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Park SH, Hur H, Park JH, Lee CM, Son YG, Jung MR, Lee HH, Hwang SH, Lee MS, Seo SH, Jeong IH, Son MW, Kim CH, Yoo MW, Oh SJ, Hwang SH, Il Choi S, Choi HS, Keum BR, Yang KS, Park S. Reappraisal of optimal reconstruction after distal gastrectomy - a study based on the KLASS-07 database. Int J Surg 2024; 110:32-44. [PMID: 37755373 PMCID: PMC10793744 DOI: 10.1097/js9.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUNDS This study aimed to compare the incidence of bile reflux, quality of life (QoL), and nutritional status among Billroth II (BII), Billroth II with Braun anastomosis (BII-B), and Roux-en-Y (RY) reconstruction after laparoscopic distal gastrectomy (LDG). MATERIALS AND METHODS We reviewed the prospective data of 397 patients from a multicentre database who underwent LDG for gastric cancer between 2018 and 2020 at 20 tertiary teaching hospitals in Korea. Postoperative endoscopic findings, QoL surveys using the European Organization for Research and Treatment of Cancer questionnaire (C30 and STO22), and nutritional and surgical outcomes were compared among groups. RESULTS In endoscopic findings, bile reflux was the lowest in the RY group ( n =67), followed by the BII-B ( n =183) and BII groups ( n =147) at 1 year (3.0 vs. 67.8 vs. 84.4%, all P <0.05). The anti-reflux capability of BII-B was statistically better than that of BII, but not as perfect as that of RY. From the perspective of QoL, BII-B was not inferior to RY, but better than BII reconstruction in causing fewer STO22 reflux symptoms at 6 and 12 months. However, only RY caused fewer C30 nausea symptoms than BII at 6 and 12 months, but not BII-B. Nutritional status and morbidities were similar among the three groups, and the operative time did not differ between the BII-B and RY groups. CONCLUSIONS BII-B cannot substitute for RY in preventing bile reflux, shortening the operative time, or reducing morbidities. Regarding short-term QoL, BII-B was sufficient to reduce STO22 reflux symptoms but failed to reduce C30 nausea symptoms postoperatively.
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Affiliation(s)
- Shin-Hoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon
| | - Jong-Hyun Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
| | - Chang-Min Lee
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Department of Surgery, Korea University Ansan Hospital, Ansan
| | - Young-Gil Son
- Department of Surgery, Keimyung University Dongsan Medical Centre, Daegu
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Jeollanam-do
| | - Han Hong Lee
- Department of Surgery, Catholic University of Seoul St Mary’s Hospital, Seoul, Republic of Korea
| | - Sun-Hwi Hwang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Moon-Soo Lee
- Department of Surgery, Eulji University Hospital, Daejeon
| | - Sang Hyuk Seo
- Department of Surgery, Busan Paik Hospital, Inje University
| | - In Ho Jeong
- Department of Surgery, Jeju National University School of Medicine, Jeju
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Hospital Cheonan, Cheonan
| | - Chang Hyun Kim
- Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Moon-Won Yoo
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan
| | - Seong Ho Hwang
- Department of Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul
| | - Hyuk Soon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Bo-Ra Keum
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul
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Role of New Anatomy, Biliopancreatic Reflux, and Helicobacter Pylori Status in Postgastrectomy Stump Cancer. J Clin Med 2022; 11:jcm11061498. [PMID: 35329824 PMCID: PMC8952228 DOI: 10.3390/jcm11061498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 01/14/2023] Open
Abstract
Distal gastrectomy for benign gastroduodenal peptic disease has become rare, but it still represents a widely adopted procedure for advanced and, in some countries, even for early distal gastric cancer. Survival rates following surgery for gastric malignancy are constantly improving, hence the residual mucosa of the gastric stump is exposed for a prolonged period to biliopancreatic reflux and, possibly, to Helicobacter pylori (HP) infection. Biliopancreatic reflux and HP infection are considered responsible for gastritis and metachronous carcinoma in the gastric stump after oncologic surgery. For gastrectomy patients, in addition to eradication treatment for cases that are already HP positive, endoscopic surveillance should also be recommended, for prompt surveillance and detection in the residual mucosa of any metaplastic-atrophic-dysplastic features following surgery.
