Functional jejunal interposition versus Roux-en-Y anastomosis after total gastrectomy for gastric cancer: A prospective randomized clinical trial. (September 2020)

• Record Type: Journal Article
• Authors: Wang, Huashe; Hu, Xiansheng; Chen, Shi; Xiang, Jun; Yang, Zuli; Zhou, Zhiwei; Chen, Yingbo; Lin, Yijia; Chen, Yonghe; Peng, Junsheng
• Is Part Of: Surgical oncology. Volume 34(2020)
• Page Start: 236
• Page End: 244
• Publication Date: 2020-09
• Subjects: Total gastrectomy -- Functional jejunal interposition -- Roux-en-Y anastomosis -- Nutritional status -- Quality of life; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2020.04.023
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Background: Nutritional status and quality of life deteriorate significantly after total gastrectomy for patients with gastric cancer. The numerous types of reconstruction proposed by medical researchers around the world have limited effect. This prospective, randomized clinical trial compared functional jejunal interposition with Roux-en-Y anastomosis to identify the optimal reconstruction procedure. Methods: This was a multi-center, prospective, randomized control trial. The enrolled patients were randomly assigned into the functional jejunal interposition group and the Roux-en-Y group. All patients were followed up at regular intervals after surgery. The endpoints were postoperative nutritional status, quality of life, and long-term postoperative complications. Results: A total of 113 patients were enrolled from August 2012 to September 2017. Until March 2018, the median follow-up period was 18 months. At 12 months after surgery, food intake per meal (P = 0.021), Prognosis Nutritional Index (P = 0.015), weight loss (P = 0.019), and Gastrointestinal Symptom Rating Scale score (P = 0.015) of the functional jejunal interposition group were significantly worse than those of the Roux-en-Y group. There was no significant difference in operative time, intraoperative blood loss, perioperative complications, time of first flatus and defecation after surgery, postoperative plasma nutritional parameters, Visick score, Eastern Cooperative Group physical condition score, and survival rate. Conclusion: For patients with long-term survival after total gastrectomy for gastric cancer, the Roux-en-Y anastomosis is a better choice compared with functional jejunal interposition. Highlights: The optimum reconstruction after total gastrectomy hasn't been determined. Functional jejunal interposition is creative and theoretically advantageous. Functional jejunal interposition may improve postoperative nutrition and quality of life.