Nutritional status and dietary assessment of patients with gastrectomy

BACKGROUND: Nutrition is a crucial factor in gastric resection surgery and the most suitable alimentary canal reconstruction method must be considered in order to reduce the risk of malnutrition. The cause of postgastrectomy malnutrition has not been clearly determined, but the mechanisms behind malnutrition are evidently multifactorial. AIM: To evaluate the nutritional status of patients who underwent different reconstructive procedures after total or subtotal gastrectomy. PATIENTS AND METHODS: Fifty patients who have undergone gastrectomy for 0.5-39 years were assessed. The surgical procedures used were Billroth I in 7, Billroth II in 26, Henley in 3 and Roux-en-Y in 14 of the patients. Twenty one of them have followed gastrectomy for cancer. The nutritional status was evaluated by subjective global assessment, dietary recall and anthropometry. RESULTS: According to subjective global assessment, 6 of 50 patients were mild malnourished. The mean body mass index was 22 4.75 kg/m2, the average daily calorie intake was 1624 477 Kcal. Of the patients operated for cancer, those who underwent subtotal gastrectomy followed by Roux-en-Y presented higher body mass index. No relationship between the period of time since surgery with body mass index or with calorie intake was found. CONCLUSIONS: Among patients operated for cancer, subtotal gastrectomy with Roux-en-Y reconstruction is associated with better nutritional status. Factors other than low calorie intake are the cause of weight loss in patients with gastrectomy.     

Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients

AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients. METHODS: From October 2005 to July 2006, we studied 80 patients with no evidence of recurrent disease and no loss to follow-up after curative surgery for gastric cancer. In this group, 9 patients underwent total gastrectomy and 71 patients subtotal gastrectomy. At admission, 6 and 12 mo after surgery, the patients were assess...     

The nutritional advantages of proximal gastrectomy for early gastric cancer.

BACKGROUND/AIMS: Total gastrectomy has generally been performed for the treatment of early gastric cancers involving the upper third of the stomach. However, proximal gastrectomy has also been used for the treatment of cardial early gastric cancer. METHODOLOGY: To compare the nutritional parameters after proximal gastrectomy with the parameters after total gastrectomy, and to also determine the advantages of the postoperative nutritional states, a retrospective analysis was made to evaluate the nutritional status of patients with early gastric cancer who underwent proximal gastrectomy with those undergoing total gastrectomy. Forty-nine patients were studied for one year after surgery; 9 underwent proximal gastrectomy while 40 had a total gastrectomy. RESULTS: Proximal gastrectomy allowed the patient to better maintain both their nutritional parameters and body weight. CONCLUSIONS: Proximal gastrectomy was thus found to be a beneficial modality for early gastric cancer patients regarding terms of the postoperative nutritional status, in comparison to total gastrectomy.     

围手术期消化道肿瘤患者营养风险与营养支持情况研究

目的对围手术期消化道肿瘤患者营养风险情况、营养支持情况进行调查探究，了解围手术期消化道肿瘤患者营养管理现状，为营养干预质量提升提供指导。 方法选取2021年4月至2022年4月解放军总医院第一医学中心消化内科医学部收治手术治疗的消化道肿瘤患者为研究对象，通过营养风险筛查表(NRS2002)与临床资料收集分析，了解其营养风险与营养支持情况。 结果本次纳入研究的患者684例，年龄平均(58.65±12.25)岁，体重指数正常者占60.09%，体重异常者占39.91%。从体重指数来看，营养不良风险位于前3位的临床诊断为食管癌(13.46%)、胃癌(17.09%)、肠癌(18.06%)。NRS2002平均分为(4.26±1.84)分，35.67%的患者NRS2002评分≥3分，以肠癌、胃癌、食管癌为主。266例(38.89%)患者在围手术期接受营养支持，其中肠外营养占79.70%。NRS2002评分≥3患者中71.72%接受营养支持，NRS2002评分<3患者中20.68%接受营养支持。食管癌(32.05%)、胃癌(56.96%)、肠癌(56.25%)、肝癌(29.59%)患者接受营养支持的比例较高。营养支持后患者营养指标水平高于营养支持前(P<0.05)。 结论围手术期消化道肿瘤患者营养不良风险较高，营养支持对改善患者健康状况存在积极影响。目前虽然有部分消化道癌患者在围手术期接受了营养支持，但从整体来看营养支持仍有待改进。     

Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection

AIM: To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis.METHODS: A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis.RESULTS: All but 12 patients were classified as Child's class A. Only 35 patients (37.2%) were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy (77.7%) and 21 patients (22.3%)underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients (3.8%) who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients (39.4%) experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level (P = 0.011) and transfusion did (P= 0.008). The most common postoperative complication was ascites (13.9%) followed by wound infection (10.6%).CONCLUSION: We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.     

