scholarly journals Novel Reconstruction Using Roux-en-Y Plus Antral Obstruction Following Proximal Gastrectomy: Feasibility and Quality of Life Benefits

2019 ◽  
Author(s):  
Dejun Yang ◽  
Changming Wang ◽  
Hongbing Fu ◽  
Ziran Wei ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Reflux Esophagitis ◽  
Proximal Gastrectomy ◽  
Partial Gastrectomy ◽  
Incidence Rates ◽  
Reconstruction Method ◽  
Reflux Symptoms ◽  
Reconstruction Methods ◽  
Postoperative Reflux

Abstract Background and Aims Routine gastroesophagostomy has been shown to have adverse effects on the recovery of digestive functions and quality of life because patients typically experience reflux symptoms after proximal gastrectomy. This study was performed to assess the feasibility and quality of life benefits of a novel reconstruction method termed Roux-en-Y anastomosis plus antral obstruction (RYAO) following proximal partial gastrectomy. Methods A total of 73 patients who underwent proximal gastrectomy from June 2015 to June 2017 were divided into two groups according to digestive reconstruction methods [RYAO (37 patients) and conventional esophagogastric anastomosis with pyloroplasty (EGPP, 36 patients)]. Clinical data were compared between the two groups retrospectively. Results The mean operative time for digestive reconstruction was slightly longer in the RYAO group than in the EGPP group. However, the incidence of postoperative short-term complications did not differ between the RYAO and the EGPP groups. At the 6-month follow-up, the incidence rates of both reflux esophagitis and gastritis were lower in the RYAO group than in the EGPP group (P = 0.002). Additionally, body weight recovery was better in the RYAO group (P = 0.028). The scale tests indicated that compared with the patients in the EGPP group, the patients in the RYAO group had significantly reduced reflux, nausea and vomiting and reported improvements in their overall health status and quality of life (all P < 0.05). Conclusion RYAO reconstruction may be a feasible procedure to reduce postoperative reflux symptoms and the incidence of reflux esophagitis and gastritis, thus improving patient quality of life after proximal gastrectomy.

scholarly journals Various Kinds of Functional Digestive Tract Reconstruction Methods After Proximal Gastrectomy

2021 ◽  
Vol 11 ◽  
Author(s):  
Shuaibing Lu ◽  
Fei Ma ◽  
Zhandong Zhang ◽  
Liangqun Peng ◽  
Wei Yang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Digestive Tract ◽  
Proximal Gastrectomy ◽  
Perioperative Outcomes ◽  
Reconstruction Method ◽  
Proximal Gastric Cancer ◽  
Reconstruction Methods

The incidence of proximal gastric cancer has shown a rising trend in recent years. Surgery is still the main way to cure proximal gastric cancer. Total gastrectomy with D2 lymph node dissection was considered to be the standard procedure for proximal gastric cancer in the past several decades. However, in recent years, many studies have confirmed that proximal gastrectomy can preserve part of the stomach function and can result in a better quality of life of the patient than total gastrectomy. Therefore, proximal gastrectomy is increasingly used in patients with proximal gastric cancer. Unfortunately, there are some concerns after proximal gastrectomy with traditional esophagogastrostomy. For example, the incidence of reflux esophagitis in patients who underwent proximal gastrectomy with traditional esophagogastrostomy is significantly higher than those patients who underwent total gastrectomy. To solve those problems, various functional digestive tract reconstruction methods after proximal gastrectomy have been proposed gradually. In order to provide some help for clinical treatment, in this article, we reviewed relevant literature and new clinical developments to compare various kinds of functional digestive tract reconstruction methods after proximal gastrectomy mainly from perioperative outcomes, postoperative quality of life and survival outcomes aspects. After comparison and discussion, we drew the conclusion that various functional reconstruction methods have their own advantages and disadvantages; large scale high-level clinical studies are needed to choose an ideal reconstruction method in the future. Besides, in clinical practice, surgeons should consider the condition of the patient for individualized selection of the most appropriate reconstruction method.

