Current Status of Digestive Tract Reconstruction in Total Gastrectomy for Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Jian , CHEN Xinzu ,  HU Jiankun

Department of Gastrointestinal Surgery， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

HU Jiankun, Email: hujkwch@126.com

Keywords：

Gastric cancer; Total gastrectomy; Digestive tract reconstruction

Video：

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Objective 　To summarize the research progress of digestive tract reconstruction after total gastrectomy in gastric cancer.
Methods 　The domestic and international published literatures about digestive tract reconstruction after total gastrectomy in gastric cancer were retrieved and reviewed.
Results 　More and more attention had been paid to the postoperative quality of life after total gastrectomy in gastric cancer， and the most related factor for postoperative quality of life was the type of digestive tract reconstruction. The pouch reconstruction and preservation of enteric myoneural continuity showed beneficial effects on clinical outcomes. Current opinion considered the pouch reconstruction might be safe and effective， and was able to improve the postoperative quality of life of patients with gastric cancer. However， the preservation of duodenal pathway didn’t show significant benefits.
Conclusion 　The optimal digestive tract reconstruction after total gastrectomy is still debating， in order to resolve the controversies， needs more in-depth fundamental researches and more high-quality randomized controlled trials.

Citation： CHEN Jian,CHEN Xinzu,HU Jiankun. Current Status of Digestive Tract Reconstruction in Total Gastrectomy for Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(6): 604-607. doi: Copy

