Results of a randomized, prospective trial comparing residual stomach, duodenum and uncut jejunal interposition (Gastrojejunoduodenostomy) to standard Billroth-II reconstruction after subtotal gastrectomy for distal gastric cancer
qin zhang1,2, Mark S. Talamonti2, Zaiyuan Ye3, Hongqi Shi4, Jianfa Yu1; 1Gastrointestinal Surgery, Affilliated Hospital of Zhejiang College of Traditional Chinese Medicine, Hangzhou, China; 2Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; 3Department of Surgery, Zhejiang Provincial People Hospital, Hangzhou, China; 4Department of Surgery, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
This randomized, prospective study compares a new type of digestive reconstruction, gastrojejunoduodenostomy with uncut jejunal interposition, to standard Billroth-II gastrojejunostomy after subtotal gastrectomy. The new procedure consists of: an end-to-side gastrojejunostomy 25cm distal to the Treitz ligament, a side-to-end jejunoduodenostomy at the efferent jejunum 30cm distal to the gastrojejunostomy, and side-to-side jejunojejunostomy, two jejunal occlusions one proximal to the gastrojejunostomy and a second distal to the jejunoduodenostomy. 86 cases with distal gastric cancer were randomized: 41 cases with the new procedure(Group A) and 45 cases with standard Billroth-II procedure(Group B). Body weight(BW), Prognosis nutritional indexes(PNI) and Visick scoring(VS) at three & six months after surgery were compared. BW and PNI in Group A at 6 months were back to the level before surgery unlike those in Group B. VS in Group A at six months was superior to that in Group B(u=2.85,P<0.01). This new procedure may offer a better option for digestive reconstruction after subtotal gastrectomy by restoring digestive physiological passage through the duodenum, avoiding bile reflux, and improving quality of life.
Table1 Results of pre- and post operative conditions
| group | n | Body Weight(kilogram) | Prognosis nutritional indexes | ||||
| before | 3 months | 6 months | before | 3 months | 6 months | ||
| A | 41 | 59.29±6.13 | 56.34±5.33Δ | 59.71±5.11 | 45.89±4.88 | 39.93±5.2Δ | 45.54±4.37 |
| B | 45 | 58.27±5.12 | 53.44±3.79Δ | 55.53±4.00* | 44.83±5.51 | 36.3±4.05Δ | 40.05±4.41Δ* |
Δ:compared to "before" of the same group,there was a significant difference(P<0.05) *:compared to "3 month" of the same group,there was a significant difference(P<0.05)
Fig: Gastrojejunoduodenostomy A,B: mark the ligation location
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