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Realis Luc M, Bonomi AM, Carbone F, Ascari F, de Pascale S, Fumagalli Romario U. Roux-en-Y with or without jejunal J-pouch reconstruction after total gastrectomy for gastric cancer: systematic review and meta-analysis of long-term functional outcomes. J Gastrointest Surg 2024; 28:291-300. [PMID: 38445924 DOI: 10.1016/j.gassur.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/16/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Increased survival of patients undergoing total gastrectomy for gastric cancer has prompted several efforts to improve long-term postgastrectomy syndrome (PGS) outcomes. Whether a J-pouch (JP) reconstruction may be more beneficial than a standard Roux-en-Y (RY) is controversial. METHODS A systematic review with meta-analysis was conducted, including studies reporting long-term outcomes of patients treated with total gastrectomy and JP vs RY esophagojejunostomy for gastric adenocarcinoma. A literature search was performed on PubMed, Scopus, and Google Scholar. Primary endpoints were symptom control, weight loss, eating capacity (EC), and quality of life (QoL) with at least 6 months of follow-up. Safety endpoints were explored. RESULTS Overall, 892 patients were included from 15 studies (6 randomized controlled trials [RCTs] and 9 non-RCTs): 452 (50.7%) in the JP group and 440 (49.3%) in the RY group. Compared with RY, JP showed a significantly lower rate of dumping syndrome (13.8% vs 26.9%, odds ratio [OR], 0.29; 95% confidence interval [CI], 0.14-0.58; P < .001; I2 = 22%) and heartburn symptoms (20.4% vs 39.0%; OR, 0.29; 95% CI, 0.14-0.64; P = .002; I2 = 0%). Reflux (OR, 0.61; 95% CI, 0.28-1.32; P = .21; I2 = 42%) and epigastric fullness (OR, 0.60; 95% CI, 0.18-2.05; P = .41; I2 = 69%) were similar in both groups. Weight loss and EC were similar between the groups. QoL outcome seemed to be burdened by bias. There was no difference in morbidity, mortality, and anastomotic leak rate between groups. Operative time was significantly longer for JP than for RY (271.9 vs 251.6 minutes, respectively; mean difference, 21.55; 95% CI, 4.64-38.47; P = .01; I2 = 96%). CONCLUSION JP reconstruction after total gastrectomy for gastric cancer is as safe as RY and may provide an advantage in postgastrectomy dumping syndrome and heartburn symptoms.
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Affiliation(s)
- Marco Realis Luc
- Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy; University of Milan, Milan, Italy
| | - Alessandro Michele Bonomi
- Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy; University of Milan, Milan, Italy
| | - Fabio Carbone
- Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy.
| | - Filippo Ascari
- Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy
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Xu JY, Zhang S, Song C, Jiang XH. [Effects of gastrectomy on quality of life of patients with gastric cancer and its evaluation methods]. Zhonghua Wei Chang Wai Ke Za Zhi 2022; 25:636-644. [PMID: 35844129 DOI: 10.3760/cma.j.cn441530-20220115-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Surgery is the main curative treatment for gastric cancer. As surgical techniques continue to improve, the scope of radical resection and lymph node dissection has formed consensus and guidelines, so people's attention has gradually shifted to the quality of life (QOL) of patients after surgery. Postgastrectomy syndrome is a series of symptoms and signs caused by complications after gastrectomy, which can affect the quality of life of patients with gastric cancer after surgery. Gastrectomy and anastomosis are closely related to postgastrectomy syndrome. The selection of appropriate surgical methods is very important to the quality of life of patients after surgery. This article reviews the effects of gastrectomy procedures on postoperative quality of life of patients with gastric cancer and its evaluation methods.
