Symptoms after total gastrectomy on food intake, body composition, bone metabolism, and quality of life in gastric cancer patients - Is reconstruction with a reservoir worthwhile
B. Liedman, Symptoms after total gastrectomy on food intake, body composition, bone metabolism, and quality of life in gastric cancer patients - Is reconstruction with a reservoir worthwhile, NUTRITION, 15(9), 1999, pp. 677-682
Gastric cancer is worldwide one of the most common causes of cancer death.
Operation is the only treatment at this time that curls some patients. The
side effects of the operation are, however, considerable, and include posto
perative weight loss, loss of appetite, and other metabolic and nutritional
changes. The recovery is very slow and incomplete. Reconstruction with dif
ferent types of pouches has been asserted to facilitate the nutritional rec
overy, but results from different studies are somewhat contradictory. Malnu
trition, osteoporosis, osteomalacia, and impaired quality of life are often
but not always described. We can, however, establish that after a total ga
strectomy, gastric cancer patients are very much at risk for these complica
tions, which are probably caused by impaired food intake and steathorrhea e
ven when the patients are cured from their cancer disease. In order to mini
mize the nutritional problems, it is crucial to avoid anastomotic narrowing
and bile reflux. Roux-en-Y reconstruction seems to be the method of choice
. Evidence from several randomized studies now speak in favor of including
some type of pouch in the reconstruction. The most commonly used pouch toda
y is the jejunal J-pouch. How the effect is exerted is not clear. probably
both the reservoir function of the pouch and changes in intestinal transit
time are important. The importance of nutritional surveillance of these pat
ients should not be underestimated, and most of the observed differences fr
om various reports are probably due to dissimilarity in the follow-up proto
cols. A patient surviving his/her cancer has a decreased risk of developing
severe disturbances in bone metabolism, food intake, body composition, and
quality of life if the patient is under concerned nutritional surveillance
and reconstructed with a pouch. (C) Elsevier Science Inc. 1999.