The incidence of upper gastric cancer has increased significantly in recent years, and there is still a debate on whether the best surgical procedure for progressive upper gastric cancer is total gastrectomy or proximal gastrectomy, mainly involving radical surgery and postoperative GI reconstruction. With the improvement of people’s living standard and the prolongation of survival time after gastric cancer surgery, the requirements for quality of life and the efficacy of gastric substitution are also increasing, and the quality of life and nutrition metabolism after proximal gastrectomy are closely related to the type of GI reconstruction. The study was conducted to investigate the problems of reflux esophagitis and nutritional disorders that often occur after conventional pancreatic cancer surgery.
In this paper, we analyzed the data of two different surgical procedures that preserved the distal stomach for GI reconstruction after major proximal gastrectomy for upper gastric cancer from June 2009 to June 2011, and discussed a more satisfactory GI reconstruction after upper gastric cancer resection.
The gastroesophageal anastomosis, which has been widely used in clinical practice for many years, is simple to perform, but the frequent occurrence of significant reflux esophagitis seriously affects the survival quality of patients, and is the main reason why total gastrectomy is recommended instead of this procedure. However, the complete loss of gastric function after total gastrectomy will have a great impact on patients psychologically and physiologically, and many patients will die not from cancer recurrence but from malnutrition. We wanted to design a modified distal gastric preservation procedure to ensure that the distal stomach could be preserved during radical surgery instead of having to perform total gastrectomy or still using direct gastroesophageal anastomosis, and for this reason there were no surgical deaths, anastomotic bleeding, anastomotic leakage, or anastomotic stenosis in the two groups, and the operative times were 186±56 min and 228±65 min, respectively. Discussion: The gastroesophageal anastomosis, which has been widely used clinically for many years, is simple to perform, preserves the duodenal access in accordance with physiological function, and a large number of patients can survive for a long time indicating the possibility of preserving the distal stomach. However, due to the absence of the cardia, the anastomosis cannot be extended during feeding resulting in a feeling of obstruction to feeding, and the residual gastric peristalsis occurs due to the inability to close the anastomosis with reflux of gastric contents, especially the latter often seriously affects the quality of survival of the patient, and is the main reason why this procedure is recommended to be abandoned.
However, the complete loss of gastric function after total gastrectomy will have a great impact on the patient psychologically and physiologically. In addition to nutritional problems, many patients will suffer from upper abdominal pain, fullness, nausea, vomiting, diarrhea and dumping syndrome, which also seriously affect patients’ postoperative quality of life. Since 1897, when Schlatter first used endo-jejunal anastomosis to reconstruct the GI tract after total gastrectomy, there have been about 70 types of GI tract reconstruction, the most typical and commonly used being Roux-en-Y esophago-jejunal anastomosis, P-collar substitution of the stomach and interposition of the jejunum to preserve the duodenal access. to a perfect degree.
For this reason, the reconstruction of the digestive tract after proximal gastrectomy remains a topic for continued research. Rather than having to perform a total gastrectomy or still use a direct gastroesophageal anastomosis, we would like to design a modified distal gastric preservation procedure to ensure that the distal stomach can be preserved during radical surgical treatment. Because the simple gastroesophageal anastomosis is still often used after proximal gastrectomy, we started the modified approach by selecting cases with direct gastroesophageal anastomosis performed at the same time as a control study.
From our comparison of the Visick classification of the discomfort symptoms in nearly 20 patients after the modified approach, there was a significant difference between the two groups. The design of the procedure revealed that the modified approach combined anti-reflux and preservation of duodenal access for digestion and absorption. The quality of life of the patients was significantly higher than that of the control group.