Control observation of different digestive tract reconstruction methods in total gastrectomy for gastric cancer

Abstract

BACKGROUND

For patients with advanced gastric cancer, surgical resection remains the main treatment option. Total gastrectomy combined with radical resection of gastric cancer lesions and sentinel lymph nodes can significantly prolong the survival of patients. Digestive tract reconstruction after total gastrectomy is essential to maintain gastrointestinal function and optimize postoperative recovery. Therefore, it is very important to choose a suitable reconstruction method to improve the quality of life of total gastrectomy patients.

AIM

To evaluate the effects of different digestive tract reconstruction methods in gastric cancer patients undergoing total gastrectomy.

METHODS

This retrospective study included 172 patients who underwent total gastrectomy for gastric cancer at The First Hospital of Hebei Medical University for analysis. The patients were categorized into two groups: Group A, consisting of 90 patients who underwent modified Roux-en-Y gastrojejunostomy, and group B, consisting of 82 patients who underwent uncut Roux-en-Y gastrojejunostomy. The general patient characteristics, perioperative indicators, postoperative gastrointestinal mucosal barrier function, nutritional status, immunological markers, and occurrence of complications were compared between the two groups.

RESULTS

Group A showed shorter digestive tract reconstruction time than group B (P < 0.05). On the first postoperative day, group A showed lower serum levels of D-lactate, diamine oxidase, and endotoxin than group B (P < 0.05). One month postoperatively, group A showed higher prognostic nutritional index, serum albumin, total protein, and body weight than group B (P < 0.05). One month postoperatively, the levels of cluster of differentiation (CD) 3 +, CD4 +, and CD8 + cells were not significantly different between two groups (P > 0.05). The complication rates were 10.00% in group A and 24.39% in group B; group A had a significantly lower complication rate than group B (P < 0.05).

CONCLUSION

Using modified Roux-en-Y gastrojejunostomy during total gastrectomy shortens the time required for gastrointestinal anastomosis, reduces surgery-induced gastrointestinal mucosal damage, and mitigates postoperative declines in nutritional status.

Keywords: Total gastrectomy; Digestive tract reconstruction; Gastric cancer; Gastrointestinal barrier; Immune function; Safety

Core Tip: Total gastrectomy combined with radical resection of gastric cancer lesions and sentinel lymph nodes can significantly prolong the survival of patients. Postoperative digestive tract reconstruction is crucial to maintain gastrointestinal function and optimize postoperative recovery. This study found that the application of modified Roux-en-Y gastrojejunostomy in total gastrectomy shortened the gastrointestinal anastomosis time, reduced the gastrointestinal mucosal injury caused by the operation, and alleviated the decline in postoperative nutritional status. This approach also reduces the overall incidence of surgical complications.