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

Abstract

Background Total gastrectomy has detrimental effects on postoperative nutritional status and quality of life (QOL), but it is often unavoidable in the treatment of gastric cancer. Roux-en-Y (RY) is the most common reconstruction method following total gastrectomy. Trials to explore other means of reconstruction have been conducted but have failed to identify a method that is globally accepted. Methods Aboral pouch reconstruction (AP), in which an anisoperistaltic jejunal pouch is created in the Y limb of the RY reconstruction, is considered effective and technically feasible. A prospective randomized trial was conducted to compare AP with RY. Gastric cancer patients requiring total gastrectomy for R0 resection were randomly assigned during surgery to receive either RY (n = 51) or AP (n = 49). Postoperative QOL as assessed by the EORTC QLQ-C30 and STO22, body composition, and morbidity were compared between the two reconstruction methods. The physical functioning score of the QLQ-C30 was selected as the primary endpoint. Results The incidences of postoperative complications were similar between the two groups (29 % in the RY group and 27 % in the AP group). No significant difference was observed in the physical functioning score, and the superiority of AP was demonstrated only for the nausea and vomiting score at 12 months (p = 0.041) and the reflux score at 1 month (p = 0.036). No significant differences were observed in body composition or serum biochemistry. Conclusions Although AP was safely implemented, no increased benefits in nutritional or QOL-related parameters were observed for this method over RY within 12 months postoperatively.

Long‐term effects of an oral elemental nutritional supplement on post‐gastrectomy body weight loss in gastric cancer patients (KSES002)

“…As remarkable BWL occurs especially after TG, various reconstruction methods have been applied, such as jejunal pouch, jejunal interposition, or double‐tract reconstruction. However, no prospective trials have achieved striking improvement with respect to BWL . Meanwhile, the ERAS protocol, which encompasses all types of perioperative management, has been recommended in gastric surgery for improving nitrogen balance under the condition of hypercatabolism associated with inflammatory reactions as a result of surgical stress, by shortening the fasting period as much as possible.…”

Long-term quality of life and nutrition status of the aboral pouch reconstruction after total gastrectomy for gastric cancer: a prospective multicenter observational study (CCOG1505)

“…Briefly, eligibility criteria of the CCOG 1101 trial included patients aged 20-80 years who underwent total gastrectomy for histologically confirmed adenocarcinoma of the stomach. Patients with cancer of the gastric remnant, those who failed to undergo R0 resection, those who were under systemic administration of corticosteroids and those with uncontrolled diabetes mellitus or other severe systematic diseases were excluded [11].The schemas of the RY and AP reconstruction were depicted in Supplemental Fig. 1.…”

“…In the original report by Horvath [9] that compared AP with RY, significantly higher serum cholesterol levels and superior postoperative quality of life in terms of the Gastrointestinal Quality of Life Index (GIQL1) score were observed in the AP group. Since this study was a single-center comparison analyzing short-term QOL with no data on body composition, we conducted a prospective multicenter randomized trial to compare nutritional status and QOL assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) and Stomach Module (STO22) [10] between the two groups (CCOG1101 / UMIN -CTR 000006155) [11], but failed to show benefit of AP over RY within 12 months postoperatively. We hypothesized, however, that the reconstruction procedure could still influence the QOL and nutritional outcomes in the long term [12].…”

Semi‐end‐to‐end esophagojejunostomy after laparoscopy‐assisted total gastrectomy better reduces stricture and leakage than the conventional end‐to‐side procedure: A retrospective study

“…However, the method by which to perform digestive tract reconstruction after TG was always considered the main obstacle for surgeons. ETS EJ after Roux‐en‐Y reconstruction was reported in 1947, and it became the most widely used reconstruction method because it could be simply performed with few anastomotic stoma and could effectively prevent reflux esophagitis …”

“…ETS EJ after Roux-en-Y reconstruction was reported in 1947, and it became the most widely used reconstruction method because it could be simply performed with few anastomotic stoma and could effectively prevent reflux esophagitis. [35][36][37] At present, most surgeons commonly perform lymphadenec- reported that the incidence of EJ stricture after LATG was 3.4%, and the incidence of EJ leakage was 7.6%. Lee et al 11 reported that a single center study on 67 LATG cases found that the incidence of EJ stricture after LATG was 9.0%, and the incidence of leakage was 1.5%.…”