Final conclusion

E. Strong (ed.). Gastric cancer. Principles and practice. Springer (2015)


For this chapter, the authors have tried to provide the reader with a summary of the available data on reconstruction techniques after major gastric surgery. Only data from RCTs and when possible from meta-analyses are presented. On a cautionary note: a meta-analysis can only be as good as the single RCTs included. The presented metaanalyses use stringent selection criteria on individual trials before inclusion. This, nevertheless, often results in comparisons with a restricted number of trials with low numbers of patients. This has to be kept in mind, as not finding a significant difference might be a result of the low patient numbers. Of course, notwithstanding the merits of evidence-based medicine, the individual patient has to be taken into account, balancing factors such as the preoperative state and life expectancy with the complexity and associated morbidity rate of the different reconstruction techniques.

Based on the available data the authors advocate for distal gastric resection a Roux-enY reconstruction. For proximal reconstruction available data do not support an evidence-based suggestion yet. For total gastrectomies equal results are obtained by either a Roux-en-Y reconstruction with a Jor O-pouch or a jejunal interposition with pouch.

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