Clinical Control Trial On The Reconstruction Of Digestive Tract After Radical Total Gastrectomy For Gastric Cancer

Objective The aim of the study was to explore the most option of reconstruction of the digestive tract from total gastrectomy,the quality of life,postoperative complications and 3-year overall survival rate of patients with gastric cancer after radical total gastrectomy in two different groups.Methods This was a retrospective cohort study.From September 2014 to February 2017,87 patients who were eligible for the inclusion criteria in Tongde Hospital of Zhejiang Province were collected in this study.According to the pattern of intraoperative digestive tract reconstruction,42 patients were assigned to routine Roux-en-Y group and 45 patients were divided into uncut Roux-en-Y with distal jejunal pouch replacement group.The demographic variables,postoperative complications,operation related conditions,nutritional status,inflammatory immune indicators and quality of life scores of the two groups were recorded and analyzed.The follow-up period was up to February 2020.Results Among the 87 patients in this study,72.4%were males and 27.6%were females,with an average age of 62.4±12.2 years(range:32-90),and an average BMI of 22.7 ± 3.1(range:16.7-31.2).The stage I,II and III of postoperative pathological TNM were 14.9%,47.1%and 37.9%,the R0 resection rate is 98.6%,and the 3-year OS was 73.8%in group A and 77.8%in group B(P=0.718).The difference between the two groups in gender,age,BMI,tumor diameter,pathological TNM stage and tumor Lauren classification was no significance.The difference was not significant in operation time,estimated blood loss,number of lymph node dissection,time to ambulation,oral intake,soft diet,and first flatus,duration of hospitalization.In the comparison of laparoscopic and open surgery,the laparoscopic group was much better than the open surgery group in estimated blood loss,the first time to ambulation,first flatus,time to oral intake and soft diet,and the hospital stay,the difference was statistically significant(P<0.05).There was no significant difference in the number of lymph node dissection and the overall complications between the two groups,P>0.05.The ROC curves of LMR,NLR and PLR were drawn respectively.The results showed that the best critical values for predicting the total survival time of gastric cancer patients were 2.98,3.42 and 171.8,and the area under the curve was 0.763,0.687 and 0.763.The value of LMR and PLR in predicting the prognosis of gastric cancer before operation was greater than that of NLR,but there was no significant difference between the group A and B.Quality of life was obviously improved in the pouch reconstruction group beginning 12 months postoperatively.Weight loss persisted in all patients,decreased rapidly for all patients within the first 3 months to a final body weight slightly above 86%of their preoperative weight.It was stable until one year after operation,and basically recovered to 95%of the preoperative weight in the second year after operation.Conclusion Compared with routine Roux-en-Y group,uncut Roux-en-Y group does not need to disconnect jejunum and mesentery,which is not only simple to operate,but also able to prevent the interruption of intestinal electrophysiology and the damage of motor function,to block the reflux of bile and pancreatic juice effectively,to avoid reflux esophagitis,to ensure the normal pacing potential of duodenum spread to the distal jejunum,and to reduce the disadvantages of the syndrome of the retention of roux.The distal jejunal pouch is able to compensate for the storage function of the stomach,to increase the food intake,to delay the passage time of food obviously,to make the food fully mix with the bile and pancreatic juice from the Y intestinal loop,to make the digestive juice have enough time to digest the food,to benefit of the digestion and absorption of the intestinal tract,to maintain the hormone balance of the gastrointestinal tract in the body,to improve the nutritional status and quality of life after operation,which has a better safety and reliability.Laparoscopic surgery,which is equivalent to open surgery in terms of the safety of tumor therapy,has the advantages of less estimated blood loss,less postoperative overall complications,faster recovery of intestinal function and shorter duration of hospitalization.