Improved quality of life with jejunal pouch reconstruction after total gastrectomy.
BACKGROUND
There is increasing evidence that the effect of jejunal pouch reconstruction is satisfactory for reservoir function in several randomized control studies. However, these studies were performed in patients with advanced gastric cancer, where significant numbers of the patients died of disease recurrence. In order to exclude the influence of disease recurrence, we performed jejunal pouch reconstruction after total gastrectomy in patients with early gastric cancer in a randomized controlled study and investigated whether or not an improved quality of life (QOL) was observed with jejunal pouch reconstruction.


METHODS
Fifty consecutive patients receiving total gastrectomy for early gastric cancer were prospectively divided into the Roux-en-Y reconstruction group without pouch (RY group) or the jejunal pouch reconstruction group (pouch group). Body weight, eating capacity, QOL assessment by gastrointestinal symptom rating scale (GSRS), nutritional parameters, endoscopical examination, 24-hour pH monitoring and Bilitec monitoring were evaluated at 3, 12, and 48 months after surgery.


RESULTS
Jejunal pouch reconstruction provided the better QOL than Roux-en-Y reconstruction without pouch both at short-term and long-term periods in a randomized control study. Moreover, as a new finding, pouch reconstruction provided less bile reflux into the esophagus compared with Roux-en-Y reconstruction.


CONCLUSIONS
Jejunal pouch reconstruction provided improvement of QOL in patients receiving total gastrectomy.
Kono
Koji
K
First Department of Surgery, Yamanashi Medical University, 1110 Tamaho, 409-3898, Yamanashi, Japan. kojikono@res.yamanashi-med.ac.jp
Iizuka
Hidehiko
H
Sekikawa
Takayoshi
T
Sugai
Hidemitsu
H
Takahashi
Akihiro
A
Fujii
Hideki
H
Matsumoto
Yoshirou
Y
D000368:Aged; D000713:Anastomosis, Roux-en-Y; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*