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Ma F, Ma Y, Cui L, Zhao X, Wang B, Xue L, Wang H, Tian Y. Development and characterization of a mouse model of duodenogastric reflux. Life Sci 2020; 260:118412. [PMID: 32926924 DOI: 10.1016/j.lfs.2020.118412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 12/24/2022]
Abstract
AIMS Rat models of duodenogastric reflux have been used to study gastric stump cancer (GSC), but the underlying molecular mechanisms are poorly understood. Unlike rats, mice can be genetically modified, providing a superior model for studying the molecular mechanisms underlying GSC development, which is associated with duodenogastric reflux. This study aimed at developing a mouse model of duodenogastric reflux. MAIN METHOD C57BL/6 mice were randomly assigned to the control (n = 6), sham operation (n = 9), or gastrojejunostomy group (n = 12). Mice were sacrificed at 1, 3, and 6 months after surgery. Stomach tissue was stained with hematoxylin and eosin. Lesions were classified as chronic inflammation, intestinal metaplasia, or atypical hyperplasia. KEY FINDINGS Nine mice underwent gastrojejunostomy without mortality. The animals in the gastrojejunostomy group exhibited chronic inflammation at 1, 3, and 6 months after surgery, showing intestinal metaplasia (n = 2) and atypical hyperplasia (n = 1) at 3 months and intestinal metaplasia (n = 2) and atypical hyperplasia (n = 2) at 6 months. The mice in the control group did not exhibit chronic inflammation or intestinal metaplasia, whereas those in the sham operation group exhibited chronic inflammation at 1, 3, and 6 months after surgery, without intestinal metaplasia or atypical hyperplasia. Intestinal metaplasia or atypical hyperplasia were more common in the gastrojejunostomy group than in the sham operation group (p = 0.012). SIGNIFICANCE A duodenogastric reflux mouse model can be created using gastrojejunostomy without gastrectomy.
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Affiliation(s)
- Fuhai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yiming Ma
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Liang Cui
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xinhua Zhao
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hongying Wang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Yantao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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4
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Roux-en-Y versus Billroth I following distal gastrectomy. Eur Surg 2018. [DOI: 10.1007/s10353-018-0532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Comparison Between Billroth-II with Braun and Roux-en-Y Reconstruction After Laparoscopic Distal Gastrectomy. J Gastrointest Surg 2016; 20:1083-90. [PMID: 27067234 DOI: 10.1007/s11605-016-3138-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/22/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aims to compare the effectiveness of Billroth-II with Braun and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. METHODS From April 2010 to August 2012, 66 patients underwent laparoscopic distal gastrectomy (Billroth-II with Braun reconstruction, 26; Roux-en-Y, 40). The patients' data were collected prospectively and reviewed retrospectively. RESULTS The mean operation and reconstruction times were statistically shorter for Billroth-II with Braun reconstruction than Roux-en-Y (198.1 ± 33.0 vs. 242.3 ± 58.1 min, p = 0.001). One case of postoperative stricture was observed in each group. One case each of intra-abdominal abscess and delayed gastric emptying occurred in the Billroth-II with Braun group. At 1 year postoperatively, gastric residue and reflux esophagitis were not significantly different between the groups. Gastritis and bile reflux were more frequently observed in the Billroth-II with Braun group (p = 0.004 and p < 0.001, respectively). At 2 years postoperatively, gastric residue was not significantly different, but gastritis, bile reflux, and esophagitis were more frequent in the Billroth-II with Braun group (p = 0.029, p < 0.001, and p = 0.036, respectively). CONCLUSION The postoperative effectiveness of Roux-en-Y reconstruction may be superior to Billroth-II with Braun reconstruction after laparoscopic distal gastrectomy.