Gastric cancer surgery in cirrhotic patients： Result of gastrectomy with D2 lymph node dissection

AIM: To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. METHODS: A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. RESULTS: All but 12 patients were classified as Child's class A. Only 35 patients (37.2%) were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy (77.7%) and 21 patients (22.3%) underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients (3.8%) who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients (39.4%) experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level (P=0.011) and transfusion did (P=0.008). The most common postoperative complication was ascites (13.9%) followed by wound infection (10.6%). CONCLUSION: We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.     

Gastrectomized patients are in a state of chronic protein malnutrition analyses of 23 amino acids

BACKGROUND/AIMS: Malnutrition is one of the major postoperative complications of radical subtotal or total gastrectomy for gastric cancer. This study was conducted to clarify the nutritional consequences of radical gastrectomy with respect to protein metabolism. METHODOLOGY: To evaluate the nutritional status and the abnormalities in protein metabolism in such cases, serum concentrations of 23 amino acids were measured by high performance liquid chromatography in 40 patients who had undergone either subtotal (n = 20) or total (n = 20) gastrectomy more than 6 months prior to this analysis. RESULTS: Serum concentrations of total amino acids and nonessential amino acids were the same between gastrectomized patients and healthy controls (n = 50). However, concentrations of essential amino acids, essential amino acid/nonessential amino acid and branched-chain amino acid/total amino acid ratios were significantly lower in patient groups than in normal controls. Each essential amino acid was decreased and concentrations of glutamate and citrulline were increased in both patient groups compared with controls. The major differences between patients with subtotal and total gastrectomies included an increased ornithine and a decreased arginine concentration in patients with subtotal gastrectomy. CONCLUSIONS: These changes suggest that malabsorption of protein from the intestinal tract causes persistent proteolysis in the skeletal muscle for long periods of time after surgery in these patients and that changes in ornithine and citrulline levels may reflect more severe alterations in those with total gastrectomy.     

Changes in plasma ghrelin concentration immediately after gastrectomy in patients with early gastric cancer

Although the majority of circulating ghrelin originates from the stomach, no prospective study of the proportion of ghrelin derived from the stomach has been reported. Patients with early gastric cancer who underwent gastric resection were divided into three groups according to the extent and site of gastric resection: subtotal gastrectomy group (n = 24), proximal gastrectomy group (n = 4), and total gastrectomy group (n = 12). Patients with advanced gastric cancer who underwent gastrojejunostomy without gastrectomy served as the bypass group (n = 5). Blood samples were collected from all patients preoperatively, at 1 h after gastric resection or gastrojejunostomy, and on postoperative d 1, 3, and 7. The plasma ghrelin level was determined in all samples and expressed as a percentage of the preoperative level. In the bypass group, no significant drop in the ghrelin level was observed at 1 h after gastrojejunostomy, and the ghrelin level remained stable through postoperative d 7. In the subtotal gastrectomy group, the ghrelin concentration reached a nadir of 38.8 +/- 12.9% of preoperative levels at 1 h after gastric resection and then gradually increased to 88.1 +/- 13.2% by postoperative d 7. In the proximal gastrectomy group, the nadir ghrelin level was 24.5 +/- 15.4% at 1 h after gastric resection and was followed by a gradual recovery. However, the recovery rate was slower than that in the subtotal gastrectomy group, with the ghrelin level reaching only 47.6 +/- 18.8% by postoperative d 7 (P < 0.05). In the total gastrectomy group, the nadir ghrelin level was 28.6 +/- 11.1% at 1 h after gastric resection and remained at 30.0 +/- 13.2% until postoperative d 7. These results suggest that compensatory ghrelin production can occur in the remnant stomach after the surgical removal of part of the stomach and that the proximal fundus is more important than the distal antrum and body in terms of the capacity for ghrelin production. The principal site of ghrelin production is clearly the stomach, which contributes 70% of the circulating ghrelin concentration.     

Surgical management of corrosive strictures of stomach.

