Functional results of reconstruction after subtotal or total gastrectomy

The aim of surgical treatment of gastric cancer must be complete removal of the tumor including systematic lymphadenectomy. The performance of R0-resection has to take into consideration tumor site as well as the histomorphological type described by Lauren. Therefore, subtotal distal- or total gastrectomy are complementary operative procedures nowadays. From the oncological point of view proximal gastrectomy might be indicated in some situation but increased postoperative morbidity including severe reflux-esophagitis can be obtained. According to the functional outcome subtotal distal gastrectomy should be preferred whenever justified oncologically in comparison to total gastrectomy. Among the different reconstructive methods after total gastrectomy the Roux-en-Y technique is one of the most common procedure performed. Furthermore, some patients can benefit from a reconstruction of a gastric substitute and maintenance of duodenal passage but the superiority of this technique must be evaluated in further prospective studies. The question of the optimal mode of reconstruction of the upper gastrointestinal tract is still open.