Research Of Randomized Clinical Trial On Functional Jejunal Interposition After Total Gastrectomy

Objective:To investigate the effectiveness and necessity of preserving the food duodenum passway and jejunal continuity in digestive tract reconstruction after total gastrectomy through a variety of ways such as safety of surgery, postoperative complications, postoperative nutrient status and life quality by randomized clinical trial(RCT).Methods:The trial divided into FJI group and R-Y group. All patients underwent conventional lymph node dissection and total gastrectomy. Datas was measured and analyzed at different time after surgery such as:1.Surgery-related indicators:Recent:the time of reconstruction (minutes),the incidence of postoperative complications, mortality rate of perioperative. Forward:reflux esophagitis, heartburn, the incidence of Dumping syndrome and R-S syndrome(bellyache, nausea, vomit, fullness and discomfort after a meal),number of daily consumption and habits.2.Nutrition indicators:weight, serum total protein, serum albumin, hemoglobin, retinol binding protein, prealbumin, serum ferritin, transferrin, vitamin B12,folic acid, triceps skinfold thickness3.Evaluation of quality of life:application EORCT (European Organization for Research and Treatment of Cancer) life quality questionnaire(core questionnaire EORCT QLQ-C30V3,gastric cancer supplementary questionnaire EORCT-QLQ-STO22) to evaluate quality of life. All datas of patients were analyzed by SPSS17.0. Count data using the x2test and measurement data using the t-test.Results:All patients in this cohort received more than one week followed-up. Among them,4patients died of metastasis,2patients were lost, actual109patients were enrolled.57patients underwent R-Y and52patients underwent FJI. All subjects signed informed consent on the basis of informed consent. There was no significant difference in gender, age, postoperative pathologic staging between the two groups(P>0.05). Time spent in reconstruction of digestive tract was much longer in the R-Y group than in the FJI group (25±10.3,34±8.6min; P=0.0471). The incidence of Dumping syndrome and R-S syndrome of FJI group showed a better result than R-Y group(P<0.05), however, the symptom of "reflux, heartburn " in3rd month of R-Y group showed better result than FJI group (P=0.0221). There were no significant difference in most of the nutrition indicators at different time after surgery except the follows:the transferrin in R-Y group was less than in FJI group at1st week after surgery (1.5±0.5,1.7±0.4g/L, P=0.0342) and more than in FJI at6th month after surgery (3.9±1.6,2.6±1.3g/L, P=0.0053); folic acid in R-Y group was less than in FJI group at1st month after surgery (19.0±6.3,21.9±3.2nmol/L; P=0.0054). By C30life quality scores, slight difference in subprojects between the two groups as follows:Scales of Cognitive Function in FJI group were much more than in R-Y group at1st month postoperation (97.5±4.3,87.7±15.8, P=0.0001), at3rd month postoperation (96.4±5.3,90.1±16.4, P=0.0411), and at9th month postoperation(97.9±6.5,81.4±19.4, P=0.0381); Scales of Fatigue Symptom in FJI group were much more than in R-Y group at1st month postoperation (33.6±20.1,17.5±7.8, P<0.0001), at3rd month postoperation (22.9±19.7,11.7±7.7, P=0.0061), and at6th month postoperation (22.8±15.9,11.8±9.1, P=0.0121); Scale of Constipation Symptom in FJI group was much more than in R-Y group at3rd month postopera-tion (21.1±30.9,7.8±16.5, P=0.0412); Scale of Society Function in R-Y group was much more than in FJI group at6th month postoperation (86.8±17.0,72.8±21.6, P=0.0222).The Scales of Food Intake of STO22in R-Y group were munch more than in FJI group at1st month(36.0±28.7,14.2±16.3, P<0.0001), and at3rd month (24.8±15.2,12.7±17.7, P=0.0048). while the Scale of Reflux Symptom in FJI group was much more than R-Y group at3rd month postoperation (22.9±17.2,11.7±12.2, P=0.0036). The changing trends were similar of the most of the nutrient indicators except the follows:the changing trend of serum ferritin in R-Y group was gradually decending trend, while in FJI group was gradually ascending trend from1st week to6th month; the changing trend of weight in R-Y group was gradually descending trend, while in FJI group was gradually ascending trend from3rd month to6th month. Conclusions:Compared with R-Y reconstruction of the digestive tract, FJI can significantly reduce the incidence of postoperative Dumping syndrome and R-S syndrome, improve the situation of food intake of the patients suffered from total gastrectomy, and significantly shorten the time spent in the reconstruction of digestive tract. However, the incidence of postoperative reflux esophagitis in3rd month in R-Y group showed better result than in FJI group.