BACKGROUND: Corrosive injuries of the upper aero-digestive tract are a frequent cause of morbidity in India. We report here our institution's experience in managing patients with corrosive strictures of the stomach. METHODS: Records of 28 patients who underwent definitive surgery for corrosive strictures of the stomach in our institution over a 15-year period were reviewed. RESULTS: The main presenting complaints were vomiting (75%), dysphagia (46%) and significant weight loss (100%). Pre-operative evaluation included barium and endoscopic studies. Most patients had antro-pyloric strictures (n=22); in 6 patients, however, near-total or total gastric involvement was observed. Thirteen (46%) patients had associated strictures of the esophagus; of these, 7 responded to esophageal dilation. Strictures of the stomach were managed with resectional procedures like distal gastrectomy (n=16), subtotal gastrectomy (1) or total gastrectomy (3) and esophagogastrectomy (1) in 21 (75%) patients. The remaining 7 patients underwent bypass procedures like gastrojejunostomy (5), stricturoplasty (1), and colonic bypass of esophagus and stomach (1). Three patients had entero-cutaneous fistulae in the postoperative period. One patient died in hospital of septicemia and malnutrition. CONCLUSIONS: In patients with corrosive strictures of the stomach, surgery, tailored according to the extent of gastric involvement and presence of associated esophageal strictures, gives excellent results.     

Nutritional risk index as a predictor of postoperative wound complications after gastrectomy

AIM: To investigate the correlation between the nutritional risk index (NRI) and postoperative wound complications.METHODS: From January 2008 through June 2008, 669 patients who underwent curative gastrectomy for gastric cancer were included in a retrospective study. Medical records of consecutive patients were collected and analyzed to determine postoperative wound complication rates. The NRI was assessed on the fifth postoperative day and other possible risk factors for the incidence of wound complications were analyzed to identify the factors affecting postoperative wound complications. Patients with other postoperative complications were excluded from the study.RESULTS: On the 5th postoperative day, the NRI sh-owed a malnutrition rate of 84.6% among postoperative patients. However, postoperative wound complications occurred in only 66/669 (9.86%) patients. Of the patients with wound complications, 62/66 (94%) belonged to the malnourished group (NRI < 97.5), and 4/66 (6%) patients to the non-malnourished group (NRI ≥ 97.5). The only factor correlated with wound complications was the NRI on the 5th postoperative day (odds ratio of NRI ≥ 97.5 vs NRI < 97.5: 0.653; 95% confidence interval: 0.326-0.974; P = 0.014) according to univariate analysis as well as multivariate analysis.CONCLUSION: This study suggests that malnutrition immediately after surgery may play a significant role in the development of wound complications.     

胃癌病人全胃切除、代胃及人工幽门括约肌重建术的远期疗效观察

目的 观察胃癌病人行全胃切除、代胃及人工幽门括约肌重建术的远期疗效。方法 连续5年对应用此法治疗的106例胃癌患者的营养状况、生存率、术后并发症发生率以及术后生活质量等情况进行定期随访。结果 本组患者5年生存率42．5％，碱性反流性食管炎的发生率为0．9％，术后5年胆石症发生率为5．66％，生活质量优良率为89．6％。结论 全胃切除、代胃及人工幽门括约肌重建术治疗进展期胃癌有较好的远期疗效。     

Nutritional support in patients with chronic liver disease

Malnutrition is highly prevalent among patients with chronic liver disease and is nearly universal among patients awaiting liver transplantation. Malnutrition in patients with cirrhosis leads to increased morbidity and mortality rates. Furthermore, patients who are severely malnourished before transplant surgery have a higher rate of complications and a decreased overall survival rate after liver transplantation. In light of the high incidence of malnutrition among patients with chronic liver disease and the complications that result from malnutrition in these patients, it is essential to assess the nutritional status of all patients with liver disease, and to initiate treatment as indicated. This review addresses the etiologies of malnutrition, methods used to assess nutritional status, and appropriate treatment strategies.     

