Reconstruction after gastrectomy and quality of life

Abstract

To evaluate quality of life and functional results following surgery for gastric cancer we studied 104 patients with no evidence of disease at a minimum of 12 months postoperatively. Patients were treated with total gastrectomy and jejunal pouch reconstruction according to Hunt-Lawrence-Rodino (n = 59) or simple esophagojejunostomy (n = 24) and distal subtotal gastrectomy (n = 21). No significant differences were found between total gastrectomy with pouch reconstruction and distal gastric resection with respect to dumping or heartburn, whereas patients with total gastrectomy and restoration with esophagojejunostomy suffered from both. The latter group of patients also had reduced nutritional status. Although there is a lack of a proper definition of quality of life, all instruments applied to its measurement indicated improved results for patients with pouch reconstruction and those after distal gastrectomy, but we could not state any significant differences. We conclude that in terms of postoperative functional results as well as quality of distal gastric resection has no advantage over total gastrectomy with pouch reconstruction; hence a reduction of surgical radicality in an attempt to improve postoperative results is not justified. Pouch reconstruction should be considered the treatment of choice for reconstruction after total gastrectomy.

Total Gastrectomy Severely Alters the Central Regulation of Food Intake in Rats

“…As the feeding system is characterized by redundancy and adaptability, 37,49,50 the organism can adapt after gastrectomy to a certain extent, but probably at the expense of a reduced quality of life. 28,30,51,52 Rather than looking for a perfect reconstruction method, it might be worth looking at pathways that regulate food intake after total gastrectomy. The manipulation of these pathways by defined receptor agonist or antagonist treatments might be an alternative way to increase body weight after total gastrectomy, 18,43,53 possibly alleviating the sequelae of total gastrectomy for these patients.…”

Postoperative Adjuvant Therapy Is an Important Factor in Surgical Management of Resectable Distal Gastric Carcinoma With D2 Lymph Node Dissection

“…On the other hand, Davies et al, (Davies, Johnston et al, 1998) and Jentschura et al, (Jentschura, Winkler et al, 1997) reported that at one year after surgery, DG patients had a significantly better quality of life than TG patients. The QOL ANNALS OF Cancer Research and Therapy of patients who underwent subtotal gastrectomy was also significantly better after surgery than before, whereas the QOL of the TG group was not significantly better after the operation than before it (Buhl, Lehnert et al, 1995, Jentschura, Winkler et al, 1997, Svedlund, Sullivan et al, 1997, Davies, Johnston et al, 1998. Chareton, Landen et al, (1996) andFuchs, Thiede et al, (1995) also failed to demonstrate that the reconstruction of the duodenal passage was a significant predictor of long-term survival, although several studies have proposed that the theoretical advantages of this surgical procedure are that patients will have a significantly better life quality, higher body weight, and better physiologic regulation of gastrointestinal hormones (Del Gaudio, Marzo et al, 1991, Schwarz, Buchler et al, 1996.…”

“…Although many studies have attempted to determine the minimal amount of gastric resection followed by duodenal food passage reconstruction (DFPR), the theoretical advantage of this minimalist approach has not been confirmed (Espat and Karpeh 1998). As for operating time, infra-and post-operative complications, patient body weight, functional assessment, and quality of life, the minimal gastric resection followed by DFPR produced better outcomes than did extensive gastric resection without DFPR (Buhl, Lehnert et al, 1995, Jentschura, Winkler et al, 1997, Svedlund, Sullivan et al, 1997, Davies, Johnston et al, 1998. The long-term consequences of gastrectomy and of different reconstructive techniques are still a matter of controversy.…”

Cancer de l’estomac : prise en charge chirurgicale

“…La plupart des patients inclus dans ces essais étaient porteurs d'un cancer gastrique avancé ;o r, la récidive tumorale constitue un événement majeur altérant la qualité de vie. Ce phénomène explique probablement, en partie, pourquoi la qualité de vie àlong terme af inalement tendance às 'améliorer quel que soit le montage [66,67]. L'ensemble de ces éléments explique le faible niveau de preuve sur l'intérêt d'un type de rétablissement de continuité par rapport àunautreaprès gastrectomie totale.…”