[Stomach carcinoma. Optimizing therapy by stomach replacement or subtotal resection?]

The extent of surgical resection in the treatment of gastric carcinoma depends on the tumor site as well as on the histomorphological type according to Lauren taking into account the margins of clearance at the oral resection line. Following subtotal distal gastrectomy functional long-term results might be generally better in comparison to total gastrectomy. Among the large variety of operative methods of reconstruction after total gastrectomy the Roux-en-Y procedure is preferred by the majority of surgeons. Nevertheless, according to experimental and clinical trials jejunal interposition technique seems to allow a more physiological gastric replacement with improved postoperative function and quality of life. Furthermore, jejunal interposition can influence the motility of the entire intestinal tract resulting in a better functional outcome. The importance of pouches for gastric substitute with positive impact on the long-term nutritional status must be clarified in further clinical trials. In conclusion, the question of ideal mode of reconstruction of the upper gastrointestinal tract is still open and continues to be found out.