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Functional jejunal interposition, a reconstruction procedure, promotes functional outcomes after total gastrectomy.

Ding X, Yan F, Liang H, Xue Q, Zhang K, Li H, Ren X, Hao X - BMC Surg (2015)

Bottom Line: Patients with the FJI procedure showed significant increase of blood hemoglobin and total protein, compared to those at one month after surgery, and the prognostic nutrition index scores at three and twelve months after surgery.Compared to beagles receiving Roux-en-Y, more ICC in the intestinal submuocsa, less intestinal epithelial cell apoptosis, and decreased inflammation in serosal side of the intestine were found in the FJI group.The intestinal transit rate in FJI group was lower than that in Roux-en Y group, indicating that FJI benefits food storage.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Oncology, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, P. R. China. dingxuew@hotmail.com.

ABSTRACT

Background: Functional jejunal interposition (FJI) has been applied as a reconstruction procedure to maintain the jejunal continuity and duodenal food passage after total gastrectomy in patients with gastric cancer. The purpose of this study was to evaluate clinical efficacy of the FJI procedure by comparing the functional outcomes of FJI to Roux-en-Y after total gastrectomy in gastric cancer patients, and investigate physiologic mechanisms by which FJI exerts beneficial outcomes in beagles.

Methods: Patients with stage I-IV gastric cancer without metastasis and recurrence one year after surgery were enrolled in this retrospective study. Seventy one patients received FJI and seventy nine patients received Roux-en-Y after total gastrectomy. We evaluated the nutritional status at three and twelve months and incidence of complications up to twelve months after surgery. Beagles receiving sham operation, FJI, or Roux-en-Y after total gastrectomy were sacrificed forty eight hours postoperatively. Beagles were gavaged with active carbon for evaluating the intestinal transit rate. Intestinal tissues from the duodenojejunal anastomosis were collected for examining interstitial cells of Cajal (ICC), inflammation, and apoptosis.

Results: Compared to the bodyweight before surgery, the bodyweight loss at three and twelve months after surgery in patients receiving FJI was significant less than that in patients with Roux-en-Y. Patients with the FJI procedure showed significant increase of blood hemoglobin and total protein, compared to those at one month after surgery, and the prognostic nutrition index scores at three and twelve months after surgery. The incidence rates of post-operative complications, including reflux esophagitis, dumping syndrome, and Roux-en-Y syndrome were decreased in patients with FJI. Compared to beagles receiving Roux-en-Y, more ICC in the intestinal submuocsa, less intestinal epithelial cell apoptosis, and decreased inflammation in serosal side of the intestine were found in the FJI group. The intestinal transit rate in FJI group was lower than that in Roux-en Y group, indicating that FJI benefits food storage.

Conclusion: The FJI procedure promotes nutritional recovery and decreases post-operative complications in gastric cancer patients after total gastrectomy, which may be through ameliorating intestinal inflammation and damage and reducing ICC loss to preserve food reservoir function and intestinal motility.

No MeSH data available.


Related in: MedlinePlus

FJI decreases inflammation and neutrophil and macrophage infiltration into the small intestine in beagles. Beagle tissue sections were prepared as described in Figure 2. Tssue sections were stained using hematoxylin and eosin to assess injury and inflammation (A). Neutrophil and macrophage were stained using Cy3-conjugated anti-Ly-6C/G (a marker for neutrophil) and FITC-conjugated anti-F4/80 (a marker for macrophage) antibodies, respectively. Nuclei were stained using DAPI (blue) (B). The numbers of neutrophil (C) and macrophage (D) per 10X power field are shown. Sham = 5 beagles, FJI = 10 beagles, Roux-en-Y = 7 beagles.
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Fig3: FJI decreases inflammation and neutrophil and macrophage infiltration into the small intestine in beagles. Beagle tissue sections were prepared as described in Figure 2. Tssue sections were stained using hematoxylin and eosin to assess injury and inflammation (A). Neutrophil and macrophage were stained using Cy3-conjugated anti-Ly-6C/G (a marker for neutrophil) and FITC-conjugated anti-F4/80 (a marker for macrophage) antibodies, respectively. Nuclei were stained using DAPI (blue) (B). The numbers of neutrophil (C) and macrophage (D) per 10X power field are shown. Sham = 5 beagles, FJI = 10 beagles, Roux-en-Y = 7 beagles.

Mentions: Inflammation is a major factor to disrupt intestinal motility, including ICC network. Therefore, we evaluated the inflammatory responses after surgery. 60% (6/10) beagles receiving FJI and 100% (7/7) beagles receiving Roux-en-Y showed inflammation in serosal side of the small intestine around anastomosis, including hemorrhage, fibrin deposition, and ulceration (Figure 3A). The degree of serosal inflammation was lower in FJI, compared to that in Roux-en-Y group. Inflammatory responses after surgery include significant increase in lymphocyte infiltration and pro-inflammatory cytokine production. We found that the numbers of neutrophil and macrophage infiltration in muscularis mucosae of the small intestine were less in FJI group than that in Roux-en-Y group (Figure 3B-D). We did not find significant inflammation in mucosa of the small intestine in any of these three groups.Figure 3


Functional jejunal interposition, a reconstruction procedure, promotes functional outcomes after total gastrectomy.