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Otsuka R, Natsume T, Maruyama T, Tanaka H, Matsuzaki H. Antecolic reconstruction is a predictor of the occurrence of roux stasis syndrome after distal gastrectomy. J Gastrointest Surg 2015; 19:821-4. [PMID: 25693423 DOI: 10.1007/s11605-015-2770-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/02/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Roux-en-Y reconstruction after distal gastrectomy can result in delayed gastric emptying, called Roux stasis syndrome (RSS). The cause of RSS has not been completely identified. This study retrospectively investigated the development of RSS. METHODS Between April 2008 and March 2014, we performed 138 procedures with distal gastrectomy using Roux-en-Y reconstruction. The development of RSS was analyzed and examined for correlations with the length of the operation, amount of blood loss, and surgical procedure. RESULTS RSS was observed in 16 of the 138 patients. There were no relationships between the length of the operation or amount of blood loss and the development of RSS according to the Mann-Whitney U test. There were also no significant differences in the development of RSS between the patients treated with laparotomy and laparoscopic surgery, end-to-side, side-to-side, or end-to-end anastomosis or isoperistaltic or antiperistaltic anastomosis, as determined using the chi-square test. However, the development of RSS tended to lower in the patients who underwent laparoscopic surgery, side-to-side anastomosis, and isoperistaltic anastomosis. In addition, there was a significant difference between the patients who received antecolic and retrocolic reconstruction (p=0.005). CONCLUSIONS Our findings suggest that antecolic reconstruction correlates with a lower likelihood of developing RSS.
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Affiliation(s)
- Ryota Otsuka
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1, Kanasugi, Funabashi-shi, Chiba, 273-8588, Japan,
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Pan Y, Mou YP, Chen K, Xu XW, Cai JQ, Wu D, Zhou YC. Three cases of laparoscopic total gastrectomy with intracorporeal esophagojejunostomy for gastric cancer in remnant stomach. World J Surg Oncol 2014; 12:342. [PMID: 25392032 PMCID: PMC4237785 DOI: 10.1186/1477-7819-12-342] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 10/20/2014] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer in remnant stomach is a rare tumor but with poor prognosis. Compared with conventional open surgery, laparoscopic gastrectomy has potential benefits for these patients due to advantages resulting from its minimally invasive approach. Herein, we report on three patients with gastric cancer in remnant stomach who underwent laparoscopic total gastrectomy with intracorporeal esophagojejunostomy successfully. The operative time was 280, 250 and 225 minutes, the estimated blood loss was 100, 80 and 50 ml and the length of postoperative hospital stay was seven, eight and nine days respectively. Our experience has suggested that laparoscopic total gastrectomy with intracorporeal esophagojejunostomy can be a safe, feasible and promising option for patients with gastric cancer in remnant stomach.
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Affiliation(s)
| | - Yi-Ping Mou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China.
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Lin YS, Chen MJ, Shih SC, Bair MJ, Fang CJ, Wang HY. Management of Helicobacter pylori infection after gastric surgery. World J Gastroenterol 2014; 20:5274-82. [PMID: 24833857 PMCID: PMC4017042 DOI: 10.3748/wjg.v20.i18.5274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/30/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
The Maastricht IV/Florence Consensus Report and the Second Asia-Pacific Consensus Guidelines strongly recommend eradication of Helicobacter pylori (H. pylori) in patients with previous gastric neoplasia who have undergone gastric surgery. However, the guidelines do not mention optimal timing, eradication regimens, diagnostic tools, and follow-up strategies for patients undergoing gastrectomy and do not indicate if eradication of H. pylori reduces the risk of marginal ulcer or stump cancer in the residual stomach after gastrectomy. The purpose of this review is to provide an update which may help physicians to properly manage H. pylori infection in patients who have undergone gastric surgery. This review focuses on (1) the microenvironment change in the stomach after gastrectomy; (2) the phenomenon of spontaneous clearance of H. pylori after gastrectomy; (3) the effects of H. pylori on gastric atrophy and intestinal metaplasia after gastrectomy; (4) incidence and clinical features of ulcers developing after gastrectomy; (5) does eradication of H. pylori reduce the risk of gastric stump cancer in the residual stomach? (6) does eradication of H. pylori reduce the risk of secondary metachronous gastric cancer in the residual stomach? and (7) optimal timing and regimens for H. pylori eradication, diagnostic tools and follow-up strategies for patients undergoing gastrectomy.
