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PubMed1996

Nutrient malassimilation following total gastrectomy.

BACKGROUND: The aim of the study was to elucidate the degree and the pathophysiology of abdominal symptoms, malnutrition and malassimilation after total gastrectomy. METHODS: In 174 consecutive patients, with potentially curative total gastrectomy for gastric malignancy, subjective symptoms and objective parameters of malassimilation were evaluated. RESULTS: Abdominal symptoms were present in 86% of the patients. In spite of a high daily calorie intake (median 37.8 kcal/kg body weight) mean body mass index had been decreasing since good health. Anaemia was found in 46%, sideropenia in 31% and oesophagitis in 26%. Mean faecal fat excretion was 17.4 (1.4) g/day and mean fat malassimilation 14.8% (1.1) of the intake. A shortened small-bowel transit was measured in 21.7% of the patients, and bacterial overgrowth was present in 37.7%. CONCLUSIONS: Malassimilation post total gastrectomy seems to be multifactorial. Shortened small-bowel transit and subsequent dyssynchrony of pancreatic enzyme supply seem to be of major importance.

Adult↗
PubMed1996

Oesophageal squamous cell carcinoma after gastrectomy for benign ulcer disease.

Of 684 patients treated for squamous cell carcinoma of the oesophagus in 1982-1993, 19 (2.8%) had previously undergone partial gastrectomy for benign ulcer disease. The average interval between gastrectomy and diagnosis of oesophageal carcinoma was 14 years. In six of the 19 (31.6%) cases the carcinoma was in the lower thoracic oesophagus, an incidence not significantly higher than the 25% in the total series. The oesophageal resectability rates were 52.6% in the gastrectomized patients and 44.4% in the total series (intergroup difference not significant). Of the ten gastrectomized patients who underwent oesophageal resection, only one had oesophagitis at the oesophagogastric junction, without significant histologic characteristics. The relationship between oesophageal squamous cell carcinoma and previous gastrectomy for benign ulcer disease may be incidental.

Adult↗
PubMed1993

Roux-en-Y end-to-side esophagojejunostomy with stapler after total gastrectomy.

One hundred gastric cancer patients who underwent total gastrectomy and Roux-en-Y, end-to-side esophagojejunostomy by using stapling devices were analyzed with regard to their operative results. The median time required for the anastomosis was 18 minutes (range of 15 to 45 minutes). A cartridge of 25 mm in diameter was preferred (85% of 25 mm vs. 15% of 28 mm). In 92 patients, procedures were uneventful. Intraoperative problems happened in 8 patients: Two misfirings of stapler due to mechanical problems, in 6 patients, doughnut tissues were incomplete. Mechanical problems were solved by a change of the stapler and for incomplete doughnut tissues, anastomosis was simply reinforced (2 cases) or reanastomosed with restaplings (4 cases). Anastomotic leakage occurred in 2 patients but it was seen only in radiological studies. During the follow up period, two cases of anastomotic stricture were found and they were treated with endoscopic dilatations. There was no operative mortality nor other complication. In addition, routine use of the Levin tube after total gastrectomy was appraised by comparing postoperative courses. Twenty patients were randomly divided into two groups; for 10 patients the Levin tube was removed at the recovery room and for another 10 patients the Levin tube was indwelled until peristalsis returned. Timing of the tube removal did not affect the duration of the hospital stay and starting day of oral intake. We think that the stapler, when properly used, can facilitate the esophagojejunostomy safely and routine use of the Levin tube after total gastrectomy may be unnecessary.

Adult↗
PubMed2004

Long-term effect on carcinoma of esophagus of distal subtotal gastrectomy.

