title: Functional jejunal interposition, a reconstruction procedure, promotes functional outcomes after total gastrectomy.
abstract: BACKGROUND
  Functional jejunal interposition (FJI) has been applied as a reconstruction procedure to maintain the jejunal continuity and duodenal food passage after total gastrectomy in patients with gastric cancer. The purpose of this study was to evaluate clinical efficacy of the FJI procedure by comparing the functional outcomes of FJI to Roux-en-Y after total gastrectomy in gastric cancer patients, and investigate physiologic mechanisms by which FJI exerts beneficial outcomes in beagles.
  
  
  METHODS
  Patients with stage I-IV gastric cancer without metastasis and recurrence one year after surgery were enrolled in this retrospective study. Seventy one patients received FJI and seventy nine patients received Roux-en-Y after total gastrectomy. We evaluated the nutritional status at three and twelve months and incidence of complications up to twelve months after surgery. Beagles receiving sham operation, FJI, or Roux-en-Y after total gastrectomy were sacrificed forty eight hours postoperatively. Beagles were gavaged with active carbon for evaluating the intestinal transit rate. Intestinal tissues from the duodenojejunal anastomosis were collected for examining interstitial cells of Cajal (ICC), inflammation, and apoptosis.
  
  
  RESULTS
  Compared to the bodyweight before surgery, the bodyweight loss at three and twelve months after surgery in patients receiving FJI was significant less than that in patients with Roux-en-Y. Patients with the FJI procedure showed significant increase of blood hemoglobin and total protein, compared to those at one month after surgery, and the prognostic nutrition index scores at three and twelve months after surgery. The incidence rates of post-operative complications, including reflux esophagitis, dumping syndrome, and Roux-en-Y syndrome were decreased in patients with FJI. Compared to beagles receiving Roux-en-Y, more ICC in the intestinal submuocsa, less intestinal epithelial cell apoptosis, and decreased inflammation in serosal side of the intestine were found in the FJI group. The intestinal transit rate in FJI group was lower than that in Roux-en Y group, indicating that FJI benefits food storage.
  
  
  CONCLUSIONS
  The FJI procedure promotes nutritional recovery and decreases post-operative complications in gastric cancer patients after total gastrectomy, which may be through ameliorating intestinal inflammation and damage and reducing ICC loss to preserve food reservoir function and intestinal motility.
authors.affiliation: Department of Gastrointestinal Oncology, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, P.R. China.
authors.forename: Xuewei
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA.|Department of Immunology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, P.R. China.
authors.forename: Fang
authors.initials: F
authors.lastname: Yan
authors.affiliation: Department of Gastrointestinal Oncology, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, P.R. China.
authors.forename: Han
authors.initials: H
authors.lastname: Liang
authors.affiliation: Department of Gastrointestinal Oncology, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, P.R. China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Xue
authors.affiliation: Department of Laboratory Animal Science, Peking University Health Science Center, Beijing, P.R. China.
authors.forename: Kuo
authors.initials: K
authors.lastname: Zhang
authors.affiliation: Department of Immunology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, P.R. China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Immunology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, P.R. China.
authors.forename: Xiubao
authors.initials: X
authors.lastname: Ren
authors.affiliation: Department of Gastrointestinal Oncology, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, P.R. China. haoxishan@tjmuch.com.
authors.forename: Xishan
authors.initials: X
authors.lastname: Hao
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000818:Animals; D004285:Dogs; D004386:Duodenum / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome