Impact of reconstructive procedures with and without preserving the duodenal passage on body weight in patients after total gastrectomy for gastric cancer

Abstract

Introduction/Objective The ideal reconstruction procedure after total gastrectomy should replace all lost functions of the stomach. The aim of this study was to evaluate the usefulness of preserving the duodenal passage in subsequent improvement of body weight (BW) and body mass index (BMI) in patients with gastric cancer after total gastrectomy. Methods A total of 30 patients with gastric cancer were prospectively randomly divided into a group of reconstruction with double-tract (n = 15) and a group of reconstruction with simple Roux-en-Y after total gastrectomy. They were stratified by sex, age, their anthropometric measurements (BW, BMI), primary tumor localization, Lauren's classification, TNM stage classification, length of hospital stay, operation duration, postoperative complications, and mortality. Postoperatively, BW and BMI were measured at three, six, and 12 months and compared between the two groups. Results The clinical group of double-tract patients had significantly higher the values of BW in the postoperative period after six (66.6 ± 4.9 vs. 61.7 ± 7.6; p < 0.05 paired Student's t-test) and after 12 months (67.0 ± 4.9 vs. 62.3 ± 7.2; p < 0.05 paired Student's t-test) compared to the group of Roux-en-Y patients. On the other hand, the clinical group of double-tract patients also had significantly higher the values of BMI in postoperative period after 12 months (23.6 ± 1.1 vs. 22.5 ± 1.6; p < 0.05 paired Student's t-test) in relation to the Roux-en-Y group of patients. Conclusion Reconstruction procedure carried out after total gastrectomy which implies preserving the duodenal passage has significant increase of BW and BMI, compared to reconstruction procedure without the preservation of the duodenal passage.

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

“…Reasons included: unclarified reconstruction methods, mixed with reconstruction methods other than DT and RY, no outcome of interest, duplications. Finally, 8 studies [8][9][10][11][12][13][14][15] were eligible for the meta-analysis, among which, 2 were RCTs 9,10 and 6 were nonrandomized matched cohort studies. 8,[11][12][13][14][15] A summary of the included studies with the general clinical characteristics and quality assessment is shown in Table 1.…”

“…Patient age and gender were balanced between Group DT and Group RY in 6 studies. [10][11][12][13][14][15] Four studies [10][11][12][13][14] recorded body mass index (BMI) of both groups, with no significant difference. In all studies, gastrectomy was carried out for gastric carcinoma.…”

“…Six studies 9,10,[12][13][14][15] reported data of operative time. Metaanalysis showed no significant difference in operative time between Group DT and Group RY [WMD, −5.79; 95% confidence interval (CI), −21.06 to 9.48; P = 0.46, Table 2].…”

“…Three 10,12,14 and 2 studies 13,15 provided data of length of postoperative stay and total hospital stay, respectively. Meta-analysis showed that both postoperative stay and total hospital stay were similar between Group DT and Group RY (length of postoperative stay: WMD, −0.47; 95% CI, −2.37 to 1.42; P = 0.62; length of total hospital stay: WMD, 0.07; 95% CI, −0.68 to 0.81; P = 0.85, Table 2).…”

Reconstructive Procedures after Total Gastrectomy for Gastric Cancer

“…Relative pancreatic insufficiency may also lead to malabsorption of patients in whom reconstruction excludes the passage of food through the duodenum [54]. Studies have shown that patients with TG who have undergone DP prevention have less loss of body weight and body mass index and have fewer symptoms as consequences of RP [55][56][57][58]. Fat and protein malabsorption occurs in over 50% of patients after total gastrectomy.…”