Yu J, Li M, Qin XZ, Gong L, Qin L, Lv ZB, Guo W, Huang B, Tian YH. Application of modified Roux-en-Y digestive tract reconstruction in total gastrectomy for patients with gastric cancer. World J Gastrointest Surg 2025; 17(6): 106009 [DOI: 10.4240/wjgs.v17.i6.106009]
Corresponding Author of This Article
Yun-Hong Tian, Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, No. 97 Renmin South Road, Shunqing District, Nanchong 637000, Sichuan Province, China. drtianyunhong@126.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jun 27, 2025; 17(6): 106009 Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.106009
Application of modified Roux-en-Y digestive tract reconstruction in total gastrectomy for patients with gastric cancer
Jing Yu, Min Li, Xiang-Zhi Qin, Lei Gong, Long Qin, Zhen-Bing Lv, Wei Guo, Bin Huang, Yun-Hong Tian
Jing Yu, Min Li, Xiang-Zhi Qin, Lei Gong, Long Qin, Zhen-Bing Lv, Wei Guo, Bin Huang, Yun-Hong Tian, Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Jing Yu, Min Li, Xiang-Zhi Qin, Lei Gong, Long Qin, Zhen-Bing Lv, Wei Guo, Bin Huang, Yun-Hong Tian, Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
Co-first authors: Jing Yu and Min Li.
Co-corresponding authors: Zhen-Bing Lv and Yun-Hong Tian.
Author contributions: Yu J wrote the article and conducted the statistical analyses; Li M collected the clinical data and abstracted the data; Yu J and Li M contributed equally to this article and are the co-first authors of this manuscript; Qin XZ, Gong L, Qin L, Guo W, and Huang B participated in modification and data analysis; Tian YH and Lv ZB designed the research protocols for the present study, provided guidance for writing and revising the article, they contributed equally to this article, they are the co-corresponding authors of this manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Nanchong Central Hospital Affiliated to North Sichuan Medical College ( Approval No. 2022005).
Informed consent statement: Due to the retrospective study design, informed consent was waived by Nanchong Central Hospital Affiliated with North Sichuan Medical College Ethics Committee.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: All relevant data are included in the paper, and no additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Hong Tian, Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, No. 97 Renmin South Road, Shunqing District, Nanchong 637000, Sichuan Province, China. drtianyunhong@126.com
Received: February 21, 2025 Revised: April 1, 2025 Accepted: April 25, 2025 Published online: June 27, 2025 Processing time: 98 Days and 20.5 Hours
Abstract
BACKGROUND
At present, the concept of surgical treatment of gastric cancer (GC) has changed from “radical treatment” to “care for patients” to a certain extent. The reconstruction method is the most likely to affect the postoperative life of the patient. Currently, the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC. However, more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure, with more reconstruction steps and longer reconstruction time, and the incidence of postoperative complications such as adhesive intestinal obstruction, internal abdominal hernia and volvulus is high. Moreover, the incidence of Roux stasis syndrome is 10%-30% after traditional Roux-en-Y reconstruction. Thus, we modified the traditional Roux-en-Y alimentary tract reconstruction, and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.
AIM
To evaluate the clinical advantages, feasibility, and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.
METHODS
Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy (total gastrectomy) for GC were divided into two groups: fifty-four in the conventional Roux-en-Y reconstruction group (Orr group) and forty-three in the modified Roux-en-Y reconstruction group (the modified group). Perioperative and short-term outcomes were analyzed, including complications, postoperative weight loss, hemoglobin levels, and nutritional status.
RESULTS
The Orr group and the modified group showed no statistically significant differences in baseline characteristics. Compared with the Orr group, the modified group had shorter digestive tract reconstruction and operation times, less intraoperative bleeding, and shorter postoperative hospital stays compared to the Orr group. Although both groups had similar amounts of intraoperative blood loss, postoperative recovery times, and hospital expenses, the Orr group experienced longer operation times and digestive tract reconstruction times. Furthermore, the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications, with a reduced incidence of reflux esophagitis and improved nutritional status.
CONCLUSION
The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety, simplicity, and a reduction in bile reflux. This method shortens operation times and minimizes postoperative complications, aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival. This method warrants further clinical application and promotion.
Core Tip: This study compared modified vs traditional Roux-en-Y reconstruction in 97 patients with gastric cancer undergoing laparoscopy-assisted total gastrectomy. The modified method (n = 43) demonstrated shorter operation (160.9 vs 211.7 minutes) and reconstruction times (21.46 vs 52.25 minutes), reduced intraoperative bleeding, and fewer complications (e.g., reflux esophagitis: 0% vs 11.1%). Postoperative recovery and nutritional outcomes (weight loss, hemoglobin levels) were superior in the modified group. Findings suggest that the modified technique improves safety, efficiency, and patient prognosis, aligning with rapid rehabilitation principles. Clinical adoption is recommended.
