Yuichi Ito1, Takaki Yoshikawa2, Michitaka Fujiwara3, Hiroshi Kojima4, Takanori Matsui4, Yoshinari Mochizuki5, Haruhiko Cho2, Toru Aoyama2, Seiji Ito1, Kazunari Misawa1, Hiroshi Nakayama6, Yuki Morioka7, Akiharu Ishiyama8, Chie Tanaka3, Satoshi Morita9, Junichi Sakamoto10, Yasuhiro Kodera11. 1. Department of Gastroenterological Surgery, Aichi Cancer Center Chuo Hospital, Nagoya, Japan. 2. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan. 3. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 4. Department of Gastroenterological Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan. 5. Department of Surgery, Komaki Municipal Hospital, Komaki, Japan. 6. Department of Surgery, Nagoya Medical Center, Nagoya, Japan. 7. Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan. 8. Department of Surgery, Okazaki City Hospital, Okazaki, Japan. 9. Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan. 10. Tokai Central Hospital, Kagamigahara, Japan. 11. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. ykodera@med.nagoya-u.ac.jp.
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.
RCT Entities:
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 cancerpatients 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.
Entities:
Keywords:
Body composition; Jejunal pouch; Patient-reported outcome; Reconstruction; Total gastrectomy
Authors: K Kobayashi; F Takeda; S Teramukai; I Gotoh; H Sakai; S Yoneda; Y Noguchi; H Ogasawara; K Yoshida Journal: Eur J Cancer Date: 1998-05 Impact factor: 9.162
Authors: Ralf Gertler; Robert Rosenberg; Marcus Feith; Tibor Schuster; Helmut Friess Journal: Am J Gastroenterol Date: 2009-08-11 Impact factor: 10.864