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Abstract
Alterations of the stomach mucosa in response to different adverse effects result in various morphological and clinical symptoms. Gastric mucosa alterations can be classified on the bases of diverse viewpoints. It makes this overview difficult, that identical toxic effects may cause different mucosal changes and different toxic agents may produce similar mucosal appearance. The more accurate understanding of the pathological processes which develop in the stomach mucosa needs reconsideration. The authors make an attempt to define gastritis and gastropathy in order to classify and present their features. Gastritis is a histological definition indicating mucosal inflammation. Acute gastritis is caused by infections. The two most important forms of chronic gastritis are metaplastic atrophic gastritis with an autoimmune origin and Helicobacter pylori inflammation. Gastropathy is the name of different structural alterations of the mucosa. Its most important feature is the paucity of inflammatory signs. Gastropathies can be divided into 4 categories based on the nature of the underlying pathological effect, on its morphological appearance and the way of the development. Differential diagnosis is an important pathological and clinical task because different treatment methods and prognosis.
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Affiliation(s)
- Emese Mihály
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Tamás Micsik
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Patológiai és Kísérleti Rákkutató Intézet Budapest
| | - Márk Juhász
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - László Herszényi
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Zsolt Tulassay
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088 Semmelweis Egyetem, Általános Orvostudományi Kar MTA-SE Molekuláris Medicina Kutatócsoport Budapest
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10
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Hirao M, Takiguchi S, Imamura H, Yamamoto K, Kurokawa Y, Fujita J, Kobayashi K, Kimura Y, Mori M, Doki Y. Comparison of Billroth I and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol 2012; 20:1591-7. [PMID: 23104705 DOI: 10.1245/s10434-012-2704-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE This randomized, controlled trial evaluated the clinical efficacy of Billroth I (BI) and Roux-en-Y (RY) reconstruction at 1 year after distal gastrectomy for gastric cancer. METHODS The primary end point was the amount of body weight lost at 1 postoperative year, and secondary end points included other items related to nutritional status such as serum albumin and lymphocyte count, as well as endoscopic examination findings of the remnant stomach and esophagus. Of the 332 patients enrolled, 163 were assigned to the BI group and 169 were randomized to the RY group. RESULTS The loss in body weight 1 year after surgery did not differ significantly between the BI and RY groups (9.1 % and 9.7 %, respectively, p = 0.39). There were no significant differences in other aspects of nutritional status between the 2 groups. Endoscopic examination 1 year after gastrectomy showed reflux esophagitis in 26 patients (17 %) in the BI group versus 10 patients (6 %) in the RY group (p = 0.0037), while remnant gastritis was observed in 71 patients (46 %) in the BI group versus 44 patients (28 %) in the RY group (p = 0.0013); differences were significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis. CONCLUSIONS RY reconstruction was not superior to BI in terms of body weight change or other aspects of nutritional status at 1 year after surgery, although RY more effectively prevented reflux esophagitis and remnant gastritis after distal gastrectomy.
