Functional outcomes according to the size of the gastric remnant and the type of reconstruction following distal gastrectomy for gastric cancer: an investigation including total gastrectomy

• Published in: Japanese journal of clinical oncology Vol. 43; no. 12; pp. 1195 - 1202
• Main Authors: Nomura, Eiji, Lee, Sang-Woong, Tokuhara, Takaya, Nitta, Toshikatsu, Kawai, Masaru, Uchiyama, Kazuhisa
• Format: Journal Article
• Language: English
• Published: England 01.12.2013
• Subjects: Adult; Aged; Anastomosis, Roux-en-Y; Esophagitis, Peptic; Female; Gastrectomy - methods; Gastric Emptying; Gastroenterostomy; Humans; Japan; Male; Middle Aged; Neoplasm Invasiveness; Quality of Life; Reconstructive Surgical Procedures - methods; Retrospective Studies; Stomach Neoplasms - pathology; Stomach Neoplasms - physiopathology; Stomach Neoplasms - surgery; Surveys and Questionnaires; Treatment Outcome; Japan; gastric remnant size; reconstruction; distal gastrectomy; gastric cancer; quality of life
• ISSN: 0368-2811; 1465-3621
• DOI: 10.1093/jjco/hyt141

In gastric cancer, various methods of gastric resection have been devised according to the location of the primary tumor and the depth of invasion. Functional outcomes were compared among different types of reconstruction following open 2/3- or 4/5 distal gastrectomy for gastric cancer. Resection and reconstruction were performed by one of the following three methods, depending on the depth of cancer invasion and the date of the procedure relative to the introduction of Roux-en-Y reconstruction: distal 2/3 gastrectomy with Roux-en-Y reconstruction (1/3 Roux-en-Y, n = 30); distal 4/5 gastrectomy with Roux-en-Y reconstruction (1/5 Roux-en-Y, n = 15) and distal 2/3 gastrectomy with Billroth I reconstruction (1/3B1, n = 30). Open total gastrectomy with Roux-en-Y reconstruction (total gastrectomy with RY reconstruction, n = 30) was taken as the control procedure. Comparison of postoperative/preoperative body weight ratios and food intake ratios revealed better preservation among patients with a larger remnant stomach (the 1/3 Roux-en-Y and 1/3B1 groups), regardless of the reconstruction. The gastric emptying pattern in larger remnant stomach groups was milder than in the 1/5 Roux-en-Y and total gastrectomy with RY reconstruction groups. Reflux esophagitis was often observed on endoscopy in the 1/3B1 group. Better functional outcomes were observed in patients with a large remnant stomach regardless of the reconstruction.