RECONSTRUCTION OF THE FOOD PASSAGE AFTER TOTAL GASTRECTOMY - RANDOMIZED TRIAL

Controversial results have been reported regarding the importance of t he duodenal food passage after total gastrectomy. There are a number o f experimental and clinical studies showing an advantage for the jejun al interposition between esophagus and duodenum. Others favor the Roux -en-Y reconstruction, as it is technically less demanding. The purpose of this study was the randomized comparison between two major reconst ruction principles after total gastrectomy for gastric cancer (i.e., j ejunal interposition with pouch versus Roux-en-Y pouch reconstruction) . A group of 120 patients with gastric cancer were randomized and oper ated on during a 5-year period according to standardized operative pro tocols, using either a jejunal interposition with pouch (JIP) or the R oux-en-Y reconstruction with pouch (RYP). Endpoints of this study were operation time, intra- and postoperative problems and complications, patients' body weight, functional assessment, and quality of life. Of the 120 patients, 14 had to be withdrawn during the operation because only the Roux-en-Y reconstruction was technically possible. Finally, 5 3 patients with JIP were compared with 53 patients with RYP for the pe rioperative course. There were no significant differences between the two procedures (RYP and JIP) regarding complications (24.5% and 26.4%, respectively), mortality (3.8% and 1.9%, respectively), and operation time (4.35 hours and 4.40 hours, respectively). For long-term functio nal comparison 46 (RYP, n = 26; JIP, n = 20) patients were without rec urrence after 3 years of survival. Comparison of body weight, Visick s coring, and the Spitzer Index also did not reveal any significant diff erence between the two operation methods. In conclusion, patients with gastric cancer after total gastrectomy do not benefit from reconstruc ting the duodenal food passage by a jejunal interposition with pouch r egarding their postoperative quality of life when compared to the wide ly used and technically less demanding Roux-en-Y reconstruction with p ouch. Differences between the two reconstruction principles, documente d by sophisticated functional assessment, may well exist, but they hav e no major clinical importance.