A Comparative Study of Double-Tract Reconstruction and Roux-en-Y After Gastrectomy for Gastric Cancer

Abstract

Background: The meta-analysis was performed to compare surgical and functional results of double-tract (DT) and Roux-en-Y (RY) reconstruction, applied in both partial and total gastrectomy. Methods: PubMed, Ovid, Web of Science, Wiley, EBSCO, and the Cochrane Library Central were searched for studies comparing DT and RY after partial or total gastrectomy. Surgical, nutritional, and long-term outcomes were collected and analyzed.Results: A total of 595 patients from 8 studies were included. Operative time, time to first flatus, length of hospital stays, complications, postoperative nutritional variables, and functional result were similar between 2 groups. Group DT had significantly less blood loss, shorter time to oral intake and less loss of body weight at 2 years after operation.Conclusions: DT reconstruction is comparable with RY after gastrectomy in safety, surgical outcomes including reflux symptom and postoperative recovery and shows better food intake and body weight maintenance.

Double-tract reconstruction for oesofagocardial gastric cancer: A systematic review

“…In the works of Kim DJ, Kim W et al, and Park et al the data on the lower requirement of vitamin B12 and iron preparations in the postoperative period in those that underwent DT are presented [ [31] , [32] ]. At the same time, other studies have provided data on the absence of a significant difference between changes in blood test parameters (haemoglobin, ferritin, ferritin saturation, total protein, albumin, and cholesterol) and the development of anaemia in those that underwent DT or TG [ 33 ]. For example, although ferritin and haemoglobin levels have been reported to be higher in those that underwent DT, the values of both those that underwent DT or TG were within the normal range.…”

Are There Advantages in Double Transit Reconstruction After Total Gastrectomy in Patients With Gastric Cancer? A Systematic Review

“…It is still a controversial issue in clinical research, though, whether reconstruction after total gastrectomy for gastric cancer should be done with or without some type of reservoir or placement of the duodenum in the alimentary transit 7 , 17 , 18 , 37 .…”

“…This technique has proven to be effective in reducing reflux symptoms and mixing bile and pancreatic juice with food, improving digestion and absorption. By allowing passage through the duodenum, it facilitates the investigation and treatment of biliary diseases that require endoscopic intervention, which is quite common in gastrectomized individuals 7 , 22 .…”

A review on double tract reconstruction after proximal gastrectomy for proximal gastric cancer

“…In some instances, these patients required management with a protein pump inhibitor (PPI) or other medications for symptom relief. Many studies have indicated that proximal gastrectomy with DTR is safe and depending on the case can provide better results when compared to TG [ 5 , [13] , [14] , [15] , [16] , [17] ].…”

“…Double tract means that two pathways have been formed for the passage of food; one for the entry of food into the stomach and duodenum (where most food is expected to flow into) and the other from the esophagus into the jejunum. DTR after proximal gastrectomy consists of three anastomoses: an esophagojejunostomy (EJ-stomy), a gastrojejunostomy (GJ-stomy) and a jejunostomy- jejunostomy (JD-stomy) [ 5 , 6 ]. DTR has been studied as an alternative reconstruction to TG for proximal gastric cancer (PGC) and, for certain patient populations has also become the choice of reconstruction.…”