1.	胡建昆，陈心足. 胃癌手术消化道重建方式的选择及评价[J].中华消化外科杂志， 2013， 12(1)：25-29.
2.	Wen L， Chen XZ， Wu B， et al. Total vs. proximal gastrectomy for proximal gastric cancer：a systematic review and meta-analysis[J]. Hepatogastroenterology， 2012， 59(114)：633-640.
3.	Hu JK， Yang K， Zhang B， et al. D2 plus para-aortic lymphadenectomy versus standardized D2 lymphadenectomy in gastric cancer surgery[J]. Surg Today， 2009， 39(3)：207-213.
4.	Hoffmann V. Eine methode des plastischen magenersatzes[J]. Zentralbl Chir， 1922， 499：1477-1478.
5.	Dikic S， Randjelovic T， Dragojevic S， et al. Early dumping synd-rome and reflux esophagitis prevention with pouch reconstruction[J]. J Surg Res， 2012， 175(1)：56-61.
6.	Hunt CJ. Construction of food pouch from segment of jejunum as substitute for stomach in total gastrectomy[J]. AMA Arch Surg， 1952， 64(5)：601-608.
7.	Lawrence W Jr. Reservoir construction after total gastrectomy：an instructive case[J]. Ann Surg， 1962， 155(2)：191-198.
8.	Fein M， Fuchs KH， Thalheimer A， et al. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy：a randomized trial[J]. Ann Surg， 2008， 247(5)：759-765.
9.	Kono K， Iizuka H， Sekikawa T， et al. Improved quality of life with jejunal pouch reconstruction after total gastrectomy[J]. Am J Surg， 2003， 185(2)：150-154.
10.	Lehnert T， Buhl K. Techniques of reconstruction after total gastr-ectomy for cancer[J]. Br J Surg， 2004， 91(5)：528-539.
11.	Gertler R， Rosenberg R， Feith M， et al. Pouch vs. no pouch following total gastrectomy：meta-analysis and systematic review[J]. Am J Gastroenterol， 2009， 104(11)：2838-2851.
12.	Nanthakumaran S， Suttie SA， Chandler HW， et al. Optimal gastric pouch reconstruction post-gastrectomy[J]. Gastric Cancer， 2008， 11(1)：33-36.
13.	Tsujimoto H， Sakamoto N， Ichikura T， et al. Optimal size of jej-unal pouch as a reservoir after total gastrectomy：a single-center prospective randomized study[J]. J Gastrointest Surg， 2011， 15(10)：1777-1782.
14.	Kalmár K， Németh J， Kelemen D， et al. Postprandial gastrointestinal hormone production is different， depending on the type of reconstruction following total gastrectomy[J]. Ann Surg， 2006， 243(4)：465-471.
15.	Dikic S， Randjelovic T， Dragojevic S， et al. Nutritional insight into preduodenal pouch reconstruction one year after total gastrec-tomy[J]. J Surg Res， 2012， 176(1)：34-41.
16.	Mouchet A， Camey M. New procedure for the reestablishment of continuity after total gastrectomy by the interposition of a segment of the small intestine between the esophagus and the duodenum；5 case reports[J]. Arch Mal Appar Dig Mal Nutr， 1953， 42(5)：621-633.
17.	Chin AC， Espat NJ. Total gastrectomy：options for the restoration of gastrointestinal continuity[J]. Lancet Oncol， 2003， 4(5)：271-276.
18.	肖仕明，姜淮芜，陈进，等. 全胃切除调节型双通道间置空肠消化道重建[J]. 中国普外基础与临床杂志， 2008， 15(1)：23-26.
19.	Pan Y， Li Q， Wang DC， et al. Beneficial effects of jejunal contin-uity and duodenal food passage after total gastrectomy：a retrospective study of 704 patients[J]. Eur J Surg， 2008， 34(1)：17-22.
20.	Iwahashi M， Nakamori M， Nakamura M， et al. Evaluation of double tract reconstruction after total gastrectomy in patients with gastric cancer：prospective randomized controlled trial[J]. World J Surg， 2009， 33(9)：1882-1888.
21.	Ishigami S， Natsugoe S， Hokita S， et al. Postoperative long-termevaluation of interposition reconstruction compared with Roux-en-Y after total gastrectomy in gastric cancer：prospective randomized controlled trial[J]. Am J Surg， 2011， 202(3)：247-253.
22.	Yang YS， Chen LQ， Yan XX， et al. Preservation versus nonpr-eservation of the duodenal passage following total gastrectomy：a systematic review[J]. J Gastrointest Surg， 2013， 17(5)：877-886.
23.	Gustavsson S， Ilstrup DM， Morrison P， et al. Roux-Y stasis syndrome after gastrectomy[J]. Am J Surg， 1988， 155(3)：490-494.
24.	Mathias JR， Fernandez A， Sninsky CA， et al. Nausea， vomiting，and abdominal pain after Roux-en-Y anastomosis：motility of the jejunal limb[J]. Gastroenterology， 1985， 88(1 Pt 1)：101-107.
25.	Kiciak A， Woliñski J， Borycka K， et al. Roux-en-Y or “uncut”Roux procedure? Relation of intestinal migrating motor complex recovery to the preservation of the network of interstitial cells of Cajal in pigs[J]. Exp Physiol， 2007， 92(2)：399-408.
26.	Yanagida H， Yanase H， Sanders KM， et al. Intestinal surgical resection disrupts electrical rhythmicity， neural responses， and interstitial cell networks[J]. Gastroenterology， 2004， 127(6)：1748-1759.
27.	van der Mijle HC， Kleibeuker JH， Limburg AJ， et al. Manometric and scintigraphic studies of the relation between motility disturbances in the Roux limb and the Roux-en-Y syndrome[J]. Am J Surg， 1993， 166(1)：11-17.
28.	Van Stiegmann G， Goff JS. An alternative to Roux-en-Y for treatment of bile reflux gastritis[J]. Surg Gynecol Obstet， 1988， 166(1)：69-70.
29.	Tu BN， Sarr MG， Kelly KA. Early clinical results with the uncut Roux reconstruction after gastrectomy：limitations of the stapling technique[J]. Am J Surg， 1995， 170(3)：262-264.
30.	Tu BN， Kelly KA. Elimination of the roux stasis syndrome using a new type of “uncut roux” limb[J]. Am J Surg， 1995， 170(4)：381-386.
31.	Noh SM. Improvement of the roux limb function using a new typeof “uncut roux” limb[J]. Am J Surg， 2000， 180(1)：37-40.
32.	郝希山，李强. 胃癌全胃切除术后新型消化道重建方式的临床研究[J]. 中国实用外科杂志， 2001， 21(7)：424-426.
33.	郝希山，李强，张忠国. 胃癌患者全胃切除术后消化道重建方式的临床研究[J]. 中华胃肠外科杂志， 2003， 6(2)：89-92.
34.	陈映波，李元方，冯兴宇，等. 胃癌患者全胃切除术后两种消化道重建方式的比较[J]. 中华肿瘤杂志， 2011， 33(2)：126-129.
35.	王海忠，彭俊华，周胜虎，等. 全胃切除术后连续性空肠间置代胃术消化道重建的临床应用[J]. 中华临床医师杂志：电子版， 2011， 5(17)：5013-5016.