Effects of reconstruction methods on a patient’s quality of life after a proximal gastrectomy: subjective symptoms evaluation using questionnaire survey

2008 ◽  
Vol 394 (4) ◽  
pp. 637-641 ◽  
Author(s):  
Masanori Tokunaga ◽  
Naoki Hiki ◽  
Shigekazu Ohyama ◽  
Souya Nunobe ◽  
Akira Miki ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Questionnaire Survey ◽  
Proximal Gastrectomy ◽  
Subjective Symptoms ◽  
Reconstruction Methods

scholarly journals Comparison of Postoperative Quality of Life among Three Different Reconstruction Methods After Proximal Gastrectomy: Insights From the PGSAS Study

2020 ◽  
Vol 44 (10) ◽  
pp. 3433-3440
Author(s):  
Hiroshi Yabusaki ◽  
Yasuhiro Kodera ◽  
Norimasa Fukushima ◽  
Naoki Hiki ◽  
Shinichi Kinami ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Proximal Gastrectomy ◽  
Remnant Stomach ◽  
Gastric Neoplasms ◽  
Postgastrectomy Syndrome ◽  
Daily Work ◽  
Reconstruction Methods ◽  
Jejunal Pouch Interposition ◽  
Registration Number

Abstract Background Proximal gastrectomy (PG) has become an increasingly preferred procedure for early cancer in the upper third of the stomach, owing to reportedly superior quality of life (QOL) after PG when compared with total gastrectomy. However, various methods of reconstruction have currently been proposed. We compared the postoperative QOL among the three different reconstruction methods after PG using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire. Methods Post Gastrectomy Syndrome Assessment Study (PGSAS), a nationwide multi-institutional survey, was conducted to evaluate QOL using the PGSAS-45 among various types of gastrectomy. Of the 2,368 eligible data from the PGSAS survey, data from 193 patients who underwent PG were retrieved and used in the current study. The PGSAS-45 consists of 45 items including 22 original gastrectomy specific items in addition to the SF-8 and GSRS. These were consolidated into 19 main outcome measures pertaining postgastrectomy symptoms, amount of food ingested, quality of ingestion, work, and level of satisfaction for daily work, and the three reconstruction methods (n = 193; 115 esophago-gastrostomy [PGEG], 34 jejunal interposition [PGJI], and 44 jejunal pouch interposition [PGJPI]) were compared using PGSAS-45. Results Size of the remnant stomach was significantly larger in PGEG, and significantly smaller in PGJI and PGJPI (P < 0.05). There was no difference in other patient background factors among the groups. EGJPI tended to be superior to PGEG in several of the 19 main outcome with marginal significance (P = 0.047–0.076). Conclusion PGJPI appears to be the most favorable of the three reconstruction methods after PG especially when the size of remnant stomach is rather small. Trial registration number UMIN-CTR #000002116 entitled as “A study to observe correlation between resection and reconstruction procedures employed for gastric neoplasms and development of postgastrectomy syndrome”

Health-related quality-of-life assessment in accordance with reconstruction procedures for distal gastrectomy for stage I gastric cancer using data from JCOG0912.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4562-4562
Author(s):  
Keiichi Fujiya ◽  
Masahiko Ando ◽  
Junki Mizusawa ◽  
Hitoshi Katai ◽  
Takanobu Yamada ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Health Related Quality ◽  
Reconstruction Procedure ◽  
Reflux Symptoms ◽  
Reconstruction Methods ◽  
Related Quality ◽  
Health Related ◽  
Better Than

