of ATDCs. Guidelines and strategies varied significantly especially related to the extent and timing of surgical intervention; the exception was for the timing of thyroidectomy in children with MEN2. CONCLUSION Current evidence supporting prophylactic surgery in the management of pediatric cancer predisposition syndromes and nongenetic lesions is best delineated for thyroidectomy to prevent medullary thyroid cancer in children with MEN2 (Strength of Recommendation Grade B/C). Despite the lack of pediatric specific evidence-based recommendations regarding the appropriate extent and timing for risk-reduction surgery for FAP, HNPCC, HDGC and nongenetic anomalies, our review represents an opportunity towards understanding the postgenomic development of these lesions and provides current indications and techniques for preemptive cancer prevention surgery in children.
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Long-term comparison of boomerang-shaped jejunal interposition and Billroth-I reconstruction after distal gastrectomy. World J Surg 2015; 39:1127-33. [PMID: 25609115 DOI: 10.1007/s00268-015-2941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Billroth-I (BI) is a simple, physiological method of reconstruction following distal gastrectomy. In actuality, postoperative QOL is by no means favorable due to the high incidence of post-gastrectomy syndrome. The aim of this study is to assess the safety and efficacy of boomerang-shaped jejunal interposition (BJI) after distal gastrectomy. METHODS Sixty-six patients with early gastric cancer underwent the BI procedure (n = 33) or BJI (n = 33) after distal gastrectomy, following which they were compared for 5 years. Tumor characteristics, operative details, postoperative complications and complaints, number of meals, and body weight were analyzed. Patients were followed up by endoscopy every 12 months. RESULTS There were no significant differences in the incidence of postoperative complications. The incidence of heartburn (30 vs. 0 %, P = 0.0009) and oral bitterness (33 vs. 6 %, P = 0.0112) were significantly lower in the BJI cases. Endoscopic findings revealed significantly lower incidences of reflux esophagitis (24 vs. 0 %, P = 0.0051) and remnant gastritis (70 vs. 3 %, P < 0.0001) in the BJI group. The incidence of food stasis was low in both groups (12 vs. 15 %). In the BJI group, 30 patients (90 %) were eating 3 meals/day within 12 months, whereas in the BI group, 16 patients (48 %) were still eating 5 meals/day at 12 months or later. CONCLUSIONS BJI is as safe as BI, but is better in terms of improvement in bile reflux and food intake without stasis. This procedure, therefore, appears to be a useful method for reconstruction after distal gastrectomy.
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Dong HL, Huang YB, Ding XW, Song FJ, Chen KX, Hao XS. Pouch size influences clinical outcome of pouch construction after total gastrectomy: A meta-analysis. World J Gastroenterol 2014; 20:10166-10173. [PMID: 25110445 PMCID: PMC4123347 DOI: 10.3748/wjg.v20.i29.10166] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 02/17/2014] [Accepted: 03/06/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical significance of pouch size in total gastrectomy for gastric malignancies.
METHODS: We manually searched the English-language literature in PubMed, Cochrane Library, Web of Science and BIOSIS Previews up to October 31, 2013. Only randomized control trials comparing small pouch with large pouch in gastric reconstruction after total gastrectomy were eligible for inclusion. Two reviewers independently carried out the literature search, study selection, data extraction and quality assessment of included publications. Standard mean difference (SMD) or relative risk (RR) and corresponding 95%CI were calculated as summary measures of effects.
RESULTS: Five RCTs published between 1996 and 2011 comparing small pouch formation with large pouch formation after total gastrectomy were included. Eating capacity per meal in patients with a small pouch was significantly higher than that in patients with a large pouch (SMD = 0.85, 95%CI: 0.25-1.44, I2 = 0, P = 0.792), and the operative time spent in the small pouch group was significantly longer than that in the large pouch group [SMD = -3.87, 95%CI: -7.68-(-0.09), I2 = 95.6%, P = 0]. There were no significant differences in body weight at 3 mo (SMD = 1.45, 95%CI: -4.24-7.15, I2 = 97.7%, P = 0) or 12 mo (SMD = -1.34, 95%CI: -3.67-0.99, I2 = 94.2%, P = 0) after gastrectomy, and no significant improvement of post-gastrectomy symptoms (heartburn, RR = 0.39, 95%CI: 0.12-1.29, I2 = 0, P = 0.386; dysphagia, RR = 0.86, 95%CI: 0.58-1.27, I2 = 0, P = 0.435; and vomiting, RR = 0.5, 95%CI: 0.15-1.62, I2 = 0, P = 0.981) between the two groups.
CONCLUSION: Small pouch can significantly improve the eating capacity per meal after surgery, and may improve the post-gastrectomy symptoms, including heartburn, dysphagia and vomiting.
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Park S, Chung HY, Lee SS, Kwon O, Yu W. Serial comparisons of quality of life after distal subtotal or total gastrectomy: what are the rational approaches for quality of life management? J Gastric Cancer 2014; 14:32-8. [PMID: 24765535 PMCID: PMC3996247 DOI: 10.5230/jgc.2014.14.1.32] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 12/23/2022] Open
Abstract
Purpose The aims of this study were to make serial comparisons of the quality of life (QoL) between patients who underwent total gastrectomy and those who underwent distal subtotal gastrectomy for gastric cancer and to identify the affected scales with consistency. Materials and Methods QoL data of 275 patients who were admitted for surgery between September 2008 and June 2011 and who underwent subtotal gastrectomy or total gastrectomy were obtained preoperatively and postoperatively at 3, 6, 9, 12, 18, and 24 months. The Korean versions of the European Organization for Research and Treatment (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and the gastric cancer specific module, the EORTC QLQ-STO22, were used to assess QoL. Results QoL, as assessed by the global health status/QoL and physical functioning, revealed a brief divergence with worse QoL in the total gastrectomy group 3 months postoperatively, followed by rapid convergence. QoL related to restrictive symptoms (nausea/vomiting, dysphagia, reflux, and eating restrictions) and dry mouth was consistently worse in the total gastrectomy group during the first 2 postoperative years. Conclusions The general QoL of patients after gastrectomy is highly congruent with subjective physical functioning, and the differences between patients who undergo total gastrectomy and subtotal gastrectomy are no longer valid several months after surgery. In order to further reduce the differences in QoL between patients who underwent total gastrectomy and subtotal gastrectomy, definitive preoperative informing, followed by postoperative symptomatic management, of restrictive symptoms in total gastrectomy patients is the most rational approach.
