OBJECTIVETo find an ideal reconstruction method after total gastrectomy.

METHODSWith 12 healthy persons as control, a total of 120 gastric cancer patients received their digestive tract reconstruction after total gastrectomy were randomized into Roux-en-y esophagojejunostomy group (A), P pouch with Roux-en-y esophagojejunostomy group (B), Hunt-Lawrence esophagojejunostomy group (C), and jejunal interposition esophagojejunostomy group (D). After operation, quality of life, prognosis nutrition index (PNI), body weight, serum nutritional parameters, gastrointestinal hormone level and immunological state were evaluated.

RESULTSThe quality of life, PNI, body weight and serum nutritional parameters (SI, TS and Hb) were better in group D than those in groups A, B and C (P < 0.05). The cholecystokinin (CCK) level and NK cell, CD(4)(+) cell, CD(8)(+) cell and CD(4)/CD(8) ratio in group D, being similar to the control group, were significantly higher than groups A, B and C (P < 0.05).

CONCLUSIONModified jejunal interposition esophagojejunostomy is a reasonable reconstruction method. The construction of "P" pouch, reserving foods as the stomach, can preserve the duodenal passage and secretion of the gastrointestinal hormones, which results in better digestion of the food and absorption of the nutrients. This method simplifies the operation and guarantee the blood supply of interpositioned jejunum without causing ischemia at the anastomotic orifice.