4562 Background: There are three major reconstruction methods after gastrectomy for distal gastric cancer; Billroth-I (B-I), Roux-en-Y (RY) and pylorus-preserving gastrectomy (PPG). These procedures can affect postoperative health-related quality-of-life (HRQoL), but the method is often selected due to physician’s preference or each institutional policy without solid evidence. We aimed to explore differences in HRQoL after each reconstruction procedure selected in JCOG0912, a phase III noninferiority trial comparing open and laparoscopic distal gastrectomies for stage I gastric cancer. Methods: Among 33 institutions participated in JCOG0912, 4 major cancer centers were selected for HRQoL assessment. HRQoL was assessed using the EORTC QLQ-C30 and STO22 before (baseline) and at 1, 3, 12, and 36 months after surgery as preplanned exploratory analysis. Results: Excluding 2 patients who didn’t answer the questionnaire, 590 patients were analyzed in this study. For reconstruction, B-I was performed for 222 patients (37.7%), RY for 178 (30.2%) and PPG for 189 (32.1%). Proportion of the opted reconstruction procedures was not different in open and laparoscopic gastrectomies. Global health status (GHS) scores of QLQ-C30 were not different among 3 groups at any time point. In comparison of B-I and RY, B-I was better than RY in constipation, while RY was better than B-I in diarrhea and reflux symptoms. In comparison of B-I and PPG, B-I was better than PPG in constipation and reflux symptoms, while PPG was better than B-I in diarrhea. When comparing RY and PPG, RY was better than PPG in constipation and reflux symptoms, while PPG was better than RY in taste (table). Conclusions: GHS scores were similar regardless of the reconstruction procedure, however postoperative symptoms including reflux, constipation, and diarrhea were various according to reconstruction methods. [Table: see text]

scholarly journals A Novel Method of Piggyback Jejunal Interposition Reconstruction Single-Tract Reconstruction After Proximal Gastrectomy for Siewert II and III Adenocarcinoma of the Esophagogastric Junction with a Diameter <4 cm

2021 ◽  
Author(s):  
Yuchao Ma ◽  
Jianhong Dong ◽  
Baoqing Ren ◽  
Wanhong Zhang ◽  
Liqiang Lei ◽  
...  
Keyword(s):  
Reflux Esophagitis ◽  
Complication Rate ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Jejunal Interposition ◽  
Reflux Symptoms ◽  
Postoperative Reflux ◽  
Novel Method ◽  
The Mean ◽  
Jejunal Interposition Reconstruction

Abstract Background Digestive tract reconstruction after proximal gastrectomy (PG) has been extensively discussed. Herein, we introduce a novel method of PG with piggyback jejunal interposition reconstruction single-tract reconstruction (PJIRSTR) for Siewert II and III adenocarcinoma of the esophagogastric junction (AEG) with a diameter <4 cm, and investigate its safety, practicability, and short-term and long-term clinical outcomes of this procedure. Method The clinical data of 33 patients with Siewert II or Siewert III AEG who underwent PJIRSTR in Shanxi Cancer Hospital from July 2013 to November 2016 were retrospectively reviewed. Data of clinicopathologic characteristics, postoperative and surgical outcomes, and follow-up findings, especially postoperative reflux esophagitis and postoperative reflux symptoms, were analyzed.Results The mean operation time was 136.7±22.4 (range: 110-180) min, including 32.3 ± 5.0(range: 26-45) min of the digestive tract reconstruction; the mean estimated blood loss was 87.6±18.1 mL; the mean number of dissected lymph nodes was 14.7±5.1; and the mean duration of postoperative hospitalization was 7.5±1.2 days. The early complication rate was 9% (n=3), including one case each of anastomotic bleeding, incision infection, and ileus. The late complication rate was 6% (n=2): both patients had gastroesophageal reflux symptoms (Visick grade II), but only one patient had Los Angeles grade B reflux esophagitis by endoscopy. Conclusion PJIRSTR is a safe, feasible, and innovative reconstruction method after PG for patients with Siewert II and III AEG with a diameter <4 cm. Furthermore, it has excellent efficiency in terms of preventing reflux symptoms and reflux esophagitis after surgery.

scholarly journals Comparative analysis of laparoscopic proximal gastrectomy plus semi-embedded valve anastomosis with laparoscopic total gastrectomy for adenocarcinoma of the esophagogastric junction: a single-center retrospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yupeng Wu ◽  
Shihao Zhang ◽  
Liting Wang ◽  
Xuya Hu ◽  
Zhanxue Zhang
Keyword(s):  
Weight Loss ◽  
Total Gastrectomy ◽  
Reflux Esophagitis ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Laparoscopic Total Gastrectomy ◽  
Reconstruction Method ◽  
Postoperative Reflux ◽  
Significant Difference ◽  
Laparoscopic Proximal Gastrectomy