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Affiliation(s)
- Sujin Park
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Ho Young Chung
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Ohkyoung Kwon
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
| | - Wansik Yu
- Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Korea
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Namikawa T, Oki T, Kitagawa H, Okabayashi T, Kobayashi M, Hanazaki K. Impact of jejunal pouch interposition reconstruction after proximal gastrectomy for early gastric cancer on quality of life: short- and long-term consequences. Am J Surg 2012; 204:203-9. [PMID: 22813641 DOI: 10.1016/j.amjsurg.2011.09.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 09/26/2011] [Accepted: 09/26/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Proximal gastrectomy with jejunal pouch interposition (JPI) reconstruction has been advocated as a function-preserving surgery in patients with early gastric cancer located in the upper third of the stomach. METHODS This study clinically investigated 22 patients who underwent JPI reconstruction and 22 patients who underwent Roux-en-Y (RY) reconstruction after total gastrectomy for stage IA/IB gastric cancer. Patients in the 2 groups were compared to evaluate the short- and long-term postoperative outcomes. RESULTS Morbidity and nutritional parameters were no different between the 2 groups. Although postoperative food intake volume was significantly superior in JPI patients than in RY patients 1 year postsurgery, the change in body weight was equal. JPI patients outperformed RY patients with a better quality of life (QOL) at 1 year postgastrectomy. However, 5 years after the surgery, both groups had a similar QOL except for fatigue. CONCLUSIONS JPI reconstruction leads to better outcomes including QOL than RY reconstruction in the short term. However, this short-term positive impact of JPI decreases over time.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan.
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Kumagai K, Shimizu K, Yokoyama N, Aida S, Arima S, Aikou T. Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan. Surg Today 2012; 42:411-8. [PMID: 22391980 DOI: 10.1007/s00595-012-0159-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 09/19/2011] [Indexed: 12/11/2022]
Abstract
The Japanese Society for the Study of Postoperative Morbidity after Gastrectomy conducted a nationwide questionnaire survey to clarify the current status of reconstruction after gastrectomy. One hundred and forty-five institutions (66%) responded to the survey. The questionnaire dealt with the reconstruction after a distal gastrectomy, pylorus-preserving gastrectomy (PPG), total gastrectomy, and proximal gastrectomy. The most common method of reconstruction after distal gastrectomy was Billroth I in 112 institutions (74%), and Roux-en-Y (RY) in 30 (21%). Seventy-seven institutions (53%) responded to the PPG questions. The lengths of the antral cuff were widely distributed among the institutions. Segmental gastrectomy was performed by 23 institutions for limited cases. The most common method of reconstruction after total gastrectomy was RY in 138 institutions (95%). Reconstruction with a pouch after total gastrectomy was done in 26 institutions (18%). The most common reconstructions after proximal gastrectomy were esophagogastrostomy in 69 institutions (48%), jejunal interposition in 41 (28%), double tract in 19 (13%) and pouch reconstruction in 6 (7%). Although most Japanese surgeons are concerned about the revised methods of reconstruction and quality of life after gastrectomy, surgeons have not yet reached a full consensus on these issues.
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Affiliation(s)
- Kazuhide Kumagai
- Department of Surgery, Showa University Toyosu Hospital, 4-1-18 Toyosu, Koto-ku, Tokyo, Japan.
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Distal pouch reconstruction with transverse jejunoplasty after experimental gastrectomy. Langenbecks Arch Surg 2011; 397:63-7. [PMID: 21755432 DOI: 10.1007/s00423-011-0826-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 06/29/2011] [Indexed: 01/20/2023]
Abstract
PURPOSE Various reconstruction methods with or without reservoir formation after total gastrectomy have been established. Transverse intestinoplasty has benefits as a functional peristalsis modification in rectal resections. In this study, we evaluate a distal pouch combined with a transverse jejunoplasty compared to standard Roux-en-Y reconstruction. METHODS Total gastrectomy was performed on 23 pigs randomly assigned to 3 reconstruction groups-group 1 (n = 7): esophagojejunostomy without a pouch, group 2 (n = 8): esophagojejunostomy with a distal pouch, and group 3 (n = 8): distal pouch with a transverse jejunoplasty. Seven days postoperatively, weight was measured, and X-ray examinations were conducted for 1 h after oral contrast medium application. Blood glucose levels after oral glucose intake and the volume of the pouch loop were evaluated. RESULTS Upper jejunal passage was delayed and the mean volume of the jejunal loop increased by pouch formation compared to controls (p < 0.05). Body weight was the best for the pouch group with jejunoplasty (-1.9 ± 0.8% vs. pouch alone -3.3 ± 2.4% vs. no pouch -7.5 ± 2.1%, p < 0.05). CONCLUSIONS The distal jejunal pouch after total gastrectomy offers advantages with respect to bowel passage and postoperative nutrition status compared to standard Roux-en-Y reconstruction. The combination of a distal pouch and transverse jejunoplasty may provide additional functional benefits.
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