Background

Metabolic benefits of an oncometabolic reconstruction method (long limb Roux-en Y reconstruction) have been revealed in a few pilot studies. However, the nutritional safety has not been dealt with in previous literatures. This is a preliminary result of a prospective pilot study for evaluating the safety of long limb uncut Roux-en Y gastrojejunostomy (uRYGJ) for early gastric cancer patients with overweight and metabolic disease.

Methods

Between September 2015 and July 2016, long limb uRYGJ was performed in 20 patients with clinical T1N0 stage and preoperative body mass index (BMI) ≥ 32.5 kg/m2 or ≥ 27.5 kg/m2 with co-morbidities. The primary endpoint was the incidence of micronutrients’ deficiency (iron, folate, vitamin B12) at postoperative 1 year and secondary endpoints were anemia incidence, BMI change, morbidity and mortality, and remission rates of co-morbidities. This is a preliminary result at postoperative 6 months.

Results

Iron and folate deficiency were not observed in any patient (0 out of 16 patients), however vitamin B12 deficiency was detected in 1 patient (6.3%) during postoperative 6 months. Median ferritin, folate, and vitamin B12 changes (postperative values minus preoperative values) were -22.4 (-146.8 to 72) ng/mL, 4.1 (0 to 13.2) ng/mL, and -130.4 (-1289.8 to 21.9) pg/mL, respectively. Anemia of chronic illness without symptoms was occurred in 31.2% (5/16). All cases of anemia defined as anemia of chronic illness. Median BMI change was -3.43 (-4.76 to -1.05) kg/m2. Remissions of glucose intolerance, hypertentsion, and dyslipidemia were occurred in 91.7% (11/12 patients), 69.2% (9/13), and 45.5% (5/11). Four patients (20%, 4/20) experienced surgical complications (2 cases of wound dehiscence, 1 duodenal stump leakage, and 1 dumping syndrome), and one patient with wound dehiscence underwent re-operation under general anesthesia.

Conclusions

A long limb uRYGJ is nutritionally safe in early gastric cancer patients in the short term, however we have to investigate the long-term results. After finding out the long-term results of the present study, a large-scale clinical trial may be justified.