Total gastrectomy with preserving duodenal passage by double tract reconstruction in patients with gastric cancer

Uvarov I.B.; Manuilov A.M.; Derbenev S.N.; Asipovich O.M.

doi:https://doi.org/10.17116/hirurgia202506135

Uvarov I.B.

Kuban State Medical University;
Regional Oncological Center No. 1

ORCID: 0000-0002-2725-3281

Manuilov A.M.

Kuban State Medical University

ORCID: 0000-0002-5928-6520

Derbenev S.N.

Kuban State Medical University;
Regional Oncology Center No. 1

ORCID: 0000-0002-5403-4770

Asipovich O.M.

Kuban State Medical University;
Regional Oncology Center No. 1

ORCID: 0000-0001-9278-6335

Total gastrectomy with preserving duodenal passage by double tract reconstruction in patients with gastric cancer

Authors:

Uvarov I.B., Manuilov A.M., Derbenev S.N., Asipovich O.M.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2025;(6): 35‑43

DOI: 10.17116/hirurgia202506135

Read: 807 times

Contact the author

Table of contents

To cite this article:

Uvarov IB, Manuilov AM, Derbenev SN, Asipovich OM. Total gastrectomy with preserving duodenal passage by double tract reconstruction in patients with gastric cancer. Pirogov Russian Journal of Surgery. 2025;(6):35‑43. (In Russ.)
https://doi.org/10.17116/hirurgia202506135

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

OBJECTIVE

To evaluate the immediate and long-term functional results of total gastrectomy (TGE) with restoration of duodenal passage through double tract reconstruction (DTR) in comparison with Roux-en-Y reconstruction.

MATERIAL AND METHODS

The study included 55 patients with gastric cancer who underwent TGE. They were divided into 2 groups: I — TGE with DTR (n=29); II — TGE with Roux-en-Y reconstruction (n=26). Follow-up examination was performed in 3, 6 and 12 months after surgery. Short-term results, nutritional status, morbidity and severity of dumping syndrome, as well as GSRS scores of the quality of life were assessed.

RESULTS

TGE with DTR does not increase duration of surgery, blood loss and postoperative morbidity. Patients after TGE and DTR were characterized by faster and more complete recovery of body weight, BMI, serum transferrin and NRI within 6 and 12 months after surgery. No between-group differences in the incidence and severity of reflux esophagitis were found. Availability of duodenum for endoscopic examination was 93.1%. TGE with DTR was followed by significantly lower incidence and severity of dumping syndrome. Patients with DTR reconstruction were characterized by faster recovery of the quality of life.

CONCLUSION

TGE with DTR in patients with gastric cancer is characterized by comparable short-term results, faster recovery of nutritional status and quality of life in long-term period after surgery, lower incidence and severity of dumping syndrome.

Keywords:

total gastrectomy

gastric cancer

double tract reconstruction

preserving duodenal passage

Authors:

Uvarov I.B.

Kuban State Medical University;
Regional Oncological Center No. 1

ORCID: 0000-0002-2725-3281

Manuilov A.M.

Kuban State Medical University

ORCID: 0000-0002-5928-6520

Derbenev S.N.

Kuban State Medical University;
Regional Oncology Center No. 1

ORCID: 0000-0002-5403-4770

Asipovich O.M.

Kuban State Medical University;
Regional Oncology Center No. 1

ORCID: 0000-0001-9278-6335

Received:

06.08.2024

Accepted:

15.07.2024

Close metadata

References:

