scholarly journals Ileocolic Interposition as a Gastric Substitute in Patients with Total Gastrectomy; Case Series and Literature Review

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ehsan Soltani ◽  
Habibollah Mahmoudzadeh ◽  
Ramesh Omranipour
Keyword(s):  
Gastric Cancer ◽  
Weight Loss ◽  
Total Gastrectomy ◽  
Case Series ◽  
Normal Diet ◽  
Anastomotic Site ◽  
Nutritional Conditions ◽  
Barium Examination ◽  
Gastric Cancer Treatment ◽  
Nutritional Benefits

Background: The standard method for reconstruction after total gastrectomy is Roux-en-Y reconstruction, which has several negative points such as malabsorption. The most important reasons for weight loss in these patients are reserval insufficiency and reduction of food-digestive juice blending. We suggest that the creation of a food reserve with a natural conduit by ileocolic interposition may help the patient to have more normal diet habits and prevent severe weight loss. Methods: The study enrolled 8 patients with proximal gastric cancer, who underwent total gastrectomy with omentectomy and D2 lymphadenectomy. Then, the ileocolic segment with its vasculature was prepared and the anastomosis was done like right colon interposition between esophagus and duodenum. Intraoperative and postoperative events and also nutritional conditions were recorded. Results: Among 8 patients enrolled in the study, not an intraoperative bad event nor anastomotic site leakage, abscess formation, or other significant post-operative complication were seen. Except for the first two patients, the rest did not suffer from dysphagia. None of the patients suffered from delayed, chronic, or uncontrolled vomiting. All patients experienced weight loss postoperatively but after 2 months, they gained weight. Barium examination and also upper endoscopy revealed that the patients had normal reserval volume, no evidence of erosion or ulceration, no evidence of biliary esophagitis or reflux, and absence of tumor relapse. Conclusions: Because of the nutritional benefits of ileocolic interposition after total gastrectomy in gastric cancer treatment, it can be used as an acceptable alternative method of reconstruction in a subgroup of selected patients.

Risk factors for severe weight loss after gastrectomy for gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 38-38
Author(s):  
Kenki Segami ◽  
Toru Aoyama ◽  
Taiichi Kawabe ◽  
Shigeya Hayashi ◽  
Yousuke Makuuchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Weight Loss ◽  
Body Weight ◽  
Blood Loss ◽  
Total Gastrectomy ◽  
Significant Risk ◽  
Operation Time ◽  
Time Range ◽  
Eras Protocol

38 Background: Body weight loss (BWL) is frequently observed in gastric cancer patients who underwent gastrectomy for gastric cancer. Recently, we reported that severe BWL after gastrectomy was a significant risk factor for continuation of S-1 adjuvant chemotherapy. However, risk factors of BWL after surgery remain unclear. Methods: The present study retrospectively examined the patients who electively underwent curative gastrectomy for gastric cancer between January of 2012 and June of 2014. All patients received peri-operative care of ERAS protocol. %BWL was calculated by percentile of body weight at one month after surgery to preoperative body weight. Severe BWL was defined as %BWL over 10%. Risk factors for severe BWL were determined by both univariate and multivariate logistic regression analyses. Results: Two-hundred seventy eight patients were examined. Median age (range) was 68 years (27-86). Median body mass index (range) was 22 (13.4-33.5). Thirty patients had received neoadjuvant chemotherapy. Operative procedure was total gastrectomy (TG) in 97 patients (Open in 61 and laparoscopic in 36) and distal gastrectomy (DG) in 181 patients (Open in 94 and laparoscopic in 87). Median operation time (range) was 268.5 minutes (95-554). Median blood loss (range) was 115 mL (0-1600). Morbidity of grade 2 or more defined by Clavien-Dindo classification was observed in 37 patients including pancreatic fistula in 8, anastomotic leakage in 5, and abdominal abscess in 3. No mortality was found. Completion of ERAS protocol without any variance was 95.3%. Median %BWL was 6% (-4.3% to 19.5%). Both univariate and multivariate logistic analyses demonstrated that morbidity (odds rate 3.56, p=0.001), blood loss over 300ml (odds rate 2.04, p=0.0356), and total gastrectomy (odds rate 2.1, p=0.0258) were significant risk factors for severe BWL. Conclusions: Nutritional intervention trial to inhibit BWL after gastrectomy should be focused on the patients who developed morbidity, showed blood loss over 300ml, or received total gastrectomy.

scholarly journals Analysis of factors contributing to postoperative body weight change in patients with gastric cancer: based on generalized estimation equation

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9390
Author(s):  
Qiuju Tian ◽  
Liyuan Qin ◽  
Weiyi Zhu ◽  
Shaojie Xiong ◽  
Beiwen Wu
Keyword(s):  
Gastric Cancer ◽  
Weight Loss ◽  
Body Weight ◽  
Cancer Patients ◽  
Total Gastrectomy ◽  
Weight Change ◽  
Body Weight Loss ◽  
Body Weight Change ◽  
Generalized Estimation Equation ◽  
Gastric Cancer Patients

Aims The study aimed to explore factors contributing to body weight change over time in gastric cancer patients after gastrectomy, in order to find risk factors to implement nutritional intervention beforehand. Methods A cohort of gastric cancer patients who were treated with gastrectomy from January to March 2019 at a university affiliated hospital in Shanghai were consecutively identified in this study. Demographics, disease related information, nutrition knowledge, attitude, and practice score were collected before gastrectomy. In addition, body weight before surgery (T0), body weight at one month (T1), two months (T2), and three months (T3) after gastrectomy were recorded. Generalized estimation equation was used to describe body weight change and analyze factors contributing to body weight change after surgery. Results There were 49 patients recruited in the study. Patient body weight decreased by 9.2% at T1 (Wald χ = 271.173, P <0.001), 11.0% at T2 (Wald χ2 = 277.267, P <0.001), and 11.4% at T3 compared to baseline at T0 (Wald χ = 284.076, P <0.001). The results of GEE for multivariable analysis showed that surgery type (Wald χ = 6.027, P = 0.014) and preoperative BMI (Wald χ = 12.662, P = 0.005) were contributing factors of body weight change. Compared with distal gastrectomy patients, total gastrectomy patients experienced greater body weight loss (β = 2.8%, P = 0.014). Compared with patients with BMI&λτ; 18.5 kg/m2, patients with BMI ≥ 25 kg/m2experienced greater body weight loss (β = 4.5% P = 0.026). Conclusion Gastric cancer patients experienced significant weight loss during 3 months after gastrectomy. Total gastrectomy and BMI ≥ 25 kg/m2were risk factors to postoperative body weight loss for GC patients. The results suggested hinted that clinician should pay attention to postoperative nutrition status of patient undergoing total gastrectomy and obesity patients.

Long-term effects of an oral elemental nutritional supplement on post-gastrectomy body weight loss in gastric cancer patients.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 94-94
Author(s):  
Kazuhiro Nishikawa ◽  
Yutaka Kimura ◽  
Kentaro Kishi ◽  
Kentaro Inoue ◽  
Jin Matsuyama ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Weight Loss ◽  
Body Weight ◽  
Cancer Patients ◽  
Total Gastrectomy ◽  
Body Weight Loss ◽  
Nutritional Intervention ◽  
Control Group ◽  
Gastric Cancer Patients

94 Background: Postoperative weight loss could have a negative effect on quality of life and prognosis of gastric cancer patients. We have already shown that daily nutritional intervention with an oral elemental diet (ED) attenuated the short-term postoperative percentage of body weight loss (% BWL) in post-gastrectomy patients, especially in underwent total gastrectomy (TG). This study was conducted to evaluate the postoperative long-term BWL of nutritional intervention. Methods: This study was conducted in a cohort of consecutive patients which were randomly allocated to receive the control or ED diet in the original trial. Control group received the regular diet alone after gastrectomy, while ED group received 300 kcal of ED plus their regular diet for 6–8 weeks. The primary endpoint was the % BWL from the presurgical bodyweight to that at 1 year after surgery by surgical type. Secondary endpoints were changes in nutrition-related blood parameters. Results: One hundred six of registered patients in the original trial were eligible for efficacy analyses. There was not significant difference in the % BWL between the two groups (9.13 ± 7.72 % vs. 7.09 ± 7.49 %, respectively; p = 0.171). The % BWL at one year after surgery was significantly lower in ED group than in control group among patients who underwent TG (n = 19 and 17, respectively; 9.66 ± 5.98% vs. 15.11 ± 6.78%, respectively; p = 0.015), but not in patients who underwent distal gastrectomy (DG) (n = 38 and 32, respectively; 5.81 ± 7.91% vs. 5.96 ± 6.20%, respectively; p = 0.933). A multivariate analysis revealed that only type of gastrectomy was independently associated with % BWL at 1 year after surgery. And in total gastrectomy, ED administration was independently associated with % BWL. Total lymphocyte count in ED group increased more than that in control group at 1 year after surgery. Conclusions: Nutritional intervention with ED at 300 kcal per day for 6–8 weeks reduced body weight loss at 1 year as well as 6-8 weeks after surgery in patients who underwent total gastrectomy. Clinical trial information: 000023455.