Abstract Background We invented a new antireflux anastomosis method for use in proximal gastrectomy for adenocarcinoma of the esophagogastric junction (AEG) and named it semi-embedded valve anastomosis (SEV). This study was conducted to compare and analyze the short-term efficacy and long-term prognosis of this anastomosis reconstruction method versus laparoscopic total gastrectomy (LTG). Methods We retrospectively analyzed the general data and surgical outcomes of patients with AEG who underwent three united laparoscopic proximal gastrectomy plus semi-embedded valve anastomosis (TULPG-SEV, N = 20) and LTG (N = 20) at our hospital from January 2015 to September 2017 and investigated the incidence of postoperative reflux esophagitis and postoperative nutritional status between the two groups. Survival analysis was also performed. Results The operative time (178.25 ± 15.41 vs 196.5 ± 21.16 min) and the gastrointestinal reconstruction time (19.3 ± 2.53 vs 34.65 ± 4.88 min) of the TULPG-SEV group were significantly less than that of the LTG group. There was no difference in intraoperative blood loss, length of hospital stay, and postoperative complications. There was no difference in the scores on the postoperative reflux disease questionnaires (RDQs) conducted 1 month (P = 0.501), 3 months (P = 0.238), and 6 months (P = 0.655) after surgery between the TULPG-SEV group and LTG group. Gastroscopy revealed 2 cases of reflux esophagitis (grade B or higher) in each group. The postoperative hemoglobin level was better in the TULPG-SEV group than in the LTG group, and the difference was most noticeable at 1 month after surgery (P = 0.024) and 3 months after surgery (P = 0.029). The levels of albumin and total protein were not significantly different between the groups. There were more patients with weight loss over 5 kg after surgery in the LTG group than in the TULPG-SEV group (P = 0.043). There was no significant difference in the 3-year overall survival rate between the two groups (P = 0.356). Conclusion SEV has a certain antireflux effect and can reduce the anastomosis time. Proximal gastrectomy may be better than total gastrectomy for maintaining postoperative hemoglobin levels and reducing weight loss.

scholarly journals Study on the relationship of depression, anxiety, lifestyle and eating habits with the severity of reflux esophagitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rongxin Wang ◽  
Jing Wang ◽  
Shuiqing Hu
Keyword(s):  
Quality Of Life ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Reflux Esophagitis ◽  
Eating Habits ◽  
Positive Correlation ◽  
Relationship Of ◽  
The Relationship

Abstract Background The etiology of reflux esophagitis (RE) is multi-factorial. This study analyzed the relationship of depression, anxiety, lifestyle and eating habits with RE and its severity and further explored the impact of anxiety and depression on patients’ symptoms and quality of life. Methods From September 2016 to February 2018, a total of 689 subjects at Xuanwu Hospital Capital Medical University participated in this survey. They were divided into the RE group (patients diagnosed with RE on gastroscopy, n = 361) and the control group (healthy individuals without heartburn, regurgitation and other gastrointestinal symptoms, n = 328). The survey included general demographic information, lifestyle habits, eating habits, comorbidities, current medications, the gastroesophageal reflux disease (GERD) questionnaire (GerdQ), the Patient Health Questionnaire-9 depression scale and the General Anxiety Disorder-7 anxiety scale. Results The mean age and sex ratio of the two groups were similar. Multivariate logistic regression analysis identified the following factors as related to the onset of RE (p < 0.05): low education level; drinking strong tea; preferences for sweets, noodles and acidic foods; sleeping on a low pillow; overeating; a short interval between dinner and sleep; anxiety; depression; constipation; history of hypertension; and use of oral calcium channel blockers. Ordinal logistic regression analysis revealed a positive correlation between sleeping on a low pillow and RE severity (p = 0.025). Depression had a positive correlation with the severity of symptoms (rs = 0.375, p < 0.001) and patients’ quality of life (rs = 0.306, p < 0.001), whereas anxiety showed no such association. Conclusions Many lifestyle factors and eating habits were correlated with the onset of RE. Notably, sleeping on a low pillow was positively correlated with RE severity, and depression was positively related to the severity of symptoms and patients’ quality of life.

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