To cut or not to cut? A prospective randomized controlled trial on short-term outcomes of the uncut Roux-en-Y reconstruction for gastric cancer

Abstract

Background: Roux-en-Y (R-Y) anastomoses have been widely used in distal gastrectomy, while the incidence of Roux stasis syndrome remains common. Uncut R-Y anastomosis maintains the neuromuscular continuity, thus avoiding the ectopic pacemaker of the Roux limb and reducing the occurrence of Roux stasis. However, retrospective studies of Uncut R-Y anastomosis remain scarce and randomized controlled trials have not been reported.

Methods: We conducted a randomized controlled trial to compare the surgical safety, nutritional status, and postoperative quality of life (QOL) between uncut and classic Roux-en-Y (R-Y) reconstruction patients. Patients with Stage I gastric cancer were randomly enrolled and underwent laparoscopic distal gastrectomy followed by uncut or classic R-Y reconstruction. Body mass index and blood test were used to evaluate the nutritional status. QOL was evaluated using European Organization for Research and Treatment of Cancer QOL Questionnaire (STO22) and laboratory examinations at postoperative month (POM) 3, 6, 9, and 12. Computed tomography scanning was used to evaluate the skeletal muscle index (SMI) at POM 6 and 12. Endoscopy was performed at POM 12.

Results: Operation time, blood loss, time to recovery, complication morbidities, and overall survival were similar between the two groups. Compared with the classic R-Y group, the uncut R-Y group displayed a significantly decreased QOL at POM 9, possibly due to loop recanalization, determined to be occupied 34.2% of the uncut R-Y group. Post-exclusion of recanalization, the QOL was still higher in the classic R-Y group than in the uncut R-Y group, despite their hemoglobin and total protein levels being better than those in the classic R-Y group. Preoperative pre-albumin level and impaired fasting glycemia significantly correlated with the postoperative recanalization.

Conclusion: We found no significant benefit of uncut over classic R-Y reconstruction which challenges the superiority of the uncut R-Y reconstruction.

Trial registration: ClinicalTrials.gov Identifier: NCT02644148.

Keywords: Early gastric cancer; Laparoscopic distal gastrectomy; Quality of life; Recanalization; Uncut Roux-en-Y reconstruction.

Fig. 1

The patients’ follow-up schedules in R-Y group and uncut R-Y group

Fig. 2

Flow diagram of R-Y group and uncut R-Y group in this study

Fig. 3

Quality of life scores according to QLQ-STO22 questionnaires of patients in R-Y group and uncut R-Y group on the 3rd, 6th, 9th, and 12th month after surgery, including dysphagia scale (A), pain scale (B), reflux symptoms scale (C), eating restriction scale (D), anxiety scale (E), and hair loss (F)

Fig. 4

Quality of life scores according to QLQ-STO22 questionnaires of patients in R-Y group and uncut R-Y group after exclusion of those with recanalization on the 3rd, 6th, 9th, and 12th month after surgery, including dysphagia scale (A), pain scale (B), reflux symptoms scale (C), eating restriction scale (D), anxiety scale (E), and hair loss (F)

Fig. 5

Quality of life scores according to QLQ-STO22 questionnaires of patients in uncut R-Y group with or without recanalization, including dysphagia scale (A), pain scale (B), reflux symptoms scale (C), eating restriction scale (D), anxiety scale (E), and hair loss (F)

Fig. 6

Representative image of skeletal muscle area, subcutaneous fat area, and visceral fat area from CT-based analyses at the level of the fourth lumbar vertebra (L4)