AIM: To investigate the surgical treatment and long-term survival for patients with carcinoma of esophagus after distal subtotal gastrectomy. METHODS: Resections of the tumor through left thoracotomy were performed in 85 patients with esophageal carcinoma following distal subtotal gastrectomy. The procedure involved preserving the left short gastric artery and transporting the residual stomach, the spleen and tail of the pancreas into the left thoracic cavity, and using the residual stomach to reconstruct the alimentary tract. RESULTS: The resectable rate was 91.8%, complication rate 10.3%, and no death occurred in the postoperative period. The 1-, 3-, 5-, and 10-year survival rates were 85.7%, 50.7%, 30.6% and 18.8%, respectively. CONCLUSION: Surgical resection is the optimal management method for the patients with esophageal carcinoma after distal subtotal gastrectomy. The reconstruction of digestive tract using anastomosis of the esophagus and the residual stomach is not only simple but also can achieve a better curative effect, promoting the digestive function and improving the quality of life.

Adenocarcinoma↗
PubMed2005

Effects of glutamine-containing total parenteral nutrition on phagocytic activity and anabolic hormone response in rats undergoing gastrectomy.

AIM: To investigate the effect of glutamine (Gln)-containing parenteral nutrition on phagocytic activity and to elucidate the possible roles of Gln in the secretion of anabolic hormones and nitrogen balance in rats undergoing a gastrectomy. METHODS: Rats with an internal jugular catheter were divided into 2 experimental groups and received total parenteral nutrition (TPN). The TPN solutions were isonitrogenous and identical in nutrient compositions except for differences in amino acid content. One group received conventional TPN (control), and in the other group, 25% of the total amino acid nitrogen was replaced with Gln. After receiving TPN for 3 d, one-third of the rats in each experimental group were sacrificed as the baseline group. The remaining rats underwent a partial gastrectomy and were killed 1 and 3 d, respectively, after surgery. Plasma, peritoneal lavage fluid (PLF), and urine samples were collected for further analysis. RESULTS: The Gln group had fewer nitrogen losses 1 and 2 d after surgery (d1, 16.6+/-242.5 vs -233.4+/-205.9 mg/d, d2, 31.8+/-238.8 vs -253.4+/-184.6 mg/d, P<0.05). There were no differences in plasma growth hormone (GH) and insulin-like growth factor-1 levels between the 2 groups before or after surgery. The phagocytic activity of peritoneal macrophages was higher in the Gln group than in the control group 1 d after surgery (A 1185+/-931 vs 323+/-201, P<0.05). There were no differences in the phagocytic activities of blood polymorphonuclear neutrophils between the 2 groups at the baseline or on the postoperative days. No significant differences in interleukin-1beta or interleukin-6 concentrations in PLF were observed between the 2 groups. However, tumor necrosis factor-alpha level in PLF was significantly lower in the Gln group than in the control group on postoperative d 3. CONCLUSION: TPN supplemented with Gln can improve the nitrogen balance, and enhance macrophage phagocytic activity at the site of injury. However, Gln supplementation has no effect on phagocytic cell activity in the systemic circulation, GH and insulin-like growth factor-1 might not be responsible for attenuating nitrogen losses in rats with a partial gastrectomy.

Animals↗
PubMedDate not supplied

Proximal gastrectomy and jejunal pouch interposition: evaluation of postoperative symptoms and gastrointestinal hormone secretion.

Reflux esophagitis, dumping syndrome and malnutrition are included in the postgastrectomy complications. To prevent or minimize such sequelae, proximal gastrectomy with an interposed jejunal pouch has been advocated as an organ-preserving surgical strategy to improve quality of life for the patients. Proximal gastrectomy was performed in 44 patients with tumors in the upper third of the stomach; 21 had reconstruction using jejunal pouch interposition between the esophagus and the remnant stomach (JP group), while 23 had reconstruction by esophagogastrostomy (EG group). Re-construction method was selected by each patient on the basis of the informed consent. Thirty-five patients had early gastric cancer. Postoperative courses of patients were reviewed in terms of symptoms, weight maintenance, nutritional status, blood chemistry values, endoscopic findings, and radiographic appearances after a barium meal. Concentrations of gastrointestinal hormones were measured in response to a test meal. The JP procedure permitted increased dietary volume. The JP group showed fewer severe postoperative symptoms than the EG group. After operation, all patients examined in both groups showed hypergastrinemia and all patients examined in the JP group showed hypersecretinemia. In proximal gastrectomy, the JP procedure improved patient's post-operative quality of life.

