Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan

Abstract

The Japanese Society for the Study of Postoperative Morbidity after Gastrectomy conducted a nationwide questionnaire survey to clarify the current status of reconstruction after gastrectomy. One hundred and forty-five institutions (66%) responded to the survey. The questionnaire dealt with the reconstruction after a distal gastrectomy, pylorus-preserving gastrectomy (PPG), total gastrectomy, and proximal gastrectomy. The most common method of reconstruction after distal gastrectomy was Billroth I in 112 institutions (74%), and Roux-en-Y (RY) in 30 (21%). Seventy-seven institutions (53%) responded to the PPG questions. The lengths of the antral cuff were widely distributed among the institutions. Segmental gastrectomy was performed by 23 institutions for limited cases. The most common method of reconstruction after total gastrectomy was RY in 138 institutions (95%). Reconstruction with a pouch after total gastrectomy was done in 26 institutions (18%). The most common reconstructions after proximal gastrectomy were esophagogastrostomy in 69 institutions (48%), jejunal interposition in 41 (28%), double tract in 19 (13%) and pouch reconstruction in 6 (7%). Although most Japanese surgeons are concerned about the revised methods of reconstruction and quality of life after gastrectomy, surgeons have not yet reached a full consensus on these issues.

Proximal gastrectomy with exclusion of no. 3b lesser curvature lymph node dissection could be indicated for patients with advanced upper-third gastric cancer

“…c Distribution of the left gastric artery (LGA) and the right gastric artery (RGA) at the lesser curvature of the stomach gastric stasis that mainly depends on esophagogastric anastomosis remains a potential disadvantage [24]. Several reconstruction methods, such as jejunal interposition [9,16] or the double tract method [25], are used to prevent regurgitation of the gastric contents, but these procedures are slightly complicated and no general agreement exists regarding the optimal reconstruction procedures. The reasons why on -third of patients with a T1 U tumor received total gastrectomy in our institute may be related to this problem.…”

Factors that minimize postgastrectomy symptoms following pylorus-preserving gastrectomy: assessment using a newly developed scale (PGSAS-45)

“…Patients who undergo gastrectomy often suffer from PGS, resulting in a decrease in their QOL [13]. Therefore, function-preserving operations including PPG have been introduced to prevent this syndrome [1,5,7].…”

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

“…There are various reconstruction techniques that can be used after proximal gastrectomy, including esophagogastrostomy, jejunal interposition, double tract, and jejunal pouch interposition (JPI). A nationwide survey in Japan revealed that JPI was the most common reconstruction method in only 7% of 154 institutes surveyed; in comparison, 49% of institutes reported esophagogastrostomy as the most common technique 4) . However, to prevent reflux esophagitis, jejunal interposition is generally required when the remnant stomach is less than onethird of the entire stomach 4) .…”

“…A nationwide survey in Japan revealed that JPI was the most common reconstruction method in only 7% of 154 institutes surveyed; in comparison, 49% of institutes reported esophagogastrostomy as the most common technique 4) . However, to prevent reflux esophagitis, jejunal interposition is generally required when the remnant stomach is less than onethird of the entire stomach 4) . In this context, although it is not frequently performed, the interposition of the jejunum with or without pouch formation remains an important reconstruction option.…”

“…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.…”