Comparing simple and functional jejunal interposition with preserved duodenal passage after total gastrectomy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Clinical Nutrition

Background:

• Total gastrectomy for gastric cancer necessitates reconstruction to restore digestive continuity.
• Jejunal interposition techniques, including functional jejunal interposition (FJI) and simple jejunal interposition (SJI), are employed for this purpose.
• Comparing the efficacy of FJI and SJI is crucial for optimizing patient outcomes.

Purpose of the Study:

• To prospectively compare the effectiveness of functional jejunal interposition (FJI) versus simple jejunal interposition (SJI) following total gastrectomy for gastric cancer.
• To evaluate differences in nutritional status, quality of life, surgical parameters, complications, and survival rates between the two reconstruction methods.

Main Methods:

• A prospective randomized controlled trial involving 113 patients undergoing total gastrectomy for gastric cancer.
• Patients were randomized to either FJI or SJI reconstruction.
• Outcomes assessed included nutritional parameters (plasma levels, weight loss, NAI), quality of life (Cuschieri, Visick scores), operative time, blood loss, complications, and survival.

Main Results:

• No significant differences were found between FJI and SJI groups regarding nutritional status, quality of life, complications, or survival rates.
• Both reconstruction methods demonstrated comparable effectiveness in maintaining patient well-being and oncological outcomes.
• Operative time was significantly longer in the FJI group compared to the SJI group.

Conclusions:

• Both FJI and SJI are effective reconstruction methods after total gastrectomy for gastric cancer, ensuring similar nutritional status, quality of life, and survival.
• SJI is favored over FJI due to its shorter operative duration, despite FJI's complexity.
• The choice between FJI and SJI should be individualized based on patient characteristics and surgeon expertise.