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Rekonstruktionen und funktionelle Ergebnisse nach Magenresektion

Reconstruction and functional results after gastric resection

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Zusammenfassung

In Abhängigkeit vom Ausmaß der gastralen Resektion als (totale) Gastrektomie, distale oder proximale Magenresektion stehen verschiedene Rekonstruktionen zur Verfügung. Diese haben sich mit Implementierung der minimal-invasiven und robotischen Verfahren nicht grundsätzlich geändert, jedoch hat sich das Spektrum möglicher Anastomosentechniken erheblich erweitert. Funktionelle, insbesondere nutritive Störungen mit konsekutiver Einschränkung der Lebensqualität werden nach Magenresektion häufig beobachtet. Das Ausmaß dieser Störungen wird durch den partiellen Erhalt eines gastralen Reservoirs positiv beeinflusst. Die Anlage eines jejunalen Pouches nach (totaler) Gastrektomie führt ebenfalls zur signifikanten Reduktion der postoperativen Dumping-Symptomatik. Nach proximaler Magenresektion hat die Double-tract-Rekonstruktion funktionelle Vorteile gegenüber der einfachen Roux-Y-Rekonstruktion. Diese in Deutschland wenig praktizierten Rekonstruktionen sollten in das Repertoire der gastralen onkologischen Chirurgie bei entsprechender Indikation mit aufgenommen werden.

Abstract

Depending on the extent of gastric resection, namely total, proximal or distal gastrectomy, different methods of reconstruction are available. These reconstructive procedures have not changed with the implementation of minimally invasive or robotic techniques in general but the spectrum of possible anastomotic techniques has been substantially expanded. Functional, in particular nutritional disorders with subsequent impairment of the health-related quality of life, are often diagnosed after gastric resections. The partial preservation of a gastric reservoir has a positive impact on the extent of these disorders. After total gastrectomy, the placement of a jejunal pouch significantly reduces the incidence of postoperative dumping symptoms. Following proximal gastrectomy, double-tract reconstruction offers certain functional advantages as compared to the simple Roux‑Y reconstruction. In Germany, these reconstructive techniques are only used to a low extent and should be include in the repertoire of oncological gastric surgery with appropriate indications.

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Literatur

  1. Li GZ, Doherty GM, Wang J (2022) Surgical management of gastric cancer: a review. JAMA Surg 157:446–454. https://doi.org/10.1001/jamasurg.2022.0182

    Article  PubMed  Google Scholar 

  2. Ajani JA, D’Amico TA, Bentrem DJ et al (2019) Esophageal and esophagogastric junction vancers, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 17:855–883. https://doi.org/10.6004/jnccn.2019.0033

    Article  CAS  Google Scholar 

  3. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. https://doi.org/10.1007/s10120-016-0622-4

    Article  Google Scholar 

  4. Smyth EC, Verheij M, Allum W et al (2016) Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 27:v38–v49. https://doi.org/10.1093/annonc/mdw350

    Article  CAS  PubMed  Google Scholar 

  5. Information Committee of the Korean Gastric Cancer Association (2021) Korean Gastric Cancer Association-led nationwide survey on surgically treated gastric cancers in 2019. J Gastric Cancer 21:221–235. https://doi.org/10.5230/jgc.2021.21.e27

    Article  Google Scholar 

  6. Weber M‑C, Berlet M, Novotny A et al (2021) Reconstruction following gastrectomy. Chirurg 92:506–514. https://doi.org/10.1007/s00104-020-01350-0

    Article  PubMed  Google Scholar 

  7. Knight BC, Rice SJ, Devitt PG et al (2014) Proximal anastomosis using the OrVil circular stapler in major upper gastrointestinal surgery. J Gastrointest Surg 18:1345–1349. https://doi.org/10.1007/s11605-014-2478-4

    Article  PubMed  Google Scholar 

  8. Ojima T, Nakamura M, Hayata K et al (2021) Short-term outcomes of robotic gastrectomy vs laparoscopic gastrectomy for patients with gastric cancer: a randomized clinical trial. JAMA Surg 156:954–963. https://doi.org/10.1001/jamasurg.2021.3182

    Article  PubMed  Google Scholar 

  9. Huang C, Liu H, Hu Y et al (2022) Laparoscopic vs open distal gastrectomy for locally advanced gastric cancer: five-year outcomes from the CLASS-01 randomized clinical trial. JAMA Surg 157:9–17. https://doi.org/10.1001/jamasurg.2021.5104

    Article  PubMed  Google Scholar 

  10. Kang K‑C, Cho GS, Han SU et al (2011) Comparison of Billroth I and Billroth II reconstructions after laparoscopy-assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from Korea. Surg Endosc 25:1953–1961. https://doi.org/10.1007/s00464-010-1493-0

    Article  PubMed  Google Scholar 

  11. Tack J, Arts J, Caenepeel P et al (2009) Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol 6:583–590. https://doi.org/10.1038/nrgastro.2009.148

    Article  PubMed  Google Scholar 

  12. Nakada K, Ikeda M, Takahashi M et al (2015) Characteristics and clinical relevance of postgastrectomy syndrome assessment scale (PGSAS)-45: newly developed integrated questionnaires for assessment of living status and quality of life in postgastrectomy patients. Gastric Cancer 18:147–158. https://doi.org/10.1007/s10120-014-0344-4