1. 胡建昆，陈心足. 胃癌手术消化道重建方式的选择及评价[J].中华消化外科杂志， 2013， 12(1)：25-29.
2. Wen L， Chen XZ， Wu B， et al. Total vs. proximal gastrectomy for proximal gastric cancer：a systematic review and meta-analysis[J]. Hepatogastroenterology， 2012， 59(114)：633-640.
3. Hu JK， Yang K， Zhang B， et al. D2 plus para-aortic lymphadenectomy versus standardized D2 lymphadenectomy in gastric cancer surgery[J]. Surg Today， 2009， 39(3)：207-213.
4. Hoffmann V. Eine methode des plastischen magenersatzes[J]. Zentralbl Chir， 1922， 499：1477-1478.
5. Dikic S， Randjelovic T， Dragojevic S， et al. Early dumping synd-rome and reflux esophagitis prevention with pouch reconstruction[J]. J Surg Res， 2012， 175(1)：56-61.
6. Hunt CJ. Construction of food pouch from segment of jejunum as substitute for stomach in total gastrectomy[J]. AMA Arch Surg， 1952， 64(5)：601-608.
7. Lawrence W Jr. Reservoir construction after total gastrectomy：an instructive case[J]. Ann Surg， 1962， 155(2)：191-198.
8. Fein M， Fuchs KH， Thalheimer A， et al. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy：a randomized trial[J]. Ann Surg， 2008， 247(5)：759-765.
9. Kono K， Iizuka H， Sekikawa T， et al. Improved quality of life with jejunal pouch reconstruction after total gastrectomy[J]. Am J Surg， 2003， 185(2)：150-154.
10. Lehnert T， Buhl K. Techniques of reconstruction after total gastr-ectomy for cancer[J]. Br J Surg， 2004， 91(5)：528-539.
11. Gertler R， Rosenberg R， Feith M， et al. Pouch vs. no pouch following total gastrectomy：meta-analysis and systematic review[J]. Am J Gastroenterol， 2009， 104(11)：2838-2851.
12. Nanthakumaran S， Suttie SA， Chandler HW， et al. Optimal gastric pouch reconstruction post-gastrectomy[J]. Gastric Cancer， 2008， 11(1)：33-36.
13. Tsujimoto H， Sakamoto N， Ichikura T， et al. Optimal size of jej-unal pouch as a reservoir after total gastrectomy：a single-center prospective randomized study[J]. J Gastrointest Surg， 2011， 15(10)：1777-1782.
14. Kalmár K， Németh J， Kelemen D， et al. Postprandial gastrointestinal hormone production is different， depending on the type of reconstruction following total gastrectomy[J]. Ann Surg， 2006， 243(4)：465-471.
15. Dikic S， Randjelovic T， Dragojevic S， et al. Nutritional insight into preduodenal pouch reconstruction one year after total gastrec-tomy[J]. J Surg Res， 2012， 176(1)：34-41.
16. Mouchet A， Camey M. New procedure for the reestablishment of continuity after total gastrectomy by the interposition of a segment of the small intestine between the esophagus and the duodenum；5 case reports[J]. Arch Mal Appar Dig Mal Nutr， 1953， 42(5)：621-633.
17. Chin AC， Espat NJ. Total gastrectomy：options for the restoration of gastrointestinal continuity[J]. Lancet Oncol， 2003， 4(5)：271-276.
18. 肖仕明，姜淮芜，陈进，等. 全胃切除调节型双通道间置空肠消化道重建[J]. 中国普外基础与临床杂志， 2008， 15(1)：23-26.