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Affiliation(s)
- J Y Xu
- Deparment of Gastrointestinal Surgery, Shanghai East Hospital, Shanghai 200120, China
| | - S Zhang
- Deparment of Gastrointestinal Surgery, Shanghai East Hospital, Shanghai 200120, China
| | - C Song
- Deparment of Gastrointestinal Surgery, Shanghai East Hospital, Shanghai 200120, China
| | - X H Jiang
- Deparment of Gastrointestinal Surgery, Shanghai East Hospital, Shanghai 200120, China
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Lochman P, Kočí J, Páral J. Quality of life after proximal gastrectomy a review. Rozhl Chir 2018; 97:368-372. [PMID: 30441989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The quality of life in cancer patients has received increasing interest recently. The results published to date have shown a potential benefit of proximal gastrectomy compared to total gastrectomy as regards long-term improvement in the quality of life. Up to 70% of gastrectomized patients suffer from various symptoms negatively influencing the postoperative quality of life. These symptoms are collectively referred to as postgastrectomy syndrome. Proximal gastrectomy may be more beneficial as opposed to total gastrectomy since it preserves a functional part of the stomach and allows alleviation of these symptoms. Numerous questionnaires are used to evaluate the quality of life in gastric cancer patients. The PGSAS-45 questionnaire of the Japanese Postgastrectomy Syndrome Working Party is probably the best validated one. Results of works published to date evaluating the quality of life after proximal gastrectomy are summarized in the text and an overview of basic evaluated parameters is presented. CONCLUSION The works published so far related to quality of life after proximal gastrectomy have described outcomes only in patients with early gastric cancers or in cT2N0 patients. Further studies with more patients involved, comparison between every single modification of proximal gastrectomy and also inclusion of advanced stages will be necessary to determine the optimal type of surgery. Nevertheless, the majority of studies published to date favor proximal gastrectomy against total gastrectomy in terms of better postoperative quality of life. Key words: gastric cancer - esophagogastric junction cancer - quality of life - proximal gastrectomy.
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CLARK CG, CROOKS J, DAWSON AA, MITCHELL PE. The Incidence of Malabsorption of Radiotriolein following Polya Partial Gastrectomy in Patients on a Normal Diet. Scott Med J 2016; 9:365-73. [PMID: 14202032 DOI: 10.1177/003693306400900902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Magnusson B, Sölvell L, Rehnberg O. Iron absorption from ferrous ascorbate in normal male subjects and in patients 3-6 years after antrectomy with gastroduodenostomy. Scand J Haematol Suppl 2009; 26:53-67. [PMID: 1064897 DOI: 10.1111/j.1600-0609.1976.tb01455.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Nygaard K, Killander A, Myhre E, Helsingen N. Long-term observation of gastrectomized rats with regard to development of vitamin B12 deficiency. Scand J Haematol 2009; 3:213-21. [PMID: 5922603 DOI: 10.1111/j.1600-0609.1966.tb01444.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Roos D. Neurological symptoms and signs in a selected group of partially gastrectomized patients with particular reference to B12 deficiency. Acta Neurol Scand 2009; 50:719-52. [PMID: 4440450 DOI: 10.1111/j.1600-0404.1974.tb02816.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Olivarius BDF. Neurological sequelae of partial gastrectomy. Acta Neurol Scand 2009; 46:204. [PMID: 4318673 DOI: 10.1111/j.1600-0404.1970.tb02187.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
AIM: To investigate the effects of bile reflux and intragastric microflora changes on lesions of remnant gastric mucosa after gastric operation.
METHODS: Concenration of bile acid and total bacterial counts (TBC) in gastric juice were measured in 49 patients with peptic ulcer before and after gastrectomy. One year after the operation, sample of gastric mucosa taken from all the patients were used for histological examination.
RESULTS: The concentration of gastric bile acid was significantly increased in group B-I, or B-II and SV + A than that in group HSV (P < 0.05-0.01). The abnormal histological changes in the remnant gastric mucosa were more common in the first 2 groups than in the last group.
CONCLUSION: The type of gastrtectomy can affect bile reflux. The abnormal histological changes in the remnant gastric mucosa are closely related to the elevation of bile acid concentration and increase of TBC in gastric juice. HSV can effectively prevent bile reflux and keep the gastric physiological functions stable.
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Affiliation(s)
- Chao Zhang
- Department of General Surgery, Southwest Hospital, Third Military Medical University, Gaotan Yan, Chongqing 400038, China.
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Acar T, Tuncal S, Aydin R. An unusual cause of gastrointestinal obstruction: bezoar. N Z Med J 2003; 116:U422. [PMID: 12740615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Tanju Acar
- Department of Surgery, Emergency Aid and Traumatology Hospital, Balgat, Ankara, Turkey.