    Article  PubMed  Google Scholar 

  13. Tanizawa Y, Tanabe K, Kawahira H et al (2016) Specific features of dumping syndrome after various types of gastrectomy as assessed by a newly developed integrated questionnaire, the PGSAS-45. Dig Surg 33:94–103. https://doi.org/10.1159/000442217

    Article  PubMed  Google Scholar 

  14. Takiguchi N, Takahashi M, Ikeda M et al (2015) Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by Postgastrectomy Syndrome Assessment Scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer 18:407–416. https://doi.org/10.1007/s10120-014-0377-8

    Article  PubMed  Google Scholar 

  15. Moehler M, Al-Batran S‑E, Andus T et al (2019) S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL. Z Gastroenterol 57:1517–1632. https://doi.org/10.1055/a-1018-2516

    Article  PubMed  Google Scholar 

  16. Syn NL, Wee I, Shabbir A et al (2019) Pouch versus no pouch following total gastrectomy: meta-analysis of randomized and non-randomized studies. Ann Surg 269:1041–1053. https://doi.org/10.1097/SLA.0000000000003082

    Article  PubMed  Google Scholar 

  17. Dong H‑L, Huang Y‑B, Ding X‑W et al (2014) Pouch size influences clinical outcome of pouch construction after total gastrectomy: a meta-analysis. WJG 20:10166–10173. https://doi.org/10.3748/wjg.v20.i29.10166

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tan L, Ran M, Liu Z et al (2022) Comparison of the prognosis of four different surgical strategies for proximal gastric cancer: a network meta-analysis. Langenbecks Arch Surg 407:63–74. https://doi.org/10.1007/s00423-021-02378-4

    Article  PubMed  Google Scholar 

  19. Tanioka T, Waratchanont R, Fukuyo R et al (2020) Surgical and nutritional outcomes of laparoscopic proximal gastrectomy versus total gastrectomy: a meta-analysis. Surg Endosc 34:1061–1069. https://doi.org/10.1007/s00464-019-07352-2

    Article  PubMed  Google Scholar 

  20. Lee I, Oh Y, Park S‑H et al (2020) Postoperative nutritional outcomes and quality of life-related complications of proximal versus total gastrectomy for upper-third early gastric cancer: a meta-analysis. Sci Rep 10:21460. https://doi.org/10.1038/s41598-020-78458-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Li S, Gu L, Shen Z et al (2019) A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer. BMC Surg 19:117. https://doi.org/10.1186/s12893-019-0584-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Zhao L, Ling R, Chen J et al (2021) Clinical outcomes of proximal gastrectomy versus total gastrectomy for proximal gastric cancer: a systematic review and meta-analysis. DSU 38:1–13. https://doi.org/10.1159/000506104

    Article  Google Scholar 

  23. Kim MS, Kwon Y, Park EP et al (2019) Revisiting laparoscopic reconstruction for Billroth 1 versus Billroth 2 versus roux-en‑Y after distal gastrectomy: a systematic review and meta-analysis in the modern era. World J Surg 43:1581–1593. https://doi.org/10.1007/s00268-019-04943-x

    Article  PubMed  Google Scholar 

  24. Hirao M, Takiguchi S, Imamura H et al (2013) Comparison of Billroth I and roux-en‑Y reconstruction after distal gastrectomy for gastric cancer: one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol 20:1591–1597. https://doi.org/10.1245/s10434-012-2704-9

    Article  PubMed  Google Scholar 

  25. Du N, Chen M, Shen Z et al (2020) Comparison of quality of life and nutritional status of between Roux-en‑Y and Billroth‑I reconstruction after distal gastrectomy: a systematic review and meta-analysis. Nutr Cancer 72:849–857. https://doi.org/10.1080/01635581.2019.1656262

    Article  PubMed  Google Scholar 

  26. Nishizaki D, Ganeko R, Hoshino N et al (2021) Roux-en‑Y versus Billroth‑I reconstruction after distal gastrectomy for gastric cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD012998.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  27. So JB‑Y, Rao J, Wong AS‑Y et al (2018) Roux-en‑Y or Billroth II reconstruction after radical distal gastrectomy for gastric cancer: a multicenter randomized controlled trial. Ann Surg 267:236–242. https://doi.org/10.1097/SLA.0000000000002229

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    W. Schröder FACS, FEBS, H. Fuchs & B. Babic

  2. Afdeling Heelkunde, Amsterdam Universitair Medisch Centrum, Amsterdam, Niederlande

    J. Straatman

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  1. W. Schröder FACS, FEBS
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  2. H. Fuchs
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  3. J. Straatman
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  4. B. Babic
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Correspondence to W. Schröder FACS, FEBS.

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W. Schröder, H. Fuchs, J. Straatman und B. Babic geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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M. Anthuber, Augsburg

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Schröder, W., Fuchs, H., Straatman, J. et al. Rekonstruktionen und funktionelle Ergebnisse nach Magenresektion. Chirurgie 93, 1021–1029 (2022). https://doi.org/10.1007/s00104-022-01705-9

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