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Affiliation(s)
- Motohiro Hirao
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
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Masui T, Kubora T, Nakanishi Y, Aoki K, Sugimoto S, Takamura M, Takeda H, Hashimoto K, Tokuka A. The flow angle beneath the gastrojejunostomy predicts delayed gastric emptying in Roux-en-Y reconstruction after distal gastrectomy. Gastric Cancer 2012; 15:281-6. [PMID: 22041869 DOI: 10.1007/s10120-011-0107-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 09/23/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Delayed gastric emptying without mechanical obstruction after Roux-en-Y reconstruction has been defined as Roux stasis syndrome. It occurs in 10-30% of patients after such reconstruction. So far, the cause of this stasis has not been completely identified. This study aimed to reduce Roux stasis using surgical techniques. METHODS From November 2007 to October 2010, we performed 101 distal gastrectomies with Roux-en-Y reconstruction. All the gastrojejunostomies were performed with end-to-end anastomoses. Roux stasis was analyzed with respect to tumor location, extent of the dissection, tumor progression, operation time, antecolic/retrocolic reconstruction, and the shape of the gastrojejunostomy. The shape of the gastrojejunostomy was evaluated by contrast gastroradiography 4 days after the operation. RESULTS Roux stasis syndrome was observed in 17 of the 101 patients. There was no relationship between the extent of the dissection, tumor progression, or operation time and the occurrence of Roux stasis. There was no difference in the incidence of Roux stasis between antecolic and retrocolic reconstructions. However, the group that displayed a straight anastomotic shape on contrast radiography demonstrated an apparently lower incidence of Roux stasis (p = 0.0003). In addition, Roux-en-Y reconstruction following gastric cancer was more frequently followed by Roux stasis in the antrum than in the midstomach (p = 0.0036). Cases of Roux stasis occurred 11.8 days after surgery on average and resolved within 2 weeks on average. CONCLUSIONS Our findings demonstrate the substantial benefits of a straight anastomosis of the gastrojejunostomy for the prevention of Roux stasis syndrome.
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Affiliation(s)
- Toshihiko Masui
- Department of Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
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Abstract
The first postgastrectomy syndrome was noted not long after the first gastrectomy was performed. The indications for gastric resection have changed dramatically over the past 4 decades, and the overall incidence of gastric resection has decreased. This article focuses on the small proportion of patients with severe, debilitating symptoms; these symptoms can challenge the acumen of the surgeon who is providing the patient's long-term follow-up and care. The article does not deal with the sequelae of bariatric surgery.
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Affiliation(s)
- John S Bolton
- Department of Surgery Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
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Hirao M, Kurokawa Y, Fujitani K, Tsujinaka T. Randomized controlled trial of Roux-en-Y versus rho-shaped-Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. World J Surg 2009; 33:290-5. [PMID: 19023614 DOI: 10.1007/s00268-008-9828-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The main advantage of the Roux-en-Y (RY) operation is that it prevents bile and pancreatic juice from reaching the gastric mucosa, although the gastrojejunostomy may cause functional delayed gastric emptying (DGE), known as RY stasis syndrome. Rho-shaped Roux-en-Y reconstruction (rRY), an RY reconstruction with a rho-shaped anastomosis, is an established operation that has been found to be effective in preventing DGE. METHODS We conducted the randomized trial of RY versus rRY reconstruction after gastric cancer resection. The primary endpoint was the frequency of DGE, and secondary endpoints were the length of postoperative hospital stay, morbidity, and nutritional status. Seventy patients were enrolled, with 35 in each group. RESULTS The incidences of postoperative mortality and morbidity did not differ significantly between the two groups. There were no significant differences in nutritional status between the two groups after discharge. Delayed gastric emptying occurred in two patients (6%) in the RY group and four patients (11%) in the rRY group (P = 0.67). Logistic regression analysis revealed that truncal vagotomy was significantly associated with DGE inhibition. CONCLUSIONS Our findings showed that RY reconstruction after gastrectomy may be as simple and sufficient as conventional reconstruction.
