Reconstructive Procedures after Total Gastrectomy for Gastric Cancer

Abstract

Till this day, there are more than 60 described surgical procedures of the intestinal reconstructions after a total gastrectomy. In 1897, Schlatter reconstructed the digestive tract by creating a termino-lateral esophagojejunostomies that was the first successful total gastrectomy. Many of the total gastrectomy pioneers did the reconstruction by esophagoduodenostomy or by forming a loop esophagojejunostomy. The main reconstruction modalities after a total gastrectomy are a restitution of the intestinal continuity, without a preservation of the duodenal food passage (esophagojejunostomy with a Roux-en-Y configuration) and a restitution of the intestinal continuity with a preservation of the duodenal passage (esophagojejunostomy with Roux-en-Y configuration and forming of the lateral-terminal jejunoduodenal anastomosis double tract and jejunal interposition by Longmire). The surgeries in these categories can be combined with forming of an enteral pouch or a stomach reservoir which would simulate a reservoir of a normal intact stomach. The ideal reconstruction procedure after total gastrectomy should replace all lost functions of the stomach. Preservation of duodenal transit with replacement of the jejunal segment, the so-called physiological route, is now believed to be preferential for postoperative nutritional condition, prevents persistent postgastrectomy syndrome, and improves the quality of life. Reconstructive procedures which allow duodenal passage should be regarded as a key to physiological reconstruction.

A review on double tract reconstruction after proximal gastrectomy for proximal gastric cancer

“…There are conflicting reports of who invented the DTR technique, but a study reports that it was first mentioned by Japanese surgeons Kajitani and Sato [ 9 ]. DTR is classified as a duodenal preserving reconstructive method because it maintains the passage of food into the duodenum for digestion [ 10 ]. In this section the surgical procedure of DTR after PG is briefly explained.…”

“…After gastrectomy, surgical reconstruction aims at maintaining intestinal continuity, decreasing post-operative complications, and preserving good nutritional status. Gastric reconstructive procedures can be designed to either preserve the duodenal passage or without preserving the duodenal passage for food [ 4 , 10 ]. Many researchers have argued over the benefits of maintain the duodenal passage of food.…”

Nutritional Status and Related Factors in Patients with Gastric Cancer after Gastrectomy: A Cross-Sectional Study

“…They may even experience symptoms such Nutrients 2022, 14, 2634 2 of 12 as nausea, vomiting, bloating, abdominal pain, and diarrhea or suffer dysphagia [5]. Severe symptoms can cause further psychological distress [7] and negatively impact the patient's food intake [8,9]. Emotional distress, symptom disturbance, and cancer-related inflammation can increase protein energy-wasting, which leads to reduced body weight [10].…”

“…Knowledge regarding factors influencing patients' nutritional status can inform the development of appropriate measures to improve patients' nutrition quality. Previous studies have shown that gastrointestinal symptoms [8], depression [7], and difficulties with diet preparation [19] might affect the nutrient intake of patients. However, most of these studies were conducted in western countries on patients with other cancers.…”