Reconstruction following total gastrectomy: a review and summary of the randomized prospective clinical trials

Reconstruction of gastrointestinal tract continuity following total gastrectomy can be achieved using a variety of operations. Worldwide, Roux-en-Y esophago-jejunostomy with or without a pouch reservoir, is the most frequently performed operation after total gastrectomy. Others have advocated the preservation of the duodenal food passage, employing an interposed segment of bowel between the esophageal remnant and duodenum as a more physiologic operation. Several methods for either approach are described. In recent years, six randomized prospective clinical trials assessing various operations for gastrointestinal reconstruction have been reported. While there is a general consensus for the indications and patient selection criteria in order to proceed with total gastrectomy, a defined optimal procedure has not been clearly established. In the present work, these recent clinical studies addressing gastrointestinal reconstruction following total gastrectomy are reviewed and summarized.