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Preservation versus Non-preservation of the Duodenal Passage Following Total Gastrectomy: A Systematic Review

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Various reconstruction procedures have been proposed for restoring the alimentary tract continuity after total gastrectomy. However, so far there is no consensus on the ideal post-gastrectomy reconstruction procedure. The necessity of preserving the duodenal passage is one of the major focuses of the debate concerning gastrointestinal reconstruction and is the objective of this study.

Methods

A systematic literature search of PubMed, EMBASE, the Cochrane Library, SCI, and Chinese Biomedical Literature Database (CBM) was carried out before March 2012 to obtain studies of randomized controlled trials (RCT). Analysis was performed using RevMan 5.0 software.

Results

Nine RCTs involving 642 participants met the selection criteria. The results of the meta-analyses showed that operative mortality and morbidity were not significantly different between the two procedures (preservation vs. non-preservation of duodenum). However, operative time was considerably prolonged by preserving the duodenal passage. Patients in the preservation group had an improved nutritional parameters (body weight, levels of serum iron and hemoglobin) in the short term (<6 months) after surgery. Beneficial effect on preventing postgastrectomy symptom (heartburn, dumping syndrome) was not found by maintaining the duodenal passage throughout a 2-year follow-up. Moreover, a qualitative measurement showed that no significant quality of life improvement for patients with a preserved duodenal passage.

Conclusion

This systematic review failed to demonstrate obvious advantage in preserving duodenal passage after total gastrectomy.

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References

  1. Zonca P, Maly T, Herokova J, et al. Reconstruction after total gastrectomy. Bratisl Lek Listy 2002; 103: 414–7.

    PubMed  CAS  Google Scholar 

  2. Pan Y, Li Q, Wang DC, et al. Beneficial effects of jejunal continuity and duodenal food passage after total gastrectomy: a retrospective study of 704 patients. Eur J Surg Oncol 2008; 34:17–22.

    Article  PubMed  CAS  Google Scholar 

  3. Schwarz A, Beger HG. Gastric substitute after total gastrectomy—clinical relevance for reconstruction techniques. Langenbecks Arch Surg 1998; 383:485–91.

    Article  PubMed  CAS  Google Scholar 

  4. Lehnert T, Buhl K. Techniques of reconstruction after total gastrectomy for cancer. Br J Surg 2004; 91:528–39.

    Article  PubMed  CAS  Google Scholar 

  5. Iwahashi M, Nakamori M, Nakamura M, et al. Evaluation of double tract reconstruction after total gastrectomy in patients with gastric cancer: prospective randomized controlled trial. World J Surg 2009; 33:1882–8.

    Article  PubMed  Google Scholar 

  6. Chin AC, Espat NJ. Total gastrectomy: options for the restoration of gastrointestinal continuity. Lancet Oncol 2003; 4: 271–6.

    Article  PubMed  Google Scholar 

  7. Espat NJ, Karpeh M. Reconstruction following total gastrectomy: a review and summary of the randomized prospective clinical trials. Surg Oncol 1998; 7: 65–9.

    Article  PubMed  CAS  Google Scholar 

  8. Weitz J, Brennan M. Total gastrectomy with reconstruction options. Oper Tech Gen Surg 2003; 5: 23–35.

    Article  Google Scholar 

  9. Nakane Y, Michiura T, Inoue K, et al. A randomized clinical trial of pouch reconstruction after total gastrectomy for cancer: which is the better technique, Roux-en-Y or interposition? Hepatogastroenterology 2001; 48:903–7.

    PubMed  CAS  Google Scholar 

  10. Fuchs KH, Thiede A, Engemann R, et al. Reconstruction of the food passage after total gastrectomy: randomized trial. World J Surg 1995; 19:698–705.

    Article  PubMed  CAS  Google Scholar 

  11. Nakane Y, Okumura S, Akehira K, et al. Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial. Ann Surg 1995; 222:27–35.

    Article  PubMed  CAS  Google Scholar 

  12. Adachi S, Inagawa S, Enomoto T, et al. Subjective and functional results after total gastrectomy: prospective study for long-term comparison of reconstruction procedures. Gastric Cancer 2003; 6:24–9.

    Article  PubMed  Google Scholar 

  13. El Halabi HM, Lawrence W Jr. Clinical results of various reconstructions employed after total gastrectomy. J Surg Oncol 2008; 97:186–92.

    Article  PubMed  Google Scholar 

  14. Sharma D. Choice of digestive tract reconstructive procedure following total gastrectomy: a critical reappraisal. Indian J Surg 2004; 66: 270–6.

    Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: 1–6.