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Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, Sano T, Katai H. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer 2003; 5:83-9. [PMID: 12111583 DOI: 10.1007/s101200200014] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Japan, approximately half of gastric cancers are diagnosed in the early stage. Longer survival has been provided for patients with early gastric cancer (EGC). Several new surgical procedures have been employed for some EGCs. To compare the functional results of these techniques with those of classic distal gastrectomy, it is important to evaluate the remnant stomach in relation to quality of life (QOL) and secondary cancers. We propose a new endoscopic classification, regarding several aspects of the remnant stomach, which enables common understanding and description of the condition. METHODS Of 651 patients who underwent a distal gastrectomy or pylorus-preserving gastrectomy (PPG), 324 had at least one upper gastrointestinal (GI) endoscopy during the follow-up period. Ninety-three of the 324 patients underwent a Roux-en-Y reconstruction (RY); 175, Billroth type 1 (B1); and 56, PPG. Endoscopic findings regarding residual food, gastritis, and bile reflux in the gastric stump were investigated for these patients. We classified the amount of residual food into five grades, the degree and the extent of gastritis into five grades, and bile reflux into two grades. First, we evaluated the consistency of diagnosis between two endoscopists, in the first 200 patients, and then we applied the classification to all 324 patients to examine the usefulness of this classification. RESULTS Consistency of diagnosis was obtained between two endoscopists who classified the patients independently. The agreement rate was 98.5% for residual food, 93% for gastritis, and 100% for bile reflux. Residual food was observed in 14.0% of the RY group, 22.3% of the B1 group, and 37.5% of the PPG group. These differences were significant (RY versus B1; P < 0.05 and RY versus PPG; P < 0.01). The remnant stomach after B1 showed significantly more severe and extensive gastritis than that after RY and PPG ( P < 0.01). As for bile reflux, there was no significant difference among the three groups. CONCLUSION The classification (RGB classification: Residue, Gastritis, Bile) can be used easily and is practical. The results suggest some important differences among methods of reconstruction. This classification seems to be useful to describe these findings and to further evaluate these reconstructive methods.
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Affiliation(s)
- Makoto Kubo
- Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
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STEIGMANN F, SNYDER D, FERNANDEZ A. Pancreatic enzyme replacement therapy in malabsorption of pancreatic, hepatic, and gastric origin. ACTA ACUST UNITED AC 1998; 7:464-72. [PMID: 13916597 DOI: 10.1007/bf02232365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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WEIR DG, TEMPERLEY IJ, GATENBY PB. Anaemia following gastric operations for peptic ulceration in Dublin. II. Deficiency of iron and vitamin B12. Ir J Med Sci 1998; 448:151-8. [PMID: 13999664 DOI: 10.1007/bf02947194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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DELLER DJ, EDWARDS RG, ADDISON M. CALCIUM METABOLISM AND THE BONES AFTER PARTIAL GASTRECTOMY. II. THE NATURE AND CAUSE OF THE BONE DISORDER. ACTA ACUST UNITED AC 1996; 12:295-309. [PMID: 14078906 DOI: 10.1111/imj.1963.12.4.295] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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SHERWOOD WC, GOLSTEIN F, HAURANI FI, WIRTS CW. STUDIES OF THE SMALL-INTESTINAL BACTERIAL FLORA AND OF INTESTINAL ABSORPTION IN PERNICIOUS ANEMIA. ACTA ACUST UNITED AC 1996; 9:416-25. [PMID: 14169408 DOI: 10.1007/bf02239334] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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WRUBLE LD, BENNETT LD, DAVIS J, MEDLIN H, FARRELL JJ, KALSER MH. ZOLLINGER-ELLISON SYNDROME: SURGICAL REMOVAL OF PARIETAL CELL MASS WITH PRESERVATION OF ANTRUM AND PYLORUS, ILEOCOLONIC TRANSPLANT AND RESULTANT ACHLORHYDRIA. Ann Surg 1996; 158:270-6. [PMID: 14047551 PMCID: PMC1408512 DOI: 10.1097/00000658-196308000-00018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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