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Affiliation(s)
- Motohiro Hirao
- Department of Surgery, Osaka National Hospital, 2-1-14, Hoenzaka, Chuouku, Osaka, 540-0006, Japan.
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14
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Kondo T, Kitazawa R, Kitazawa S. Gastric remnant adenocarcinoma with micropapillary component. Dig Dis Sci 2008; 53:2287-9. [PMID: 18224441 DOI: 10.1007/s10620-007-0136-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Accepted: 11/24/2007] [Indexed: 02/07/2023]
Affiliation(s)
- Takeshi Kondo
- Division of Molecular Pathology, Department of Biomedical Informatics, Kobe University Graduate School of Medicine, Kobe, Japan
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15
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Greco L, Marino F, Troilo VL, Marzullo A, Gentile A. Gastric stump lymphoma after distal gastrectomy for benign peptic ulcer: Report of a case. Surg Today 2007; 36:985-8. [PMID: 17072720 DOI: 10.1007/s00595-006-3234-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 01/17/2006] [Indexed: 02/07/2023]
Abstract
We report a case of primary non-Hodgkin gastric stump lymphoma, found in a 78-year-old man 30 years after a distal gastrectomy for a benign peptic ulcer. The development of lymphoma in the gastric stump is rare. In fact, to our knowledge only 37 cases, including this one, have been documented. Although Helicobacter pylori is thought to be a predisposing factor, we found no histological evidence of this infection in our patient. Conversely, bile reflux and nitrite and N-nitrous compounds caused by abnormal bacterial growth in the gastric stump may play a role in inducing mucosa-associated lymphoid tissue lymphoma. The patient was treated by chemotherapy only, without surgery, which seems to be most appropriate for the early stages of this disease.
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Affiliation(s)
- Luigi Greco
- Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Units, University of Bari, P.za G. Cesare 11, 70124, Bari, Italy
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Chen L, Tian H, Chen J, He ZG, Tao SF, Lokesh G, Peng SY. Surgical management of gastric stump cancer: a report of 37 cases. J Zhejiang Univ Sci B 2005; 6:38-42. [PMID: 15593390 PMCID: PMC1390757 DOI: 10.1631/jzus.2005.b0038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To observe the clinicopathological characteristics of gastric stump cancer (GSC) and evaluate the benefits of radical surgery of GSC. METHODS The clinicopathological characteristics and postoperative survival time of 37 GSC patients who underwent surgery were investigated retrospectively. The survival time was compared according to the type of surgical operation (radical resection vs palliative operation). Twenty-one cases that received radical resection were analyzed based on the pTMN stage. Survival curves were traced by using Kaplan-Meier methods. RESULTS Most GSC (32/37) was detected in patients who had received Billroth II reconstruction after partial gastrectomy for benign gastric disease. The lesser curvature side and the suture line of anastomosis were the most frequent sites where GSC occurred (27/37). Differentiated adenocarcinoma was the dominant histopathological type (24/37). The postoperative 5-year survival rate of early stage GSC patients (n=9) was significantly higher than advanced stage GSC (n=12) (55.6% vs 16.5%, xL2=11.48, P<0.01). Five-year survival rate of 21 GSC patients with radical resection were 75% (3/4) for stage I, 60% (3/5) for stage II, 14.2% (1/7) for stage III, and 0% (0/5) for stage IV respectively. The median survival time of 21 GSC patients who underwent radical resection was longer than those undergoing palliative operation (43.0 m vs 13.0 m, x L2=36.31, P<0.01), the median survival time of stage IV patients with radical resection was 23.8 months. CONCLUSIONS Without remote metastasis, radical resection for GSC is possible, and is an effective way to improve the prognosis of GSC. Even in stage IV GSC, radical resection can still prolong the survival time. It is necessary for the patients with benign gastric diseases who received partial gastrectomy to carry out the endoscopy follow-up, especially in patients with Billroth II reconstruction procedure at 15-20 years.
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Affiliation(s)
- Li Chen
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
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