Ding X, Yan F, Liang H, Xue Q, Zhang K, Li H, Ren X, Hao X - BMC Surg (2015)

FJI decreases inflammation and neutrophil and macrophage infiltration into the small intestine in beagles. Beagle tissue sections were prepared as described in Figure 2. Tssue sections were stained using hematoxylin and eosin to assess injury and inflammation (A). Neutrophil and macrophage were stained using Cy3-conjugated anti-Ly-6C/G (a marker for neutrophil) and FITC-conjugated anti-F4/80 (a marker for macrophage) antibodies, respectively. Nuclei were stained using DAPI (blue) (B). The numbers of neutrophil (C) and macrophage (D) per 10X power field are shown. Sham = 5 beagles, FJI = 10 beagles, Roux-en-Y = 7 beagles.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4404078&req=5

Fig3: FJI decreases inflammation and neutrophil and macrophage infiltration into the small intestine in beagles. Beagle tissue sections were prepared as described in Figure 2. Tssue sections were stained using hematoxylin and eosin to assess injury and inflammation (A). Neutrophil and macrophage were stained using Cy3-conjugated anti-Ly-6C/G (a marker for neutrophil) and FITC-conjugated anti-F4/80 (a marker for macrophage) antibodies, respectively. Nuclei were stained using DAPI (blue) (B). The numbers of neutrophil (C) and macrophage (D) per 10X power field are shown. Sham = 5 beagles, FJI = 10 beagles, Roux-en-Y = 7 beagles.
Mentions: Inflammation is a major factor to disrupt intestinal motility, including ICC network. Therefore, we evaluated the inflammatory responses after surgery. 60% (6/10) beagles receiving FJI and 100% (7/7) beagles receiving Roux-en-Y showed inflammation in serosal side of the small intestine around anastomosis, including hemorrhage, fibrin deposition, and ulceration (Figure 3A). The degree of serosal inflammation was lower in FJI, compared to that in Roux-en-Y group. Inflammatory responses after surgery include significant increase in lymphocyte infiltration and pro-inflammatory cytokine production. We found that the numbers of neutrophil and macrophage infiltration in muscularis mucosae of the small intestine were less in FJI group than that in Roux-en-Y group (Figure 3B-D). We did not find significant inflammation in mucosa of the small intestine in any of these three groups.Figure 3

Bottom Line: Patients with the FJI procedure showed significant increase of blood hemoglobin and total protein, compared to those at one month after surgery, and the prognostic nutrition index scores at three and twelve months after surgery.Compared to beagles receiving Roux-en-Y, more ICC in the intestinal submuocsa, less intestinal epithelial cell apoptosis, and decreased inflammation in serosal side of the intestine were found in the FJI group.The intestinal transit rate in FJI group was lower than that in Roux-en Y group, indicating that FJI benefits food storage.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Oncology, National Clinical Research Center for Cancer, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Huanhuxi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, P. R. China. dingxuew@hotmail.com.

ABSTRACT

Background: Functional jejunal interposition (FJI) has been applied as a reconstruction procedure to maintain the jejunal continuity and duodenal food passage after total gastrectomy in patients with gastric cancer. The purpose of this study was to evaluate clinical efficacy of the FJI procedure by comparing the functional outcomes of FJI to Roux-en-Y after total gastrectomy in gastric cancer patients, and investigate physiologic mechanisms by which FJI exerts beneficial outcomes in beagles.

Methods: Patients with stage I-IV gastric cancer without metastasis and recurrence one year after surgery were enrolled in this retrospective study. Seventy one patients received FJI and seventy nine patients received Roux-en-Y after total gastrectomy. We evaluated the nutritional status at three and twelve months and incidence of complications up to twelve months after surgery. Beagles receiving sham operation, FJI, or Roux-en-Y after total gastrectomy were sacrificed forty eight hours postoperatively. Beagles were gavaged with active carbon for evaluating the intestinal transit rate. Intestinal tissues from the duodenojejunal anastomosis were collected for examining interstitial cells of Cajal (ICC), inflammation, and apoptosis.

Results: Compared to the bodyweight before surgery, the bodyweight loss at three and twelve months after surgery in patients receiving FJI was significant less than that in patients with Roux-en-Y. Patients with the FJI procedure showed significant increase of blood hemoglobin and total protein, compared to those at one month after surgery, and the prognostic nutrition index scores at three and twelve months after surgery. The incidence rates of post-operative complications, including reflux esophagitis, dumping syndrome, and Roux-en-Y syndrome were decreased in patients with FJI. Compared to beagles receiving Roux-en-Y, more ICC in the intestinal submuocsa, less intestinal epithelial cell apoptosis, and decreased inflammation in serosal side of the intestine were found in the FJI group. The intestinal transit rate in FJI group was lower than that in Roux-en Y group, indicating that FJI benefits food storage.

Conclusion: The FJI procedure promotes nutritional recovery and decreases post-operative complications in gastric cancer patients after total gastrectomy, which may be through ameliorating intestinal inflammation and damage and reducing ICC loss to preserve food reservoir function and intestinal motility.

No MeSH data available.


Related in: MedlinePlus