[A prospective randomized study on the method of reconstruction after total gastrectomy]

Area of Science:

• Surgical Oncology
• Gastroenterology
• Digestive System Surgery

Background:

• Total gastrectomy for gastric cancer necessitates effective digestive tract reconstruction.
• Various reconstruction methods exist, each with potential impacts on post-operative outcomes.
• Optimizing reconstruction is crucial for patient recovery and quality of life.

Purpose of the Study:

• To identify the ideal digestive tract reconstruction method following total gastrectomy.
• To compare the efficacy of four different reconstruction techniques: Roux-en-y esophagojejunostomy, P pouch with Roux-en-y, Hunt-Lawrence esophagojejunostomy, and jejunal interposition esophagojejunostomy.

Main Methods:

• A randomized controlled trial involving 120 gastric cancer patients and 12 healthy controls.
• Patients were assigned to one of four reconstruction groups (A, B, C, D).
• Evaluated outcomes included quality of life, prognosis nutrition index (PNI), body weight, nutritional parameters, gastrointestinal hormone levels, and immunological status.

Main Results:

• Jejunal interposition (Group D) demonstrated significantly better quality of life, PNI, body weight, and nutritional markers (SI, TS, Hb) compared to Groups A, B, and C.
• Group D showed significantly higher levels of cholecystokinin (CCK) and immune cells (NK, CD4+, CD8+, CD4/CD8 ratio), comparable to the control group.
• These improvements in Group D were statistically significant (P < 0.05).

Conclusions:

• Modified jejunal interposition esophagojejunostomy is a recommended reconstruction method after total gastrectomy.
• The "P" pouch construction preserves duodenal passage and gastrointestinal hormone secretion, enhancing digestion and nutrient absorption.
• This technique simplifies surgery and ensures adequate blood supply to the jejunum, preventing anastomotic ischemia.