Adult↗
PubMed2005

Total gastrectomy with or without abdominal drains. A prospective randomized trial.

The most common postoperative complications of total gastrectomy are esophagojejunal anastomotic leakage and subphrenic abscess. These complications are a cause of morbidity and mortality, relaparotomy, and longer postoperative stay. The use of abdominal drains is useful for the early diagnosis and management of anastomotic leaks. The aim of this study was to analyze our experience with total gastrectomy for gastric cancer in patients with and without abdominal drains, and to evaluate the results regarding postoperative morbidity, postoperative hospital stay, postoperative days for oral intake, relaparotomy and mortality. This prospective and randomized study examines the results in 60 consecutive patients (43 males and 17 females) with gastric cancer who underwent total gastrectomy in the Regional Clinical Hospital of Concepción, Chile, between 2000 and 2003. Patients were divided into two groups: group I (without drains) and group II (two drains). We found 31 patients in group I and 29 patients in group II. The mean length of postoperative stay was 12.9 days in group I and 18.8 days in group II (p = 0.0242, s.). Morbidity was 9.7% in group I and 37.9% in group II (p = 0.0242, s.). Re-explorations were more frequent in group II (24.1%) versus group I (9.7%) (p = 0.1239, n.s.). Postoperative days for oral intake were 9.4 in group I and 12.8 in group II (p = 0.0514, n.s.) Mortality was 0% in group I and 3.4% in group II (p = 0.4833, n.s.). In our experience, morbidity and postoperative hospital stay were statistically higher in the group of patients with abdominal drains.

Adult↗
PubMedDate not supplied

Total gastrectomy for gastric cancer in elderly patients.

BACKGROUND/AIMS: The increased average life expectancy and the changing patterns in gastric carcinoma have resulted in a considerable rise in the number of older patients requiring total gastrectomy. Results of total gastrectomy for gastric cancer in elderly patients are presented. METHODOLOGY: Between January 1987 and December 1996, 115 patients underwent total gastrectomy for gastric adenocarcinoma. At the time of surgery, 25 (21.8%) patients were older than 70 years. The results achieved in these patients were compared with those observed in 90 younger ones. RESULTS: The hospital mortality and morbidity rates for the elderly patients were 16% and 56%, respectively; for the younger ones they were 3.3% and 30%, respectively. No difference was seen between the two age groups concerning the average post-operative hospital stay. CONCLUSIONS: In our series, age was a major determinant with respect to post-operative morbidity and mortality. However, age alone could not be clearly defined as a determining risk factor considering that the accompanying illness and preexisting factors predispose for poor prognosis.

Adenocarcinoma↗
PubMedDate not supplied

Gastric emptying after segmental gastrectomy for early cancer in the middle part of the stomach.

