Background:The results of studies comparing Billroth-I(B-I)with Roux-en-Y(R-Y)reconstruction on the quality of life(QoL)are still inconsistent.The aim of this trial was to compare the long-term QoL of B-I with R-Y ana...Background:The results of studies comparing Billroth-I(B-I)with Roux-en-Y(R-Y)reconstruction on the quality of life(QoL)are still inconsistent.The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer.Methods:A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital,Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group(N=70)and R-Y group(N=70).The follow-up time points were 1,3,6,9,12,24,36,48,and 60 months after the operation.The final follow-up time was May 2019.The clinicopathological features,operative safety,postoperative recovery,long-term survival as well as QoL were compared,among which QoL score was the primary outcome.An intention-to-treat analysis was applied.Results:The baseline characteristics were comparable between the two groups.There were no statistically significant differences in terms of postoperative morbidity and mortality rates,and postoperative recovery between the two groups.Less estimated blood loss and shorter surgical duration were found in the B-I group.There were no statistically significant differences in 5-year overall survival(79%[55/70]of the B-I group vs.80%[56/70]of the R-Y group,P=0.966)and recurrence-free survival rates(79%[55/70]of the B-I group vs.78%[55/70]of the R-Y group,P=0.979)between the two groups.The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences(postoperative 1 year:85.4±13.1 vs.88.8±16.1,P=0.033;postoperative 3 year:87.3±15.2 vs.92.8±11.3,P=0.028;postoperative 5 year:90.9±13.7 vs.96.4±5.6,P=0.010),and the reflux(postoperative 3 year:8.8±12.9 vs.2.8±5.3,P=0.001;postoperative 5 year:5.1±9.8 vs.1.8±4.7,P=0.033)and epigastric pain(postoperative 1 year:11.8±12.7 vs.6.1±8.8,P=0.008;postoperative 3 year:9.4±10.6 vs.4.6±7.9,P=0.006;postoperative 5 year:6.0±8.9 vs.2.7±4.6,P=0.022)were milder in the R-Y group than those of the B-I group at the postoperative 1,3,and 5-year time points.Conclusions:Compared with B-I group,R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain,without changing survival outcomes.Trial Registration:ChiCTR.org.cn,ChiCTR-TRC-10001434.展开更多
BACKGROUND Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life,the causes,including blood sugar fluctuations,are difficult to elucidate due to limitations ...BACKGROUND Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life,the causes,including blood sugar fluctuations,are difficult to elucidate due to limitations in examining dumping symptoms as they occur.AIM To investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.METHODS Patients receiving distal gastrectomy with Billroth-I(DG-BI)or Roux-en-Y reconstruction(DG-RY)and total gastrectomy with RY(TG-RY)for gastric cancer(March 2018-January 2020)were prospectively enrolled.Interstitial tissue glycemic profiles were measured every 15 min,up to 14 d,by continuous glucose monitoring.Dumping episodes were recorded on 5 patient-selected days by diary.Within 3 h postprandially,dumping-associated glycemic changes were defined as a dumping profile,those without symptoms as a control profile.These profiles were compared.RESULTS Thirty patients were enrolled(10 DG-BI,10 DG-RY,10 TG-RY).The 47 early dumping profiles of DG-BI showed immediately sharp rises after a meal,which 47 control profiles did not(P<0.05).Curves of the 15 late dumping profiles of DG-BI were similar to those of early dumping profiles,with lower glycemic levels.DGRY and TG-RY late dumping profiles(7 and 13,respectively)showed rapid glycemic decreases from a high glycemic state postprandially to hypoglycemia,with a steeper drop in TG-RY than in DG-RY.CONCLUSION Postprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer.Furthermore,glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.展开更多
Objectives: The main steps for physiologic type reconstruction in 50 complicated corrosive strictures of upper alimentary tract are presented. Methods: In successive developed gastric outlet and esophageal strictures ...Objectives: The main steps for physiologic type reconstruction in 50 complicated corrosive strictures of upper alimentary tract are presented. Methods: In successive developed gastric outlet and esophageal strictures a limited Billroth I resection (in 9) or conversion a prior precolic GEA in such anastomosis (in 5) and middle or total gastrectomies (in 3) were performed. A second stage substernal by-pass with isoperistaltic transverse colon segment was done 6 - 12 weeks later. In all but one instances the graft was implanted high in the gastric stump. In extensive burned and retracted such lesion (in 3) a similar by-pass was carried out but the lower anastomosis was done with the not involved prepyloric segement. In concomittant antropyloric and esophageal strictures in 11 young, good risk patients, a limited Billroth I resction and simultaneous colonic bypass was used. In case of accompanied respiratory fistula (in 4) exclusion by-pass was useful for both lesions. The associated pyloric stricture (in 3) was solved at the same time. Side-to-end pharyngocolostomy was used in 4 high thoracocervical strictures. In 8 previously perforated strictures the by-ass was performed 2 months later. Reults: The overall mortality was 4%. The postoperative morbidity was low (8%). All cervical leaks closed spontaneously. Particular late complications required revisional surgery in 12, 5% of cases. Conclusion: In complicated corrosive strictures (esophageal, gastric, fistulas) limited Billoth I resection, isoperistaltic colon by-pass with high gastrocolic anastomosis, good gastric drainage and maintenance of the duodenum in gastrointestinal continuity are the main factors to achieve the best functional results.展开更多
