Evaluation Of The Early Efficacy Of Accommodated Double Tract Digestive Reconstruction Of Jejunal Interposition After Total Gastrectomy

Objective:The morbidity and mortality of gastric cancer is high.Surgery is one of the possible cure for gastric cancer.Radical gastrectomy includes tumor resection,lymph node dissection and digestive tract reconstruction.With the increase of the incidence of middle and upper gastric cancer,the number of gastric cancer patients requiring total gastrectomy is increasing.The Roux-en-Y reconstruction is the most commonly used operation after total gastrectomy.Today,individualized and accurate comprehensive treatment is gradually applied to patients with gastric cancer,making the overall efficacy of total gastrectomy patients with gastric cancer can be improved,but no stomach syndrome such as anemia,malnutrition,reflux esophagitis,dumping syndrome,Roux-en-Y stasis syndrome greatly reduce the quality of life of patients after surgery.Therefore,how to improve the quality of life of gastric cancer patients with total gastrectomy by improving the way of digestive tract reconstruction has become the long-term effort of the scholars.Accommodated double tract digestive reconstruction of jejunal interposition is an improvement based on the reconstruction of functional jejunum interposition digestive tract.The purpose of this study is to analyze the clinical data of two types of digestive tractreconstruction after operation,so as to explore the safety and feasibility of a-DJI in total gastrectomy for gastric cancer.Methods:In this study,a prospective study was conducted to enrolle patients with gastric cancer who were scheduled for total gastrectomy.The patients were randomly divided into groups according to the envelope method.The observation group was a-DJI and the control group was RY.The patients were followed up for 6 months.The complete clinical data were recorded:general information(sex,age,body mass index,tumor staging),perioperative results(reconstruction time,blood loss,first postoperative exhaust time after operation,first time after operation,time of hospitalization),complications(anastomotic leakage,obstruction,bleeding,regurgitation,heartburn,dumping syndrome,RSS occurrence).Patients’ body weight,hemoglobin,serum total protein,serum albumin,vitamin B12 and ferritin were recorded after 1 month,3 months and 6 months.At the same time,the quality of life of the patients was scored on the quality of life scale [EORTC QLQ-C30(V3.0)and EORTC QLQ-STO22] developed by the European Organization for Research and Treatment of Cancer at three postoperative time points.SPSS20.0 software was used to make statistics,and quantitative data was tested by t test.The count data were tested by chi-square test.Results:The two groups of gastric cancer patients completed the operation successfully.There were no serious anastomotic fistula,bleeding and obstruction in the perioperative period.In the observation group,one case werelost,one case in the control group were lost,and one case were eliminated because of the recurrence of tumor.In this study,77 cases of gastric cancer were included,39 cases in the observation group and 38 cases in the control group.There was no significant difference in sex,age,body mass index and tumor staging between the two groups of gastric cancer patients before operation(P>0.05).Perioperative outcomes:there was no significant difference in the time of digestive reconstruction,intraoperative blood loss,postoperative first exhaust time,postoperative first time of eating and hospitalization time between the two operation methods(P>0.05).Diet: in 6 months,there was no statistically significant difference between the two groups in the amount of diet and the number of daily drinks and drinks(P>0.05).With the extension of postoperative time,the dietary habits of the patients gradually improved.Complications:(1)two groups of patients with postoperative regurgitation and heartburn incidence was not statistically significant difference(P>0.05);(2)in first mouth,the a-DJI group had a lower incidence of dumping syndrome,the difference was statistically significant(P=0.037);in third and sixth months,two groups of patients with gastric cancer collapse syndrome incidence is similar to;(3)in first month,two groups of patients had similar rates of RSS after operation,but in third and sixth months,the incidence rate of RSS in a-DJI group was significantly lower than that in RY reconstruction group,the difference was statistically significant(P=0.029;P=0.038).Nutrition index results:(1)the two groups of patients with gastric cancer before and aftersurgery within 6 months of weight,hemoglobin,serumtotal protein and albumin showed no significant difference(P>0.05);(2)in sixth month,vitamin B12 and ferritin in a-DJI group were lower than those in the RY group,the difference was statistically significant(P=0.043;P=0.012),but the results were in the normal range.Finally,the EORTC QLQ-C30 scale was applied to two groups of patients with gastric cancer.According to the results of the scoring,most of the subgroups of patients with gastric cancer showed no significant difference at 3time points(all P> 0.05).There were differences in the molecular weight scale:(1)in third month after surgery,the role-function scores of a-DJI group were lower than those of the RY group(P=0.032);(2)in third and sixth months,the individual scores of nausea and vomiting in a-DJI group were lower than that of RY group(P= 0.020;P=0.017);(3)The individual score of appetite loss in a-DJI symptom sub-scale in first month after operation was higher than RY group(P=0.045);4)in sixth month after surgery,the individual score of diarrhea in symptom subscale of a-DJI group was lower than that of RY group(P=0.014).The EORTC QLQ-STO22 quality of life score showed that the higher the subscale score was,the worse the quality of life was:(1)The a-DJI group had a higher score in the regurgitation component than the RY group in first month(P=0.011).After 6 months of surgery,the a-DJI group showed a lower score than the RY group(P=0.042);(2)in the sixth month after surgery,the a-DJI dietary subscale score was lower than that of the RY group(P=0.000).Conclusion:Accommodated double tract digestive reconstruction ofjejunal interposition after total gastrectomy is safe and feasible.Compared with Roux-en-Y reconstruction,this reconstruction method is conducive to the recovery of nutritional indicators of patients,can reduce the incidence of patients with dumping syndrome,RSS and can improve the quality of life of patients after surgery.