BACKGROUND/AIMS: We evaluated the quality of life and gastric emptying in patients who had undergone a segmental gastrectomy to treat early gastric cancer in the middle part of the stomach. METHODOLOGY: Thirty patients were considered in this study. Their mean age was 65.5 years (range: 44-83). All of the patients were free from recurrence of their cancer in the follow-up period. This ranged from 5 to 50 months (mean 30). Patients were interviewed at regular intervals to assess their quality of life and to note particular complaints. The upper gastrointestinal tract was assessed endoscopically. A gastric emptying study was performed at 3, 6, and 12 months after surgery. The meal used in this dual-phase study had solid and liquid phases. For the solid phase, 74 MBq of 99mTc sulfur colloid was injected into an egg, which was then hard-boiled. For the liquid phase, 18.5 MBq of (111)In-diethyltriaminopenta acetic acid (DTPA) were mixed into 150 ml of a commercial, elentary liquid diet. RESULTS: Three months after surgery, the patients' main complaints were gastric stasis (25%), heartburn (8%) and belching (8%). The patients gradually became asymptomatic following surgery. Fifty-nine percent were asymptomatic at the 3-month follow-up, 84% at 6 months, and 92% at 12 months. There was no evidence of reflux esophagitis or gastritis after the 3-month follow-up. One patient developed a complicated duodenal ulcer. Initially, the patients all had prolonged gastric emptying of the dual phase meal, compared to normal individuals. The T1/2 for liquid meal emptying was 87+/-18 min at 3 months, 77+/-20 min at 6 months and 50+/-5 min at 1 year after surgery. The last value is the same as for healthy individuals. Solid meal emptying was still prolonged, with an emptying rate of 36+/-9.7% at 2 hours, one year after surgery. CONCLUSIONS: Segmental gastrectomy patients experienced prolonged gastric emptying in the early post-operative period. This improved in the first year after surgery. The quality of life for patients who underwent segmental gastrectomy has been reasonably good in the follow-up period to date.

Adult↗
PubMedDate not supplied

Preserved esophagogastric manometric motility in patients after distal gastrectomy.

BACKGROUND/AIMS: A prospective study resolved whether commonly employed distal gastrectomies could influence the esophagogastric manometric measurements and the role of vasoactive intestinal polypeptide in mediating motility after surgery. METHODOLOGY: Studied groups consisted of 20 patients following radical subtotal gastrectomy for gastric cancer, 20 patients after subtotal gastrectomy for duodenal ulcer and 20 controls. Fasting blood was obtained to measure serum vasoactive intestinal polypeptide levels. A pneumohydraulic infusion system measured esophagogastric motility parameters. RESULTS: Measured lower esophageal sphincter pressures in subjects of gastric cancer surgery, duodenal ulcer surgery and controls were 15.3 +/- 4.7, 13.1 +/- 5.3 and 12.6 +/- 5.0 mmHg, respectively (NS), while the sphincter lengths were 3.15 +/- 0.81, 3.22 +/- 0.79 and 2.86 +/- 0.85 cm, respectively (NS). In addition, other parameters including lower esophageal body remained unchanged. The serum vasoactive intestinal polypeptide levels of three groups were 24.1 +/- 10.8, 22.5 +/- 9.5 and 21.3 +/- 7.8 pg/ml, respectively (NS). CONCLUSIONS: Neither gastric cancer nor duodenal ulcer in distal stomach removal can alter the lower esophageal body and LES manometric motilities. Unchanged serum VIP levels after gastric surgery are likely one of the mechanisms preserving esophagogastric integrity.

Aged↗
PubMed1975

The influence of calcium and calcium + vitamin D2 treatment on bone mineral after partial gastrectomy.

Sixty-three men and 23 women who had undergone partial gastrectomy for ulcer disease were randomized into three groups to study the effect of calcium (2 g per day) and calcium + vitamin D2 (1000 IU calciferol per day) treatment for eight months on bone mineral. The Americium-241 gamma ray attenuation method was used to measure the changes in bone mineral density. Calcium and calcium + vitamin D2 increased the bone mineral density statistically significantly in the males, but not in females. Partial gastrectomy causes bone rarefaction, and consequently these patients reach the risk level of bone mineral density for osteoporotic fractures earlier than healthy subjects. The conclusion drawn was that prophylactic treatment is needed after partial gastrectomy. Further study is required, especially of women, to find the most suitable form of treatment for disturbances in bone mineral metabolism after gastric resection.

Aged↗
PubMed2000

Comparison of anterior and geometric mean liquid and solid gastric emptying rates in dogs and in patients after partial gastrectomy.