基金Domestic support from the Foundation of Science&Technology Department of Sichuan Province(Nos.2020YJ0212 and 2023YFS0060)1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(No.ZYJC21006)
文摘Background:The results of studies comparing Billroth-I(B-I)with Roux-en-Y(R-Y)reconstruction on the quality of life(QoL)are still inconsistent.The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer.Methods:A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital,Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group(N=70)and R-Y group(N=70).The follow-up time points were 1,3,6,9,12,24,36,48,and 60 months after the operation.The final follow-up time was May 2019.The clinicopathological features,operative safety,postoperative recovery,long-term survival as well as QoL were compared,among which QoL score was the primary outcome.An intention-to-treat analysis was applied.Results:The baseline characteristics were comparable between the two groups.There were no statistically significant differences in terms of postoperative morbidity and mortality rates,and postoperative recovery between the two groups.Less estimated blood loss and shorter surgical duration were found in the B-I group.There were no statistically significant differences in 5-year overall survival(79%[55/70]of the B-I group vs.80%[56/70]of the R-Y group,P=0.966)and recurrence-free survival rates(79%[55/70]of the B-I group vs.78%[55/70]of the R-Y group,P=0.979)between the two groups.The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences(postoperative 1 year:85.4±13.1 vs.88.8±16.1,P=0.033;postoperative 3 year:87.3±15.2 vs.92.8±11.3,P=0.028;postoperative 5 year:90.9±13.7 vs.96.4±5.6,P=0.010),and the reflux(postoperative 3 year:8.8±12.9 vs.2.8±5.3,P=0.001;postoperative 5 year:5.1±9.8 vs.1.8±4.7,P=0.033)and epigastric pain(postoperative 1 year:11.8±12.7 vs.6.1±8.8,P=0.008;postoperative 3 year:9.4±10.6 vs.4.6±7.9,P=0.006;postoperative 5 year:6.0±8.9 vs.2.7±4.6,P=0.022)were milder in the R-Y group than those of the B-I group at the postoperative 1,3,and 5-year time points.Conclusions:Compared with B-I group,R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain,without changing survival outcomes.Trial Registration:ChiCTR.org.cn,ChiCTR-TRC-10001434.
文摘BACKGROUND Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life,the causes,including blood sugar fluctuations,are difficult to elucidate due to limitations in examining dumping symptoms as they occur.AIM To investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.METHODS Patients receiving distal gastrectomy with Billroth-I(DG-BI)or Roux-en-Y reconstruction(DG-RY)and total gastrectomy with RY(TG-RY)for gastric cancer(March 2018-January 2020)were prospectively enrolled.Interstitial tissue glycemic profiles were measured every 15 min,up to 14 d,by continuous glucose monitoring.Dumping episodes were recorded on 5 patient-selected days by diary.Within 3 h postprandially,dumping-associated glycemic changes were defined as a dumping profile,those without symptoms as a control profile.These profiles were compared.RESULTS Thirty patients were enrolled(10 DG-BI,10 DG-RY,10 TG-RY).The 47 early dumping profiles of DG-BI showed immediately sharp rises after a meal,which 47 control profiles did not(P<0.05).Curves of the 15 late dumping profiles of DG-BI were similar to those of early dumping profiles,with lower glycemic levels.DGRY and TG-RY late dumping profiles(7 and 13,respectively)showed rapid glycemic decreases from a high glycemic state postprandially to hypoglycemia,with a steeper drop in TG-RY than in DG-RY.CONCLUSION Postprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer.Furthermore,glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.
文摘Objectives: The main steps for physiologic type reconstruction in 50 complicated corrosive strictures of upper alimentary tract are presented. Methods: In successive developed gastric outlet and esophageal strictures a limited Billroth I resection (in 9) or conversion a prior precolic GEA in such anastomosis (in 5) and middle or total gastrectomies (in 3) were performed. A second stage substernal by-pass with isoperistaltic transverse colon segment was done 6 - 12 weeks later. In all but one instances the graft was implanted high in the gastric stump. In extensive burned and retracted such lesion (in 3) a similar by-pass was carried out but the lower anastomosis was done with the not involved prepyloric segement. In concomittant antropyloric and esophageal strictures in 11 young, good risk patients, a limited Billroth I resction and simultaneous colonic bypass was used. In case of accompanied respiratory fistula (in 4) exclusion by-pass was useful for both lesions. The associated pyloric stricture (in 3) was solved at the same time. Side-to-end pharyngocolostomy was used in 4 high thoracocervical strictures. In 8 previously perforated strictures the by-ass was performed 2 months later. Reults: The overall mortality was 4%. The postoperative morbidity was low (8%). All cervical leaks closed spontaneously. Particular late complications required revisional surgery in 12, 5% of cases. Conclusion: In complicated corrosive strictures (esophageal, gastric, fistulas) limited Billoth I resection, isoperistaltic colon by-pass with high gastrocolic anastomosis, good gastric drainage and maintenance of the duodenum in gastrointestinal continuity are the main factors to achieve the best functional results.
