title: Postoperative long-term evaluation of interposition reconstruction compared with Roux-en-Y after total gastrectomy in gastric cancer: prospective randomized controlled trial.
abstract: BACKGROUND
  The postoperative clinical superiority of the interposition of jejunum reconstruction (INT) to Roux-en-Y reconstruction (RY) after total gastrectomy has not been clarified. Postoperative quality of life (QOL) was evaluated between the 2 methods by a multi-institutional prospective randomized trial.
  
  
  METHODS
  A total of 103 patients with gastric cancer were prospectively randomly divided into groups for RY (n = 51) or INT reconstruction (n = 52) after total gastrectomy. They were stratified by sex, age, institute, histology, and degree of lymph node dissection. Postoperatively, body mass index (BMI) and nutritional conditions were measured serially, and QOL and postoperative squalor scores were evaluated at 3, 12, and 60 months and compared between the 2 groups.
  
  
  RESULTS
  After removing patients who did not complete the follow-up survey or censured cases, 24 patients in the RY group and 18 patients in the INT group were clinically available and their postoperative status was assessed. QOL scores were increased and complication scores were improved in the postoperative periods (P < .01). Postoperative BMI significantly deteriorated compared with preoperative BMI in each group. The postoperative QOL and complication scores at 60 months after surgery were significantly better than those at 3 months after surgery in each group (P < .01). However, there was no significant difference of QOL scores and postoperative complication scores between the 2 reconstruction groups. The nutritional condition in the INT group was nearly the same as that in the RY group.
  
  
  CONCLUSIONS
  Although our patient sample was small and patients who did not complete the follow-up survey were present, we could not identify any clinical difference between INT and RY after total gastrectomy 60 months after surgery. The safer and simpler RY method may be a more suitable reconstruction method than INT after total gastrectomy.
authors.affiliation: Office of the Japanese Society for Gastro-surgical Pathophysiology Groups, Department of Digestive Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. ishiga@m.kufm.kagoshima-u.ac.jp
authors.forename: Sumiya
authors.initials: S
authors.lastname: Ishigami
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hokita
authors.forename: Teruaki
authors.initials: T
authors.lastname: Aoki
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kashiwagi
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Sawada
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Yamamura
authors.forename: Seiji
authors.initials: S
authors.lastname: Itoh
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Ohta
authors.forename: Kenichi
authors.initials: K
authors.lastname: Mafune
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nakane
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kanda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furukawa
authors.forename: Iwao
authors.initials: I
authors.lastname: Sasaki
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kubota
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
authors.forename: Takashi
authors.initials: T
authors.lastname: Aikou
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015992:Body Mass Index; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011178:Postgastrectomy Syndromes / Q000209:etiology / Q000503:physiopathology*; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome