Assessing optimal Roux-en-Y reconstruction technique after total gastrectomy using the Postgastrectomy Syndrome Assessment Scale-45

作     者：Masami Ikeda Masashi Yoshida Norio Mitsumori Tsuyoshi Etoh Chikashi Shibata Masanori Terashima Junya Fujita Kazuaki Tanabe Nobuhiro Takiguchi Atsushi Oshio Koji Nakada 

作者机构：Department of SurgeryAsama General HospitalNagano 385-8558Japan Department of SurgeryInternational University of Health and Welfare HospitalTochigi 329-2763Japan Department of SurgeryThe Jikei University School of MedicineTokyo 105-8461Japan Department of Gastroenterological SurgeryOita UniversityOita 879-5593Japan Department of SurgeryTohoku Medical and Pharmaceutical UniversityMiyagi 983-8512Japan Division of Gastric SurgeryShizuoka Cancer CenterShizuoka411-8777Japan Department of SurgeryYao Municipal HospitalOsaka 581-0069Japan Department of Gastroenterological and Transplant SurgeryInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshima 734-8551Japan Department of Gastroenterological SurgeryChiba Cancer CenterChiba 260-8717Japan Faculty of LettersArts and SciencesWaseda UniversityTokyo 162-8644Japan Department of Laboratory MedicineThe Jikei University School of MedicineTokyo 105-8461Japan 

出 版 物：《World Journal of Clinical Oncology》 (世界临床肿瘤学杂志（英文版）)

年 卷 期：2022年第13卷第5期

页      面：376-387页

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：Supported by The Jikei University School of Medicine and Japanese Society for Gastro-surgical Pathophysiology 

主　　题：Total gastrectomy Roux-en-Y Postgastrectomy syndrome Quality of life Postgastrectomy Syndrome Assessment Scale-45 

摘      要：BACKGROUND Following a total gastrectomy,patients suffer the most severe form of postgastrectomy syndrome.This is a significant clinical problem as it reduces quality of life(QOL).Roux-en-Y reconstruction,which is regarded as the gold standard for post-total gastrectomy reconstruction,can be performed using various techniques.Although the technique used could affect postoperative QOL,there are no previous reports regarding the same.AIM To investigate the effect of different techniques on postoperative QOL.The data was collected from the registry of the postgastrectomy syndrome assessment study(PGSAS).METHODS In the present study,we analyzed 393 total gastrectomy patients from those enrolled in PGSAS.Patients were divided into groups depending on whether antecolic or retrocolic jejunal elevation was performed,whether the Roux limb was“40 cm,“shorter(≤39 cm),or“longer(≥41 cm),and whether the device used for esophageal and jejunal anastomosis was a circular or linear stapler.Subsequently,we comparatively investigated postoperative QOL of the patients.RESULTS Reconstruction route:Esophageal reflux subscale(SS)occurred significantly less frequently in patients who underwent antecolic reconstruction.Roux limb length:“ShorterRoux limb did not facilitate esophageal reflux SS and somewhat attenuated indigestion SS and abdominal pain SS.Anastomosis technique:In terms of esophagojejunostomy techniques,no differences were observed.CONCLUSION The techniques used for total gastrectomy with Roux-en-Y reconstruction significantly affected postoperative symptoms.Our results suggest that elevating the Roux limb,which is not overly long,through an antecolic route may improve patients’QOL.