    Article  Google Scholar 

  16. Higgins JPT, Green S (eds). Cochrane handbook for systematic reviews of interventions, issue 5.0.2 (Updated September 2009). The Cochrane Collaboration. www.cochrane-handbook.org.

  17. Chinn S. A simple method for converting an odds ratio to effect size for use in meta-analysis. Stat Med 2000; 19:3127–3131.

    Article  PubMed  CAS  Google Scholar 

  18. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21:1539–1558.

    Article  PubMed  Google Scholar 

  19. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7:177–88.

    Article  PubMed  CAS  Google Scholar 

  20. Lovegrove RE, Constantinides VA, Heriot AG, et al. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg 2006; 244:18–26.

    Article  PubMed  Google Scholar 

  21. Schwarz A, Büchler M, Usinger K, et al. Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: prospective randomized clinical study. World J Surg 1996; 20:60–6.

    Article  PubMed  CAS  Google Scholar 

  22. Zherlov G, Koshel A, Orlova Y, et al. New type of jejunal interposition method after gastrectomy. World J Surg 2006; 30:1475–80.

    Article  PubMed  Google Scholar 

  23. Zhang JZ, Lu HS, Wu XY, et al. Influence of different procedures of alimentary tract reconstruction after total gastrectomy for gastric cancer on the nutrition and metabolism of patients: a prospective clinical study. Zhonghua Yi Xue Za Zhi 2003; 83:1475–8.

    PubMed  Google Scholar 

  24. Ishigami S, Natsugoe S, Hokia S, et al. Postoperative long-term evaluation of interposition reconstruction compared with Roux-en-Y after total gastrectomy in gastric cancer: prospective randomized controlled trial. Am J Sur 2011; 202: 247–253.

    Article  Google Scholar 

  25. Troidl H, Kusche J, Vestweber KH, et al. Pouch vs. esophagojejunostomy after total gastrectomy: a randomized clinical trial. World J Surg 1987; 11: 699–712.

    Article  PubMed  CAS  Google Scholar 

  26. Liedmann B, Andersson H, Berglund B, et al. Food intake after gastrectomy for gastric carcinoma: the role of a gastric reservoir. Br J Surg 1996; 83: 1138–43.

    Article  Google Scholar 

  27. Horvath OP, Kalmar K, Cseke L, et al. Nutritional and life-quality consequences of aboral pouch construction after total gastrectomy: a randomized, controlled study. Eur J Surg Oncol 2001; 27: 558–63.

    Article  PubMed  Google Scholar 

  28. Schmitz R, Moser KH, Treckmann J. Quality of life after prograde jejunum interposition with and without pouch. A prospective study of stomach cancer patients on the reservoir as a reconstruction principle after total gastrectomy. Chirurg 1994; 65: 326–32.

    PubMed  CAS  Google Scholar 

  29. Iivonen MK, Koskinen MO, Ikonen TJ, et al. Emptying of the jejunal pouch and Roux-en-Y limb after total gastrectomy: a randomised, prospective study. Eur J Surg 1999; 165: 742–47.

    Article  PubMed  CAS  Google Scholar 

  30. Iivonen MK, Mattila JJ, Nordback IH, et al. Long-term follow-up of patients with jejunal pouch reconstruction after total gastrectomy. A randomized prospective study. Scand J Gastroenterol 2000; 35: 679–85.

    Article  PubMed  CAS  Google Scholar 

  31. Gertler R, Rosenberg R, Feith M, et al. Pouch vs. no pouch following total gastrectomy: meta-analysis and systematic review. Am J Gastroenterol 2009; 104: 2838–51.

    Article  PubMed  Google Scholar 

  32. Bozzetti F, Bonfanti G, Castellani R, et al. Comparing reconstruction with Roux-en-Y to a pouch following total gastrectomy. J Am Coll Surg 1996; 183: 243–8.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Thoracic Surgery, West China Hospital of Sichuan University, Number 37, Guoxue Alley, Chengdu, Sichuan, 610041, China

    Yu-Shang Yang & Long-Qi Chen

  2. The Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, 630000, China

    Xian-Xia Yan & Ya-Li Liu

Authors
  1. Yu-Shang Yang
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  2. Long-Qi Chen
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  3. Xian-Xia Yan
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  4. Ya-Li Liu
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Correspondence to Long-Qi Chen.

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Yang, YS., Chen, LQ., Yan, XX. et al. Preservation versus Non-preservation of the Duodenal Passage Following Total Gastrectomy: A Systematic Review. J Gastrointest Surg 17, 877–886 (2013). https://doi.org/10.1007/s11605-013-2174-9

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  • DOI: https://doi.org/10.1007/s11605-013-2174-9

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