Proximal Gastrectomy Reconstructed by Jejunal Pouch Interposition for Upper Third Gastric Cancer: Prospective Randomized Study

Abstract

Proximal gastrectomy with jejunal pouch interposition (PGJP) has been advocated as an alternative operation for upper third gastric cancer. However, there has been no prospective randomized trial comparing PGJP with total gastrectomy with Roux-en-Y esophagojejunostomy (TGRY). The aim of this study was to compare the short- and medium-term results of PGJP and TGRY in a randomized clinical trial. Fifty-one patients with upper third gastric cancer were randomized to either PGJP (n = 25) or TGRY (n = 26). Outcome measures were postoperative complications, nutritional status assessed by serum nutritional parameters, and postgastrectomy symptoms. There were no significant differences in operating time, hospital stay, and postoperative complications. Blood loss was significantly less in the PGJP group (P = 0.036). Nineteen patients (73%) in the TGRY group had one or more postgastrectomy symptoms, which was significantly more frequent than in the PGJP group (32%; P = 0.012). There were also significant differences between the two groups with regard to food intake, weight recovery, hemoglobin, and serum vitamin B12 levels in favor of PGJP. In conclusion, proximal gastrectomy with jejunal pouch interposition for upper third gastric cancer is safe, and is associated with a greater reduction in postgastrectomy symptoms and better nutritional status compared with conventional total gastrectomy.

Dilation and stasis: a rare but important late complication of jejunal pouch interposition after proximal gastrectomy

“…These considerations gave rise to interposition of the jejunal pouch after proximal gastrectomy, and several studies have reported on the advantages of this technique. For example, a prospective randomized study reported that proximal gastrectomy with JPI is superior to total gastrectomy in terms of several postoperative parameters, including post-gastrectomy symptoms, food intake, and weight recovery 2) . Similarly, a retrospective comparative study revealed that the food intake volume and QOL in the short term were significantly better in patients who underwent JPI after proximal gastrectomy than in those who underwent Roux-en-Y reconstruction after total gastrectomy 2) .…”

“…For example, a prospective randomized study reported that proximal gastrectomy with JPI is superior to total gastrectomy in terms of several postoperative parameters, including post-gastrectomy symptoms, food intake, and weight recovery 2) . Similarly, a retrospective comparative study revealed that the food intake volume and QOL in the short term were significantly better in patients who underwent JPI after proximal gastrectomy than in those who underwent Roux-en-Y reconstruction after total gastrectomy 2) . Furthermore, both retrospective and prospective randomized studies of the short-and medium-term postoperative results rated JPI after proximal gastrectomy better than simple jejunal interposition after proximal gastrectomy 8,13,14) .…”

“…Proximal gastrectomy is occasionally chosen for the treatment of gastric cancer located in the upper one-third of the stomach, with the aim of preserving gastric digestion 1,2) . Treatment efficacy is the prerequisite for this uncommon procedure.…”

“…In this context, although it is not frequently performed, the interposition of the jejunum with or without pouch formation remains an important reconstruction option. Moreover, recent studies indicate that the frequency of tumors located in the upper one-third of the stomach is increasing [5][6][7] suggesting that there will also be an increase in the number of patients Case Report Dilation and stasis: a rare but important late complication of jejunal pouch interposition after proximal gastrectomy Hiromichi Maeda 1) , Tsutomu Namikawa 2) , Ken Okamoto 1) , Eri Munekage 2) , Makoto Toi 3) , Makoto Hiroi 3) , Atsunori Takeshita 4) , Kazuhiro Hanazaki 2) , Michiya Kobayashi 1) needing to undergo proximal gastrectomy.…”

“…Several comparative studies have revealed that JPI after proximal gastrectomy has better short-and mediumterm postoperative outcomes, including better quality of life (QOL) scores, food intake, and body weight, than total gastrectomy or proximal gastrectomy with simple jejunal interposition 1,2,8) . However, the long-term outcomes of JPI after proximal gastrectomy have not been fully determined as yet.…”