OBJECTIVE: The purpose of this study was to determine if geometrical correction is necessary in the study of gastric emptying rate (GER) for liquids, using a low-energy radionuclide, such as 99mTc. Solid test meals were considered the reference. METHODS: Both solid and liquid GERs were investigated using regional analysis. Anterior data were compared with geometrically corrected values in 15 dogs and 9 partial gastrectomy patients. RESULTS: Anterior and geometrically corrected measurements differed significantly for solid food in the whole gastric region and in the antrum. Geometrically corrected values differed slightly from anterior data after partial gastrectomy. No difference was found for liquid food. Liquids redistributed much faster than solids within the stomach. CONCLUSION: Measurement of GER using a single-phase liquid meal does not require geometrical correction. This is due to the rapid intragastric redistribution of the liquid. Geometrical correction for solid food can be omitted only after partial gastrectomy.

Adult↗
PubMed2000

Outcome of prophylactic radical lymphadenectomy with gastrectomy in patients with early gastric carcinoma without lymph node metastasis.

BACKGROUND: Prophylactic extended lymphadenectomy with gastrectomy may prolong survival in patients with early gastric carcinoma without lymph node metastasis. However, the therapeutic value of extensive lymphadenectomy in patients with early gastric carcinoma remains controversial. METHODS: The authors retrospectively analyzed 423 patients with early gastric carcinoma without lymph node metastasis who underwent gastrectomy and did not die of other diseases to evaluate the effect of prophylactic extended lymphadenectomy on postoperative survival. The postoperative survival rate of patients who underwent prophylactic extended lymphadenectomy was compared with that of patients who underwent prophylactic limited lymphadenectomy. RESULTS: Although extended lymphadenectomy did not appear to improve the postoperative survival rate of patients with mucosal tumors, it did improve the postoperative survival rate of patients with submucosal tumors. Whether prophylactic extended lymphadenectomy was performed significantly affected outcome in patients with early gastric carcinoma who had submucosal tumors without regional lymph node metastasis. CONCLUSIONS: Extensive lymphadenectomy with gastrectomy should be performed to prolong the survival of the patients with submucosal tumors.

Aged↗
PubMed1998

[Gastro-intestinal reconstruction by substitution of "O" shaped jejunum after total gastrectomy].

OBJECTIVE: To discuss a satisfying method for alimentary continuity reconstruction after total gastrectomy. METHOD: An "O" shaped jejunum pouch or a new "stomach" was constructed in between esophagus and duodenum after total gastrectomy. RESULTS: Thirty-nine cases of gastric malignant tumor were treated by this method. The 3 and 5 years disease free survival rate were 67.7% and 55.6%. All the patients recovered their normal meal habit (3 meals a day) within 6 months postoperatively. Compared with the preoperative and the postoperative (one year after operation), body weight is equal level, increasing and decreasing in 71.1%, 15.8% and 13.1% of the cases respectively. There were no posterior sternal pain and food or digestive fluid reflux, no dumping syndrome in these patients. The volume enlargement of the "new stomach" was observed obviously, especially in "stomach fundus". CONCLUSION: This operation is a satisfying method for alimentary canal reconstruction after total gastrectomy and it is worthy to be recommended in gastric surgery.

Adenocarcinoma↗
PubMed1975

Pylorus-preserving gastrectomy for gastric ulcer--one- to nine-year follow-up study.

Of 100 patients subjected to pylorus-preserving gastrectomy for surgical treatment of gastric ulcer, 60 were available for follow-up for periods of from one to 9 years. Questionnaires and personal interviews of these 60 and additional laboratory examinations of 40 of them showed results tending to favor the procedure as a highly recommendable technique of gastrectomy. Questions about body weight gain, return to preoperative occupation, and satisfaction with the operation all were answered favorably. In the follow-up laboratory examinations, reduction rates of 57.2 percent for maximal acid concentration, 81.6 percent for maximal acid output, and 70.8 percent for peak acid output. Sphincteric function was generally well preserved on the pyloric ring. Gastric emptying times, ranging from 30 to 180 minutes in 79 percent of the cases, were nearly compatible with the control figures. The results of fat and protein absorption tests performed on some of these patients showed their rates to be within normal ranges. No instances of dumping syndrome, recurrence of ulcer, or other significant postgastrectomy sequelae were recognized. The results indicate pylorus-preserving gastrectomy to be preferable for the surgical treatment of gastric ulcer and other benign lesions of the stomach.