scholarly journals Recurrence of Gastric Cancer in the Jejunum Close to the Anastomotic Site after Total Gastrectomy

2021 ◽  
pp. 767-771
Author(s):  
Hiroshi Shintani ◽  
Shoji Oura ◽  
Shinichiro Makimoto
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Total Gastrectomy ◽  
Jejunal Mucosa ◽  
Anastomotic Site ◽  
Type I ◽  
Gastric Cancer Cells ◽  
Borrmann Type ◽  
Salvage Resection ◽  
Atypical Cells

A 61-year-old man underwent total gastrectomy with esophago-jejunostomy for Borrmann type I gastric cancer. Postoperative intra-abdominal abscess made the patient unable to receive adjuvant chemotherapy. Only 23 weeks after operation, the patient developed melena and anemia, leading to the diagnosis of recurrence in the jejunum close to the anastomotic site. The patient received salvage resection of the recurrence. Pathological study showed that the tumor was composed of atypical cells similar to those of the primary gastric cancer. Normal jejunal mucosa was observed between the esophagus and the recurrent tumor. We judged that exfoliation of the gastric cancer cells caused the recurrence due to both the very short disease-free interval and pathological findings. Surgeons should pay attention to this type of recurrence especially for Borrmann type I gastric cancer. In addition to the adjuvant chemotherapy, gastric irrigation using distilled water during the operation seems to be a feasible measure to prevent this type of recurrence.

scholarly journals MANAGEMENT OF GASTRIC CARCINOMA

2010 ◽  
Vol 17 (03) ◽  
Author(s):  
SAIF UD DIN AWAN ◽  
ANJUM A QADRI ◽  
M ANSAR MAQSOOD ◽  
Ayesha Naureen Awan
Keyword(s):  
Quality Of Life ◽  
Weight Loss ◽  
Gastric Carcinoma ◽  
Curative Resection ◽  
Case Series ◽  
Military Hospital ◽  
Anastomotic Site ◽  
Case Series Study ◽  
Tract Infections

Objective: (1) To find the best treatment modality for carcinoma stomach. Design: Case series study. Setting: Combined Military Hospital Rawalpindi. Period: From January 1996 to December 1999. Patients and methods: 42 cases of gastric carcinoma are included in this study. The mode of treatment predominantly remained surgical with the aim to cure the patient of this disease. Results: The disease occurred mostly above the age of 50 years. Common clinical features were unexplained weight-loss, malnourishment and anaemia,respiratory tract infections. No specific etiological factor was detected except that, out of 42 patients 35 were smokers or had quit smoking during the past six years. Nearly all were having at least 8-10 cups of hot tea per day. Adenocarcinoma was the most frequently encountered histological type. 03 patients could not be operated upon because of extremely poor prognosis due to multi-organ failure. 12 patients wereselected for surgery curative resection was carried out, whereas the remaining 27 were subjected to palliative resections. Five patients died during or within one month of surgical intervention. Out of the remaining 34, only 21 patients reported for follow up. In most of the patients in whom curative resection was performed, the quality of life was reasonably good. At the end of one year, another eight patients had died oftumour dissemination and cachexia, three patients developed tumour recurrence at the anastomotic site, and one patient developed stricture at anastomotic site. Patients with recurrence were sent for radiotherapy. Conclusions: It is concluded that for carcinoma of stomach the only possible treatment is surgery either alone or in combination with radiation and chemotherapy, the most common, preventable etiological factoris smoking, probably in combination with hot beverages in excess. The most common presentation remains weight loss with dyspepsia or weakness and anorexia, commonly effected age group is middle and old age, preoperative nutritional build-up achieves good postoperative results, palliative surgical procedures made the quality of life of the patient better. The prognosis remains extremely poor, in terms of morbidityand mortality.

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