Quality of life and nutritional consequences after aboral pouch reconstruction following total gastrectomy for gastric cancer: randomized controlled trial CCG1101.
BACKGROUND
Total gastrectomy has detrimental effects on postoperative nutritional status and quality of life (QOL), but it is often unavoidable in the treatment of gastric cancer. Roux-en-Y (RY) is the most common reconstruction method following total gastrectomy. Trials to explore other means of reconstruction have been conducted but have failed to identify a method that is globally accepted.


METHODS
Aboral pouch reconstruction (AP), in which an anisoperistaltic jejunal pouch is created in the Y limb of the RY reconstruction, is considered effective and technically feasible. A prospective randomized trial was conducted to compare AP with RY. Gastric cancer patients requiring total gastrectomy for R0 resection were randomly assigned during surgery to receive either RY (n = 51) or AP (n = 49). Postoperative QOL as assessed by the EORTC QLQ-C30 and STO22, body composition, and morbidity were compared between the two reconstruction methods. The physical functioning score of the QLQ-C30 was selected as the primary endpoint.


RESULTS
The incidences of postoperative complications were similar between the two groups (29 % in the RY group and 27 % in the AP group). No significant difference was observed in the physical functioning score, and the superiority of AP was demonstrated only for the nausea and vomiting score at 12 months (p = 0.041) and the reflux score at 1 month (p = 0.036). No significant differences were observed in body composition or serum biochemistry.


CONCLUSIONS
Although AP was safely implemented, no increased benefits in nutritional or QOL-related parameters were observed for this method over RY within 12 months postoperatively.
Department of Gastroenterological Surgery, Aichi Cancer Center Chuo Hospital, Nagoya, Japan.
Yuichi
Y
Ito
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Takaki
T
Yoshikawa
Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Michitaka
M
Fujiwara
Department of Gastroenterological Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
Hiroshi
H
Kojima
Department of Gastroenterological Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
Takanori
T
Matsui
Department of Surgery, Komaki Municipal Hospital, Komaki, Japan.
Yoshinari
Y
Mochizuki
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Haruhiko
H
Cho
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Toru
T
Aoyama
Department of Gastroenterological Surgery, Aichi Cancer Center Chuo Hospital, Nagoya, Japan.
Seiji
S
Ito
Department of Gastroenterological Surgery, Aichi Cancer Center Chuo Hospital, Nagoya, Japan.
Kazunari
K
Misawa
Department of Surgery, Nagoya Medical Center, Nagoya, Japan.
Hiroshi
H
Nakayama
Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan.
Yuki
Y
Morioka
Department of Surgery, Okazaki City Hospital, Okazaki, Japan.
Akiharu
A
Ishiyama
Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Chie
C
Tanaka
Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Satoshi
S
Morita
Tokai Central Hospital, Kagamigahara, Japan.
Junichi
J
Sakamoto
Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. ykodera@med.nagoya-u.ac.jp.
Yasuhiro
Y
Kodera
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009752:Nutritional Status; D011183:Postoperative Complications; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
Body composition; Jejunal pouch; Patient-reported outcome; Reconstruction; Total gastrectomy