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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Assessing optimal Roux-en-Y reconstruction technique after total gastrectomy using the Postgastrectomy Syndrome Assessment Scale-45
Masami Ikeda, Masashi Yoshida, Norio Mitsumori, Tsuyoshi Etoh, Chikashi Shibata, Masanori Terashima, Junya Fujita, Kazuaki Tanabe, Nobuhiro Takiguchi, Atsushi Oshio, Koji Nakada
Masami Ikeda, Department of Surgery, Asama General Hospital, Nagano 385-8558, Japan
Masashi Yoshida, Department of Surgery, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
Norio Mitsumori, Department of Surgery, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Tsuyoshi Etoh, Department of Gastroenterological Surgery, Oita University, Oita 879-5593, Japan
Chikashi Shibata, Department of Surgery, Tohoku Medical and Pharmaceutical University, Miyagi 983-8512, Japan
Masanori Terashima, Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, 411-8777, Japan
Junya Fujita, Department of Surgery, Yao Municipal Hospital, Osaka 581-0069, Japan
Kazuaki Tanabe, Department of Gastroenterological and Transplant Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
Nobuhiro Takiguchi, Department of Gastroenterological Surgery, Chiba Cancer Center, Chiba 260-8717, Japan
Atsushi Oshio, Faculty of Letters, Arts and Sciences, Waseda University, Tokyo 162-8644, Japan
Koji Nakada, Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Author contributions: Ikeda M, Yoshida M, Mitsumori M, Etoh T, Shibata C, Terashima M, Fujita J, Tanabe K, Takiguchi N, Nakada K developed this protocol/project, collected data and performed the research; Oshio A contributed analytical tools; Ikeda M and Nakada K analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Supported by The Jikei University School of Medicine; and Japanese Society for Gastro-surgical Pathophysiology.
Institutional review board statement: The study was approved by the Ethics Committees of all participating institutions.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interests related to the publication of this study.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: Masami Ikeda, MD, PhD, Chief Doctor, Surgeon, Department of Surgery, Asama General Hospital, 1862-1 Iwamurada, Saku, Nagano 385-8558, Japan. ikedam@tempo.ocn.ne.jp
Received: March 8, 2021
Peer-review started: March 8, 2021
First decision: May 4, 2021
Revised: May 16, 2021
Accepted: April 20, 2022
Article in press: April 20, 2022
Published online: May 24, 2022
BACKGROUND
Following a total gastrectomy, patients suffer the most severe form of postgastrectomy syndrome. This is a significant clinical problem as it reduces quality of life (QOL). Roux-en-Y reconstruction, which is regarded as the gold standard for post-total gastrectomy reconstruction, can be performed using various techniques. Although the technique used could affect postoperative QOL, there are no previous reports regarding the same.
AIM
To investigate the effect of different techniques on postoperative QOL. The data was collected from the registry of the postgastrectomy syndrome assessment study (PGSAS).
METHODS
In the present study, we analyzed 393 total gastrectomy patients from those enrolled in PGSAS. Patients were divided into groups depending on whether antecolic or retrocolic jejunal elevation was performed, whether the Roux limb was “40 cm”, “shorter” (≤ 39 cm), or “longer” (≥ 41 cm), and whether the device used for esophageal and jejunal anastomosis was a circular or linear stapler. Subsequently, we comparatively investigated postoperative QOL of the patients.
RESULTS
Reconstruction route: Esophageal reflux subscale (SS) occurred significantly less frequently in patients who underwent antecolic reconstruction. Roux limb length: “Shorter” Roux limb did not facilitate esophageal reflux SS and somewhat attenuated indigestion SS and abdominal pain SS. Anastomosis technique: In terms of esophagojejunostomy techniques, no differences were observed.
CONCLUSION
The techniques used for total gastrectomy with Roux-en-Y reconstruction significantly affected postoperative symptoms. Our results suggest that elevating the Roux limb, which is not overly long, through an antecolic route may improve patients’ QOL.
Core Tip: Following a total gastrectomy using various techniques, patients suffer the severe form of postgastrectomy syndrome. We investigated the effect of different techniques in Roux-en-Y reconstruction on postoperative quality of life (QOL) using the Postgastrectomy Syndrome Assessment Scale-45. We analyzed 393 total gastrectomy patients. Esophageal reflux subscale (SS) occurred significantly less frequently in patients who underwent antecolic reconstruction. Shorter Roux limb did not facilitate esophageal reflux SS and somewhat attenuated indigestion SS and abdominal pain SS. Our results suggest that elevating the Roux limb which is not overly long, through an antecolic route may improve patients’ QOL.
