Improved quality of life with jejunal pouch reconstruction after total gastrectomy

Kono, Koji; Iizuka, Hidehiko; Sekikawa, Takayoshi; Sugai, Hidemitsu; Takahashi, Akihiro; Fujii, Hideki; Matsumoto, Yoshirou

doi:10.1016/s0002-9610(02)01211-4

Cited by 77 publications

(86 citation statements)

References 14 publications

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“…A number of studies have suggested that construction of a pouch may improve eating capacity and therefore reduce weight loss following gastrectomy; however, there has been little attempt at standardization of pouch design [10][11][12][13][14]. Furthermore, individual studies of pouch design are generally limited by small patient numbers, short follow-up, and variable outcome measures [10,[15][16][17].…”

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confidence: 99%

Optimal gastric pouch reconstruction post-gastrectomy

et al. 2008

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Optimal gastric pouch reconstruction post-gastrectomy

et al. 2008

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“…This goal is particularly important in the Far East where gastric cancer is often found at early clinical stages so that more patients manage to survive their cancer and consequently need to face the PGS in the long term [9]. It is known that the type of gastrectomy affects the incidence and severity of PGS [10][11][12][13][14][15][16][17][18][19][20][21], and various procedures to preserve or reconstruct gastric function have been proposed to confront these problems [7,8]. To gain deeper understanding of the PGS, a group of iatrogenic disorders, and treat them appropriately, it is important to grasp the impact of various symptoms, along with feeding problems and body weight loss, to the living status and QOL of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, investigators turned to the established and authorized questionnaires for comparisons between gastric surgery procedures [10-15, 18, 20], because there are several combinations of core questionnaires and disease-specific modules that are considered appropriate and have been approved for evaluation of QOL [23,24]. A combination of SF-36, a core questionnaire, and GSRS, a symptom-specific QOL, has been one of the examples [11,14], but the GSRS may have a tendency to overlook some of the symptoms that are peculiar to the patients who have undergone gastrectomy and are unusual for other disorders of the gastrointestinal tract. EORTC QLQ-C30 [25], a cancer-specific core questionnaire, and STO-22 [26] is another combination that has been used to evaluate postgastrectomy patients [12,13].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and clinical relevance of postgastrectomy syndrome assessment scale (PGSAS)-45: newly developed integrated questionnaires for assessment of living status and quality of life in postgastrectomy patients

et al. 2014

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Background Lack of a suitable instrument to comprehensively assess symptoms, living status, and quality of life in postgastrectomy patients prompted the authors to develop postgastrectomy syndrome assessment scale (PGSAS)-45. Methods PGSAS-45 consists of 45 items in total: 8 items from SF-8, 15 items from GSRS, and an additional 22 items selected by 47 gastric surgeons. Using the PGSAS-45, a multi-institutional survey was conducted to determine the prevalence of postgastrectomy syndrome and its impact on everyday life among patients who underwent various types of gastrectomy. Eligible data were obtained from 2,368 patients operated and followed at 52 institutions in Japan. Of these, data from 1,777 patients were used in the current study in which symptom subscales of the PGSAS-45 were determined. We also considered the characteristics of the postgastrectomy syndrome and to what extent these symptoms influence patients' living status and quality of life (QOL).Results By factor analysis, 23 symptom-related items of PGSAS-45 were successfully clustered into seven symptom subscales that represent esophageal reflux, abdominal pain, meal-related distress, indigestion, diarrhea, constipation, and dumping. These seven symptom subscales and two other subscales measuring quality of ingestion and dissatisfaction for daily life, respectively, had good internal consistency in terms of Cronbach 0 s a (0.65-0.88).

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“…Randomized studies published in this fi eld mainly question the importance of reservoir construction [1,[9][10][11][12][13][14][15][16][17][18][19][20][21][22]; fewer trials research the importance of duodenal passage preservation [11,14,[23][24][25][26]. Two expert reviews have been published, each trying to draw evidence-based conclusions by means of a metaanalysis of all available randomized trials [27,28].…”

Section: Discussionmentioning

confidence: 99%

“…Thus these higher albumin levels do not refl ect a better protein metabolism in the OP patients in general. Serum protein and albumin-as some of the most well-known nutritional laboratory measures-have been examined in some studies [11,19,21], but were found to be affected in only few [11,19]. Nakane et al [11] found a significantly higher protein level in patients with an oral pouch with duodenal exclusion reconstruction, compared to Roux-en-Y, 12 and 24 but not 6 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparing aboral versus oral pouch with preserved duodenal passage after total gastrectomy: does the position of the gastric substitute reservoir count?

et al. 2008

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ing the duodenum, and respond properly to the changing levels of gastrointestinal hormones and neural information. The science of surgery is nowhere near reaching this ideal. With the gold standard Roux-en-Y reconstruction so far achieved, gastrectomized patients do not suffer from alkaline esophagitis. Different pouch construction methods and reconstructions of the duodenal passage are being trialled to improve functional results.In our previous studies, a Roux-en-Y-based but distally reconstructed pouch-the aboral pouch-was compared to Roux-en-Y reconstruction, as well as being compared to reconstruction with an aboral pouch and duodenal passage preservation [1][2][3][4]. Absorption studies supported pouch construction; gastrointestinal hormone studies suggested the superiority of duodenal passage preservation [4]. In this study, the site of the pouch is examined; two different reconstruction types, the traditional oral pouch and the aboral pouch, are compared. Based on our gastrointestinal hormonal studies, we believe in the superiority of duodenal passage preservation, that is why both pouch reconstructions were performed with duodenal passage preservation. Patients and methods Eligibility criteria and randomizationAll patients with a disease necessitating total gastrectomy were investigated for eligibility to enter the trial. Patients younger than 80 years, who had no historical data of previous bowel resection and in whom kidney and liver function tests had shown normal results, and in whom R0 resection could be performed, were considered eligible. During the operation, after evaluation of the feasibility of both reconstruction methods and clearance for technical resectability, randomization was performed via the envelope selection method. AbstractBackground. Total gastrectomy results in a signifi cant weight loss, different postgastrectomy symptoms, and a reduction in quality of life. Elaborate surgical reconstruction methods are evaluated to improve results. The present study compares two types of reconstructions-an aboral pouch with preserved duodenal passage and an oral pouch with preserved duodenal passage-differing only in the site of the pouch. Methods. Twenty-eight patients entered the study. Primary outcome measures-body weight, body mass index, and quality of life, and secondary outcome measures-serum nutritional parameters, scintigraphic small-intestinal passage, and lipid and carbohydrate absorption were measured 6, 12, and 24 months after surgery. Results. No signifi cant differences were found in anthropometric parameters or in quality of life between the groups. Regarding the secondary outcome measures, albumin levels were higher in the oral pouch group, while protein and immunoglobulin-A levels were higher in the aboral pouch group. Conclusion. The site of the reservoir does not signifi cantly infl uence the outcome after total gastrectomy and reconstruction with a preserved duodenal passage.

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Improved quality of life with jejunal pouch reconstruction after total gastrectomy

Cited by 77 publications

References 14 publications

Optimal gastric pouch reconstruction post-gastrectomy

Optimal gastric pouch reconstruction post-gastrectomy

Characteristics and clinical relevance of postgastrectomy syndrome assessment scale (PGSAS)-45: newly developed integrated questionnaires for assessment of living status and quality of life in postgastrectomy patients

Comparing aboral versus oral pouch with preserved duodenal passage after total gastrectomy: does the position of the gastric substitute reservoir count?

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