McCall MD. Quality of life: A critical outcome for all surgical treatments of gastric cancer. World J Gastroenterol. 2016;22(3):1101. https://doi.org/10.3748/wjg.v22.i3.1101
Rowsell A, Sodergren SC, Vassiliou V, Darlington AS, Guren MG, Alkhaffaf B, Moorbey C, Dennis K, Terada M. Systematic review of health-related quality of life (HRQoL) issues associated with gastric cancer: capturing cross-cultural differences. Gastric Cancer. 2022;25(4):665-677. https://doi.org/10.1007/s10120-022-01309-6
van Amelsfoort RM, Walraven I, Kieffer J, et al. Quality of Life Is Associated With Survival in Patients With Gastric Cancer: Results From the Randomized CRITICS Trial. J Natl Compr Canc Netw. 2022;20(3):261-267. https://doi.org/10.6004/jnccn.2021.7057
Baryshev AG, Porhanov VA, Popov AY, Lishenko AN, Hachaturyan NV, Valyakis DA, Bodnya MV, Efremenko YuV. Metabolism in various embodiments, the recovery of the digestive system in patients after gastrectomy. Innovative Medicine of Kuban. 2017;4(8):6-11. (In Russ.).
Chaika AV, Khomyakov VM, Ryabov AB. Functional effects of operations for malignant gastric neoplasms: prevention, diagnosis and treatment of post-gastrectomy disorders. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(3):4-17. (In Russ.). https://doi.org/10.22416/1382-4376-2018-28-3-4-17
Kinami S, Nakamura N, Zhiyong J, Miyata T, Fujita H, Takamura H, Ueda N, Iida Y, Kosaka T. Severity of postgastrectomy syndrome and quality of life after advanced gastric cancer radical gastrectomy. Mol Clin Oncol. 2020;13(2):133-140. https://doi.org/10.3892/mco.2020.2061
Nomura E, Kayano H, Lee SW, et al. Functional evaluations comparing the double-tract method and the jejunal interposition method following laparoscopic proximal gastrectomy for gastric cancer: an investigation including laparoscopic total gastrectomy. Surg Today. 2019;49:38-48. https://doi.org/10.1007/s00595-018-1699-7
Tsujiura M, Nunobe S. Functional and nutritional outcomes after gastric cancer surgery. Transl Gastroenterol Hepatol. 2020;5:29. https://doi.org/10.21037/tgh.2019.11.10
Osminin SV, Komarov RN, Ivanov DL. Methods of gastrointestinal tract reconstruction after gastrectomy for gastric cancer. Experimental and Clinical Gastroenterology. 2020;12:68-75. (In Russ.). https://doi.org/10.31146/1682-8658-ecg-184-12-68-75
Ruchkin DV, Kozlov VA, Nitkin AA. Pouch jejunogastroplasty as an method reconstruction after gastrectomy. Moscow Surgical Journal. 2020;2:54-60. (In Russ.).
Olesiński T, Szpakowski M, Saramak P, Rutkowski A, Jeziorski K. Preservation of duodenal passage as a determinant of short- and long-term quality of life in gastric cancer patients after total gastrectomy. Minerva Chir. 2017;72(5):368-374. https://doi.org/10.23736/S0026-4733.17.07364-3
Onopriev VI, Uvarov IB. Gastrectomy with end-loop jejunogastroplasty in stomach cancer. Pirogov Russian Journal of Surgery. 2004;9:32-36. (In Russ.).
Hong J, Wang SY, Hao HK. A Comparative Study of Double-Tract Reconstruction and Roux-en-Y After Gastrectomy for Gastric Cancer. Surg Laparosc Endosc Percutan Tech. 2019;29(2):82-89. https://doi.org/10.1097/SLE.0000000000000639
Yang YS, Chen LQ, Yan XX, Liu YL. Preservation versus Non-preservation of the Duodenal Passage Following Total Gastrectomy: A Systematic Review. J Gastrointest Surg. 2013;17(5):877-886. https://doi.org/10.1007/s11605-013-2174-9
Kazaryan AM, Akopov AL, Rosok B, Postriganova ND, Edvin B. Russian edition of the classification of complications in surgery. Grekov’s Bulletin of Surgery. 2014;173(2):86-91. (In Russ.).
Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11-48. https://doi.org/10.1016/j.clnu.2016.07.015
The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group Perioperative total parenteral nutrition in surgical patients. N Engl J Med 1991;325:525-532. https://doi.org/10.1056/NEJM199108223250801
Scarpellini E, Arts J, Karamanolis G, et al. International consensus on the diagnosis and management of dumping syndrome. Nat Rev Endocrinol. 2020;16(8):448-466. https://doi.org/10.1038/s41574-020-0357-5
Komarov RN, Kuznetsov NA, Osminin SV. Priorities of national surgery. Evgeny Illarionovich Zakharov. Stomach repair with small bowel substitutes. Pirogov Russian Journal of Surgery. 2021;9:103-106. (In Russ.). https://doi.org/10.17116/hirurgia2021091103
Schwarz A, Büchler M, Usinger K, Rieger H, Glasbrenner B, Friess H, Kunz R, Beger HG. Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: prospective randomized clinical study. World J Surg. 1996;20(1):60-66; discussion 66-67. https://doi.org/10.1007/s002689900011
Gertler R, Rosenberg R, Feith M, Schuster T, Friess H. Pouch vs. no pouch following total gastrectomy: meta-analysis and systematic review. Am J Gastroenterol. 2009;104(11):2838-2851. https://doi.org/10.1038/ajg.2009.456
Fujiwara Y, Kusunoki M, Nakagawa K, Tanaka T, Hatada T, Yamamura T. Evaluation of J-pouch reconstruction after total gastrectomy: rho-double tract vs. J-pouch double tract. Dig Surg. 2000;17(5):472-475. https://doi.org/10.1159/000051943
Ichikura T, Chochi K, Sugasawa H, Mochizuki H. Antireflux contrivance in jejunal pouch reconstruction after total and proximal gastrectomies. Dig Surg. 2007;23(5-6):381-386. https://doi.org/10.1159/000097898
Ignjatović N., Stanojević G., Ignjatović J. Impact of reconstructive procedures with and without preserving the duodenal passage on body weight in patients after total gastrectomy for gastric cancer. Srp Arh Celok Lek. 2017;145(1-2):26-31. https://doi.org/10.2298/SARH151123004I
Ikeguchi M, Kuroda H, Saito H, Tatebe S, Wakatsuki T. A new pouch reconstruction method after total gastrectomy (pouch-double tract method) improved the postoperative quality of life of patients with gastric cancer. Langenbecks Arch Surg. 2011;396(6):777-781. https://doi.org/10.1007/s00423-011-0779-6
Iwahashi M, Nakamori M, Nakamura M, Naka T, Ojima T, Iida T, Katsuda M, Ueda K, Yamaue H. Evaluation of double tract reconstruction after total gastrectomy in patients with gastric cancer: prospective randomized controlled trial. World J Surg. 2009;33(9):1882-1888. https://doi.org/10.1007/s00268-009-0109-0
Kondoh Y, Okamoto Y, Morita M, Nakamura K, Soeda J, Matsui H, Ogoshi K, Makcuuchi H. Clinical outcome of jejunal pouch double-tract reconstruction after total gastrectomy. Hepatogastroenterology. 2008;55(84):1118-1121.
Resanovic A, Randjelovic T, Resanovic V, Toskovic B. Double Tract vs. Roux-en-Y Reconstruction in the treatment of Gastric Cancer. Pak J Med Sci. 2018;34(3):643-648. https://doi.org/10.12669/pjms.343.14348