Long-Term Benefits of Roux-en-Y Pouch Reconstruction After Total Gastrectomy

Fein, Martin; Fuchs, Karl–Hermann; Thalheimer, Andreas; Freys, Stephan M.; Heimbucher, J.; Thiede, A.

doi:10.1097/sla.0b013e318167748c

Cited by 147 publications

(94 citation statements)

References 24 publications

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“…Previous studies reported that BWL after gastrectomy was approximately 10-20 % of the preoperative weight [3]. For example, Noguchi et al [17] evaluated 97 patients who had undergone gastrectomy, and found that the mean body weight at discharge was 79 ± 7 % in the total gastrectomy group and 84 ± 7 % in the distal gastrectomy group This discrepancy could be explained by the following factors.…”

Section: Discussionmentioning

confidence: 58%

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Body composition analysis within 1 month after gastrectomy for gastric cancer

et al. 2015

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Background A significant body weight loss (BWL) is observed during 1 month after gastrectomy for gastric cancer. However, it remains unclear which body component mainly accounts for the weight loss. Methods Two-hundred forty-four patients who underwent gastrectomy for gastric cancer between May 2010 and October 2013 were examined. Body weight and composition were evaluated by a bioelectrical impedance analyzer within 1 week before surgery (first measurement), at 1 week after surgery (second measurement), and at 1 month after surgery (third measurement). The changes in the early period were defined as the differences until the second measurement, and those in the late period were defined as the differences from the second to the third measurement. Results Total BWL within 1 month was -3.4 kg, and the rate of body weight at 1 month to the preoperative body weight was 94.1 %. BWL was significantly greater in the early period than in the late period (-2.1 kg vs -1.2 kg, p \ 0.001). In the early period, loss of lean body mass was significantly greater than loss of fat mass (-1.5 kg vs -0.6 kg, p \ 0.001). The same trend was observed when the subset of patients who had surgical morbidities was excluded.Conclusion BWL during the first week after surgery was significantly greater than that during the subsequent 3 weeks. Furthermore, loss of lean body mass accounted for a significant part of the BWL during the first week.

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Section: Discussionmentioning

confidence: 58%

“…Body weight loss (BWL) is a common problem after gastrectomy for gastric cancer, and occurs during the initial 1-3 months after surgery [2]. Previous studies demonstrated that BWL after gastrectomy was approximately 10-20 % of the preoperative body weight [3].…”

Section: Introductionmentioning

confidence: 99%

Body composition analysis within 1 month after gastrectomy for gastric cancer

et al. 2015

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“…Although various mechanisms have been considered, such as the perturbation of absorption due to reduced pancreatic excretion [4,5], a decrease in the gastric acid level [6], reflux esophagitis [7], intestinal floral alteration [8], and increased peristalsis and diarrhea [9], reduced food intake [10,11] is the most conceivable explanation for weight loss after gastrectomy. To combat loss of appetite, surgeons dealing with gastric cancers have tried to increase food intake by producing a gastric substitute, such as a jejunal pouch, with limited success [12]. However, we frequently observe that patients do not exhibit significant weight loss after total gastrectomy when they resort to small but frequent meals.…”

Section: Introductionmentioning

confidence: 99%

Clinical application of ghrelin administration for gastric cancer patients undergoing gastrectomy

et al. 2013

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Loss of body weight is a common (and the most serious) sequela after gastrectomy. It impairs quality of life, increases various diseases including infection, and may affect long-term survival. Ghrelin, an intrinsic ligand of the growth hormone secretagogue receptor, was discovered in the stomach in 1999. In addition to growth hormone secretion, ghrelin has pleiotropic functions including appetite stimulation, increasing bowel movement and absorption, and anti-inflammatory reactions. In consequence, ghrelin comprehensively leads positive energy balance and weight gain. The fundic gland of the stomach produces the majority of ghrelin, and plasma ghrelin declines to 10-30 % of the preoperative level after total gastrectomy and 50-70 % after distal gastrectomy. Although plasma ghrelin is never restored after total gastrectomy, it gradually recovers to the preoperative level within a few years after distal gastrectomy. Chronic gastritis due to Helicobacter pylori infection and vagotomy are additional factors that perturb the ghrelin secretion of gastric cancer patients after gastrectomy. A randomized clinical trial that revealed that recombinant ghrelin administration successfully increased both food intake and appetite, and ameliorated weight loss after total gastrectomy. Ghrelin administration could thus be a promising strategy to transiently improve the nutritional status of patients who who have undergone gastrectomy, but its effect in the long term remains unclear. Further studies are warranted to elucidate the mechanism of ghrelin and to create and evaluate the analogs that could be administered orally or subcutaneously.

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“…The length of the incision on the stomach is important for avoiding stenosis, because it determines the size of the stoma. The mean percent body weight loss in our patients at 12 months after surgery was 10 %, which seems to be less than that with total gastrectomy [16,17]. Although the nutritional status was not examined in detail in this study, proximal gastrectomy may also benefit patients from the nutritional point of view.…”

Section: Discussionmentioning

confidence: 79%

Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler

et al. 2012

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Proximal gastrectomy has been applied for selected patients with early upper gastric cancer, because of its potential advantages over total gastrectomy, such as preserving gastric capacity and entailing fewer hormonal and nutritional deficiencies. Esophago-gastric anastomosis is a simple reconstruction method with an excellent postoperative outcome provided that gastroesophageal reflux is properly prevented. Following open surgery, the esophagus is anastomosed to the anterior stomach wall with partial fundoplication to prevent esophageal reflux. We developed a novel laparoscopic hand-sewn method to reproduce the anti-reflux procedure that is used in open surgery. The esophagus is first fixed to the anterior stomach wall with a knifeless endoscopic linear stapler. This fixation contributes to maintaining a stable field for easier hand-sewn anastomosis, and allows us to complete the left side of the fundoplication at the same time. This novel technique was used to successfully perform complete laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis in ten patients, without any postoperative complications. No patient had symptoms of gastroesophageal reflux during a median follow-up period of 19.9 months. One patient developed anastomotic stenosis, and this was resolved with endoscopic dilatation. The mean percent body weight loss at 12 months after surgery, in comparison to the preoperative weight, was 10.4 %. Laparoscopic proximal gastrectomy with an esophago-gastric anastomosis using our novel technique would be a feasible choice would be a feasible choice and would show benefit for selected patients with early upper gastric cancer.

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Long-Term Benefits of Roux-en-Y Pouch Reconstruction After Total Gastrectomy

Abstract: Roux-en-Y pouch reconstruction after gastrectomy is simple to perform and safe. Long-term survivors benefit from pouch reconstruction. Therefore, a pouch is recommended for patients with a good prognosis.

Cited by 147 publications

References 24 publications

Body composition analysis within 1 month after gastrectomy for gastric cancer

Body composition analysis within 1 month after gastrectomy for gastric cancer

Clinical application of ghrelin administration for gastric cancer patients undergoing gastrectomy

Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler

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