C Palanivelu, R Parthasarathi, P Senthilnathan, S Rajapandian, P Praveen Raj, Subrahmaneswara Babu. GEM Hospital & Research Centre
Background: Jejunal pouch reconstruction after total gastrectomy for carcinoma stomach, aims at satisfactory reservoir function, which has shown to yield best possible functional results. With laparoscopic total gastrectomy becoming increasingly relevant, we aimed to compare laparoscopic total gastrectomy with jejunal pouch and controls without pouch, in relation to quality of life.
Methods: Total 34 patients underwent laparoscopic total gastrectomy and Roux-en-Y esophago-jejunal pouch reconstruction (JPR). These were compared with matched controls (stage and surgical procedure) without pouch (EJ, Esophago-jejunostomy). The primary outcome of this study was quality of life based on GSRS scale, EORTC QLQ C-30, STO-22 questionnaires. The secondary outcome variables were Clinico-pathological, peri-operative and pathological analysis.
Results: The mean operative time was longer in JPR group (343.7+22.4 Vs 274.4+18.9, p=0.042). Body weight was better preserved in JPR at 12 months (3.18±0.52 Vs 5.15±0.24, p=0.015) and 24 months (3.58±0.43 Vs 7.97±0.27, p<0.0001). The quality of life variables at 24 months, were significantly favoring JPR in regards to GSRS scale (4.13±0.27 Vs 8.87±1.77, p=0.0017), global health status (79.98±1.77 Vs 62.50±4.72, p=0.0004), physical functioning (94.65±1.33 Vs 76.66±4.54, p<0.0001), role functioning (89.98±2.18 Vs 77.08±6.99, p=0.038), and lesser eating restriction (11.67±1.09 Vs 19.79±3.12, p=0.006). On multivariate analysis, only the type of procedure has shown significant impact on GSRS score (p=0.001) and Global Health status (p<0.0001).
Conclusion: Jejunal Pouch Reconstruction following total gastrectomy offers better short- term outcomes and good quality of life compared with the conventional RY reconstruction.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80898
Program Number: S036
Presentation Session: Gastric
Presentation Type: Podium