Adult↗
PubMedDate not supplied

New method for jejunal pouch interposition reconstruction after distal gastrectomy.

BACKGROUND/AIMS: Recently pouch reconstruction has been reported to improve quality of life and functional results after surgery for gastric cancer. Although jejunal pouch reconstruction after distal gastrectomy has favorable results for patients' quality of life, it is complicated and takes a long time to complete. We developed a new technique using a linear stapling device to avoid this problem. METHODOLOGY: The duodenum and the jejunum are simultaneously divided with a 100-mm linear stapler 0.5 cm distal to the pyrolus ring and 20 cm distal to the ligament of Treitz, respectively. A 100-mm linear stapler is introduced into two approximated segments of the jejunum through two small stab wounds 10 cm and 15 cm distal to the stump, respectively, and side-to-side anastomosis is performed along the antimesenteric borders. The anterior wall of the pouch is cut along the prospective line of anastomosis with the gastric remnant. The anterior wall of the stomach is cut along the planned suture line having a length similar to that of the pouch. The posterior walls of the stomach and the jejunal pouch are placed back-to-back on the planned anastomotic line. End-to-end posterior anastomosis between the gastric remnant and the jejunal pouch is simultaneously performed with gastrectomy using a 100-mm linear stapler. End-to-end anterior anastomosis is created by hand. RESULTS: This technique has been used in 4 patients, and there have been no complications related to the pouch or anastomoses. Mean operative time was 255 +/- 37 min (range: 205-290 min). CONCLUSIONS: Shortening of operative time can be attributed to adoption of end-to-end posterior anastomosis between the stomach and the jejunal pouch using the linear stapling device simultaneously with gastrectomy.

Anastomosis, Surgical↗
PubMedDate not supplied

The efficacy of 1 alpha hydroxy vitamin D3 treatment of the metabolic bone disorder in patients who underwent gastrectomy for gastric cancer.

BACKGROUND/AIMS: The aim of this study was to elucidate the efficacy of 1 alpha hydroxy vitamin D3 for treatment of metabolic bone disorder after gastrectomy. METHODOLOGY: MD-MS method was performed in 16 patients who underwent gastrectomy to evaluate the metabolic bone disorder and compared before and after 1 alpha hydroxy vitamin D3 treatment. The symp-toms related to the metabolic bone disorder were also analyzed through patient interview. RESULTS: The severity of the metabolic bone disorder analyzed by the MD-MS method improved after 1 alpha hydroxy vitamin D3 treatment in 56.3% of patients. The deviation degree of the cortical bone density was also significantly improved. The symptoms related to metabolic bone disorder disappeared in 80% of patients after treatment. CONCLUSIONS: The administration of 1 alpha hydroxy vitamin D3 may be useful for the metabolic bone disorder in the treatment of patients after gastrectomy.

Aged↗
PubMedDate not supplied

Marginal ulcer on the jejunum after proximal gastrectomy by jejunal interposition.

Marginal ulcer after proximal gastrectomy has never been previously reported, despite that this procedure preserves the fundic gland area of the stomach, which secretes gastric acid. In this report, we describe a patient who developed a marginal ulcer on the oral side of the gastrojejunal anastomosis after proximal gastrectomy by jejunal interposition. This case serves as a reminder that gastric acid secretion of the remnant stomach must be carefully monitored after proximal gastrectomy in gastric cancer surgery.

Anastomosis, Surgical↗