[Influence of different procedures of alimentary tract reconstruction after total gastrectomy for gastric cancer on the nutrition and metabolism of patients: a prospective clinical study].
OBJECTIVE
To investigate the influence of different alimentary tract reconstruction procedures after total gastrectomy for treatment of gastric cancer on nutrition and metabolism and explore an ideal reconstruction procedure.


METHODS
A total of 149 patients with gastric cancer who had undergone total gastrectomy were randomly allocated into 5 groups of 30 patients (except the group HLD with 29 cases) to undergo 5 different alimentary tract reconstruction procedures: simple esophagojejunostomy using Roux-en-Y technique (RY), P pouch with Roux-en-Y reconstruction (PRY), jejunal pouch reconstruction according to Hunt-Lawrence technique (HL), jejunal pouch original interposition reconstruction modified by the authors (JOP), and Hunt-Lawrence reconstruction technique maintaining duodenal passage (HLD). Three and six months after operation, quality of life (Visick grade), PNI; body weight; and serum nutritional parameters, including albumin, (ALB), total protein (TP), transferrin (TF), hemoglobin (HB), and serum iron (SI), were evaluated.


RESULTS
In comparison with those of the PRY, HL, JOP, and HLD groups, the patients of the RY group show greater weigh loss, and lower ALB, TP, and TF (all P < 0.05). The HB, SI, and TS levels in the JOP group and HLD group were significantly higher than those in the RY, PRY, and HL groups (all P < 0.05).


CONCLUSIONS
Different procedures of alimentary tract reconstruction after total gastrectomy have great influence on the patients' nutrition at different degrees. The patients undergoing the procedures with a reservoir show higher serum nutritional parameters and better body weight. The volume of reservoir has no major clinical importance. The jejunal pouch original interposition reconstruction modified by the authors (JOP), constructing a gastric reservoir and maintaining the alimentary tract flowing through the duodenum is an ideal choice for the reconstruction after total gastrectomy.
Zhang
Jian-Zhong
JZ
Department of Oncology, Union Hospital, Fujian Medical University, Fuzhou 350001, China.
Lu
Hui-Shan
HS
Wu
Xin-Yuan
XY
Huang
Chang-Ming
CM
Wang
Chuan
C
Guan
Guo-Xian
GX
Zhang
Xiang-Fu
XF
D000230:Adenocarcinoma / Q000378:metabolism / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000378:metabolism / Q000601:surgery; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000378:metabolism / Q000601:surgery*; D016896:Treatment Outcome