title: Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial.
abstract: OBJECTIVE
  Roux-en-Y reconstruction with and without jejunal pouch was compared in a randomized controlled trial to identify the optimal reconstruction procedure in terms of quality of life.
  
  
  BACKGROUND
  Randomized trials comparing techniques of reconstruction after total gastrectomy have shown controversial results.
  
  
  METHODS
  One hundred and thirty-eight patients with gastric cancer were intraoperatively randomized for Roux-en-Y reconstruction with pouch (n = 71) or without pouch (n = 67) after gastrectomy and stratified into curative or palliative resection. Intra- and postoperative complications were recorded. Body weight and quality of life were determined every 6 months with a follow-up of up to 12 years.
  
  
  RESULTS
  Both groups were comparable for age, sex, incidence of concomitant disease, and staging. There were no differences in operative time, postoperative complications, and mortality. Short- and long-term weight loss was similar in both groups. In the first postoperative year, there were no benefits of pouch reconstruction in terms of quality of life, independent of the resection status. In the third, fourth, and fifth year after surgery quality of life was significantly improved for patients with a pouch.
  
  
  CONCLUSIONS
  Roux-en-Y pouch reconstruction after gastrectomy is simple to perform and safe. Long-term survivors benefit from pouch reconstruction. Therefore, a pouch is recommended for patients with a good prognosis.
authors.affiliation: Department of Surgery, University of Wuerzburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Fein
authors.forename: Karl-Hermann
authors.initials: KH
authors.lastname: Fuchs
authors.forename: Andreas
authors.initials: A
authors.lastname: Thalheimer
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Freys
authors.forename: Johannes
authors.initials: J
authors.lastname: Heimbucher
authors.forename: Arnulf
authors.initials: A
authors.lastname: Thiede
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D039021:Colonic Pouches; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss