Pouch versus esophagojejunostomy after total gastrectomy: A randomized clinical trial

Abstract

This is an interim report of a randomized clinical trial on esophagojejunostomy (E J) versusHunt-Lawrence-Rodino (HLR) pouch as reconstruction techniques following total gastrectomy and systematic lymphadenectomy for gastric cancer treatment. The randomized trial preceded a pilot study comparing the Longmire-Gutgemann interposition ant/ the HLR. The pilot study included 7 patients, the randomized trial 38 patients (60 planned). The main outcome variables in the pilot study were food resorption, caloric intake, and body weight. Survival probability and general well-being (quality of life) were measured in the randomized trial. A score was composed of diseasespecific and socio-personal variables with well-being ranging from 0 (worst) to 14 (best) points.Concerning food resorption in the pilot study, no relevant advantage of the duodenal passage was found. The main postoperative disorder was insufficient food intake. Despite a radical operation, a hospital mortality rate of 16%, and a complication rate of 37%, gastric cancer still has a poor prognosis. In the randomized trial only 15 (39%) of 38 patients were alive 1 year after operation, but the survival probability was higher (58%) after HLR than after EJ (24%) (p < 0.05). Hunger and appetite were strongly reduced during the first 6 months after operation. Food intake was less than half of the preoperative values, which was reflected by an average decrease in body weight of 7 kg.Patients dying within the first year after total gastrectomy suffered an irreversible loss of quality of life (scoring 7 points). They had no objective benefit from the operation. Patients surviving this period regained quality of life and exceeded preoperative values, especially after HLR.We conclude that HLR-operated patients who have a chance of surviving for at least 1 year benefit from total gastrectomy in regard to quality of life.

Quality of life and nutritional consequences after aboral pouch reconstruction following total gastrectomy for gastric cancer: randomized controlled trial CCG1101

“…Numerous other reconstruction methods have been proposed and explored, but the optimal method that is clinically beneficial, technically simple, and cost-effective remains elusive. Several studies have evaluated the effect of creating a jejunal pouch to compensate for the loss of reservoir capacity [2][3][4][5][6][7][8][9]. The construction of a pouch was once considered complex and time-consuming, but these disadvantages are no longer a concern in the era of mechanical staplers.…”

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

“…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].…”

Regular Scintigraphic Measurements of Food Transit Following Different Types of Reconstruction After Total Gastrectomy

“…13 In our trial, patients in the JIPP 15 cm group are the only ones who nearly achieved their preoperative food consumption patterns (normal amount of meals, 4-5 per day). This was especially so for those patients with a large pouch who came close to their preoperative body weight after 1 year and had only minor nutritional problems, indicating that a smaller pouch (7 cm) does not suffice.…”

“…This was especially so for those patients with a large pouch who came close to their preoperative body weight after 1 year and had only minor nutritional problems, indicating that a smaller pouch (7 cm) does not suffice. In their study Troidl et al 13 described the development of food intake after gastrectomy and the recovery of the patients with a HuntLawrence Rodino pouch compared with a Roux-en-Y reconstruction 6 months postoperatively. Patients who underwent a Roux-en-Y reconstruction did not exceed half of the preoperative food intake on average in contrast to patients with a pouch reconstruction.…”

“…The construction of a substitute gastric pouch has been proposed by some authors as a means of ameliorating postprandial symptoms and enhancing nutritional intake. 5,[13][14][15] The optimal pouch size and the functional effects of the JP have not yet been determined. To maintain the transit of food duodenally, some surgeons prefer the Longmire procedure with interposition of a jejunal segment between the esophagus and the duodenum.…”