Comparison of Functional Outcomes between Functional Jejunal Interposition and Conventional Roux-en-Y Esophagojejunostomy after Total Gastrectomy for Gastric Cancer

Abstract

Background: The reconstruction of digestive tract after total gastrectomy is associated with various postoperative complications. We aimed to investigate the differences in functional outcomes of 2 reconstruction techniques following total gastrectomy: functional jejunal interposition (FJI) versus Roux-en-Y esophagojejunostomy. Methods: Sixty patients were enrolled and divided into FJI and Roux-en-Y groups. Nutritional parameters and incidences of reconstruction-related symptoms were evaluated. Oral glucose tolerance test and endoscopy examination were carried out. Results: The postoperative prognostic nutritional index scores and postoperative/preoperative body weight, meal intake, serum albumin level ratio were significantly higher in the FJI group than in the Roux-en-Y group. At 3, 6, and 12 months postoperatively, the elevations of plasma glucose level after glucose intake were more significant in the FJI group than in the Roux-en-Y group. The incidence of postoperative stasis symptoms in the Roux-en-Y group was significantly higher than in the FJI group, but no obvious difference was observed regarding dumping and reflux symptoms. The incidence rates of severe esophageal mucosa injury and severe anastomotic stricture were also similar between the 2 groups. Conclusion: FJI reconstruction might accelerate the recovery of nutritional status and reduce the occurrence of stasis symptoms postoperatively as compared with Roux-en-Y esophagojejunostomy, which may have an advantage over FJI in stabilizing body glycometabolism after surgery. These 2 types of reconstruction may have a similar anti-reflux function to prevent severe reflux esophagitis and anastomotic stenosis.