19. Pan Y， Li Q， Wang DC， et al. Beneficial effects of jejunal contin-uity and duodenal food passage after total gastrectomy：a retrospective study of 704 patients[J]. Eur J Surg， 2008， 34(1)：17-22.
20. Iwahashi M， Nakamori M， Nakamura M， et al. Evaluation of double tract reconstruction after total gastrectomy in patients with gastric cancer：prospective randomized controlled trial[J]. World J Surg， 2009， 33(9)：1882-1888.
21. Ishigami S， Natsugoe S， Hokita S， et al. Postoperative long-termevaluation of interposition reconstruction compared with Roux-en-Y after total gastrectomy in gastric cancer：prospective randomized controlled trial[J]. Am J Surg， 2011， 202(3)：247-253.
22. Yang YS， Chen LQ， Yan XX， et al. Preservation versus nonpr-eservation of the duodenal passage following total gastrectomy：a systematic review[J]. J Gastrointest Surg， 2013， 17(5)：877-886.
23. Gustavsson S， Ilstrup DM， Morrison P， et al. Roux-Y stasis syndrome after gastrectomy[J]. Am J Surg， 1988， 155(3)：490-494.
24. Mathias JR， Fernandez A， Sninsky CA， et al. Nausea， vomiting，and abdominal pain after Roux-en-Y anastomosis：motility of the jejunal limb[J]. Gastroenterology， 1985， 88(1 Pt 1)：101-107.
25. Kiciak A， Woliñski J， Borycka K， et al. Roux-en-Y or “uncut”Roux procedure? Relation of intestinal migrating motor complex recovery to the preservation of the network of interstitial cells of Cajal in pigs[J]. Exp Physiol， 2007， 92(2)：399-408.
26. Yanagida H， Yanase H， Sanders KM， et al. Intestinal surgical resection disrupts electrical rhythmicity， neural responses， and interstitial cell networks[J]. Gastroenterology， 2004， 127(6)：1748-1759.
27. van der Mijle HC， Kleibeuker JH， Limburg AJ， et al. Manometric and scintigraphic studies of the relation between motility disturbances in the Roux limb and the Roux-en-Y syndrome[J]. Am J Surg， 1993， 166(1)：11-17.
28. Van Stiegmann G， Goff JS. An alternative to Roux-en-Y for treatment of bile reflux gastritis[J]. Surg Gynecol Obstet， 1988， 166(1)：69-70.
29. Tu BN， Sarr MG， Kelly KA. Early clinical results with the uncut Roux reconstruction after gastrectomy：limitations of the stapling technique[J]. Am J Surg， 1995， 170(3)：262-264.
30. Tu BN， Kelly KA. Elimination of the roux stasis syndrome using a new type of “uncut roux” limb[J]. Am J Surg， 1995， 170(4)：381-386.
31. Noh SM. Improvement of the roux limb function using a new typeof “uncut roux” limb[J]. Am J Surg， 2000， 180(1)：37-40.
32. 郝希山，李强. 胃癌全胃切除术后新型消化道重建方式的临床研究[J]. 中国实用外科杂志， 2001， 21(7)：424-426.
33. 郝希山，李强，张忠国. 胃癌患者全胃切除术后消化道重建方式的临床研究[J]. 中华胃肠外科杂志， 2003， 6(2)：89-92.
34. 陈映波，李元方，冯兴宇，等. 胃癌患者全胃切除术后两种消化道重建方式的比较[J]. 中华肿瘤杂志， 2011， 33(2)：126-129.
35. 王海忠，彭俊华，周胜虎，等. 全胃切除术后连续性空肠间置代胃术消化道重建的临床应用[J]. 中华临床医师杂志：电子版， 2011， 5(17)：5013-5016.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Current Status of Digestive Tract Reconstruction in Total Gastrectomy for Gastric Cancer

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