Wei M, Jiang HB, Wang YY, Shi YH, Han Z, Gao YC. Control observation of different digestive tract reconstruction methods in total gastrectomy for gastric cancer. World J Gastrointest Surg 2025; 17(4): 101599 [DOI: 10.4240/wjgs.v17.i4.101599]
Corresponding Author of This Article
Ying-Chao Gao, Associate Chief Physician, Department of Gastrointestinal Diagnosis and Treatment, First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang 050031, Hebei Province, China. gaoyingchao2000@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ming Wei, Hai-Bo Jiang, Yuan-Yuan Wang, Zhe Han, Department of Gastroenterology, Second Department of Diagnosis and Treatment, The First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
Ya-Hong Shi, Department of Stomatology, Second Hospital of Shijiazhuang, Shijiazhuang 050000, Hebei Province, China
Ying-Chao Gao, Department of Gastrointestinal Diagnosis and Treatment, First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
Co-first authors: Ming Wei and Hai-Bo Jiang.
Author contributions: Wei M, Jiang HB was the guarantor and designed the study; Wang YY, Shi YH, Han Z, participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Gao YC revised the article critically for important intellectual content.
Institutional review board statement: This study was approved by the Ethics Committee of The First Hospital of Hebei Medical University (approval No. 20220651).
Informed consent statement: Informed consent has been obtained from every participant.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data can be obtained from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Chao Gao, Associate Chief Physician, Department of Gastrointestinal Diagnosis and Treatment, First Hospital of Hebei Medical University, No. 89 Donggang Road, Yuhua District, Shijiazhuang 050031, Hebei Province, China. gaoyingchao2000@163.com
Received: October 31, 2024 Revised: December 4, 2024 Accepted: March 5, 2025 Published online: April 27, 2025 Processing time: 148 Days and 22.5 Hours
Abstract
BACKGROUND
For patients with advanced gastric cancer, surgical resection remains the main treatment option. Total gastrectomy combined with radical resection of gastric cancer lesions and sentinel lymph nodes can significantly prolong the survival of patients. Digestive tract reconstruction after total gastrectomy is essential to maintain gastrointestinal function and optimize postoperative recovery. Therefore, it is very important to choose a suitable reconstruction method to improve the quality of life of total gastrectomy patients.
AIM
To evaluate the effects of different digestive tract reconstruction methods in gastric cancer patients undergoing total gastrectomy.
METHODS
This retrospective study included 172 patients who underwent total gastrectomy for gastric cancer at The First Hospital of Hebei Medical University for analysis. The patients were categorized into two groups: Group A, consisting of 90 patients who underwent modified Roux-en-Y gastrojejunostomy, and group B, consisting of 82 patients who underwent uncut Roux-en-Y gastrojejunostomy. The general patient characteristics, perioperative indicators, postoperative gastrointestinal mucosal barrier function, nutritional status, immunological markers, and occurrence of complications were compared between the two groups.
RESULTS
Group A showed shorter digestive tract reconstruction time than group B (P < 0.05). On the first postoperative day, group A showed lower serum levels of D-lactate, diamine oxidase, and endotoxin than group B (P < 0.05). One month postoperatively, group A showed higher prognostic nutritional index, serum albumin, total protein, and body weight than group B (P < 0.05). One month postoperatively, the levels of cluster of differentiation (CD) 3 +, CD4 +, and CD8 + cells were not significantly different between two groups (P > 0.05). The complication rates were 10.00% in group A and 24.39% in group B; group A had a significantly lower complication rate than group B (P < 0.05).
CONCLUSION
Using modified Roux-en-Y gastrojejunostomy during total gastrectomy shortens the time required for gastrointestinal anastomosis, reduces surgery-induced gastrointestinal mucosal damage, and mitigates postoperative declines in nutritional status.
Core Tip: Total gastrectomy combined with radical resection of gastric cancer lesions and sentinel lymph nodes can significantly prolong the survival of patients. Postoperative digestive tract reconstruction is crucial to maintain gastrointestinal function and optimize postoperative recovery. This study found that the application of modified Roux-en-Y gastrojejunostomy in total gastrectomy shortened the gastrointestinal anastomosis time, reduced the gastrointestinal mucosal injury caused by the operation, and alleviated the decline in postoperative nutritional status. This approach also reduces the overall incidence of surgical complications.