Vitamin E malabsorption and neurological consequences after gastrectomy for gastric cancer

BACKGROUND/AIMS: In order to clarify vitamin E malabsorption after gastric surgery, we evaluated serum vitamin E level and neurological consequences in patients who had undergone gastrectomy for gastric cancer. METHODOLOGY: We studied forty-eight patients (30 men, 18 women) with a mean age of 68.0 years, who had previously undergone gastrectomy for gastric cancer and had no evidence of recurrence. The types of operation consisted of subtotal gastrectomy in 26 patients and total gastrectomy in 22 patients. We measured postoperative body weight, white blood cells, red blood cells, hemoglobin, hematocrit, platelets, and serum levels of vitamins E, vitamin B12, folic acid, total cholesterol, triglycerides, total protein, and albumin. RESULTS: Serum vitamin E level was decreased in 7 (14.6%) of the 48 patients. The occurrence of low vitamin E level was significantly more frequent in the total gastrectomy group than in the subtotal gastrectomy group. In relation to reconstruction procedures, the incidence of low vitamin E level was significantly higher in patients without food passage through the duodenum. The low vitamin E level was significantly associated with low total cholesterol level. The incidence of neuropathy was significantly higher in patients with low vitamin E level. CONCLUSIONS: We assume that vitamin E deficiency more likely occurs after the reconstruction procedure in which food does not pass through the duodenum. Transport disturbance with loss of passage through the duodenum consequently may be the major cause of malabsorption. Differential diagnosis of neurological symptoms in post-gastrectomy patients should include hypovitaminosis E.     

Postoperative morbidity and mortality after gastrectomy for gastric carcinoma.

BACKGROUND/AIMS: Surgical technique and postoperative care for gastric cancer have significantly improved in recent years. However, whether postoperative morbidity or mortality rates after gastrectomy for gastric cancer were reduced or not in recent years was unclear. In this study, we analyzed the chronological changes of postoperative morbidity and mortality rates, and we analyzed risk factors for postoperative morbidity and mortality in patients undergoing gastrectomy for carcinomas of the stomach. METHODOLOGY: A total of 887 patients with gastric cancer were gastrectomized in our hospital between January 1985 and December 1996. The patients were divided into three groups on the basis of chronology. The first group included patients treated over the period 1985 to 1988 (n = 324); the second group, 1989 to 1992 (n = 300); and the third group, 1993 to 1996 (n = 263). Postoperative morbidity rates and mortality rates were compared among the three groups. Also, significant risk factors affecting postoperative morbidity and in-hospital mortality were analyzed by the multiple logistic regression analysis. RESULTS: Postoperative complications were detected in 95 patients (10.7%) and in-hospital mortality rate was 2.4% (21/887). Postoperative morbidity rates were 10.5%, 11%, and 10.6% in the first, second, and third groups, respectively and postoperative mortality rates were 2.5%, 2%, and 2.7%, respectively. These postoperative morbidity and mortality rates were not different between the groups (P = 0.979 and P = 0.866). The most common postoperative complication was anastomotic leakage (56/95, 58.9%). Significant risk factors affecting in-hospital mortality were Stage IV (P = 0.006) and noncurative gastric resection (P = 0.004). However, the extent of lymph node dissection, combined resection, or the existence of preoperative complications were not significant risk factors of in-hospital mortality by multiple logistic regression analysis. CONCLUSIONS: These results indicate that patients with far-advanced gastric cancer might have a high risk of postoperative mortality. In noncurative operations for patients with advanced gastric cancer, unnecessary lymph node dissection or combined resection should be avoided.     

老年患者围手术期的全肠外营养支持

本文报道６６例腹部手术的老年患者，在围手术期辅以全肠外营养支持治疗，使患者的营养状态得以改善，加速了术后的恢复，提出了老年患者手术的安全性。并介绍了营养治疗的方法及途径的选择。对老年患者围手术期全肠外营养支持的必要性及术后营养物质的需要和代谢问题进行探讨，老年患者肠外营养支持应采用低糖、低脂原则，总热量不超过３０Ｃａｌ．ｋｇ＾－１／ｄ，脂肪提供的热量不超过４０％为宜。     

Long term consequences of gastrectomy for patient's quality of life: the impact of reconstructive techniques

OBJECTIVE: During recent years considerable interest has been focused on quality of life as an additional therapeutic outcome measure in the surgical treatment of gastric carcinoma. However, the long term consequences of gastrectomy and the impact on quality of life of different reconstructive techniques are still a matter of controversy. To broaden the criteria for choice of treatment, we conducted a prospective randomized clinical trial to determine the impact of various gastrectomy procedures on quality of life during a 5-yr follow-up period. METHODS: Consecutive patients (n = 64) eligible for curative gastric cancer surgery were randomized to have either total (n = 31) or subtotal (n = 13) gastrectomy or a jejunal S-shaped pouch (n = 20) as a gastric substitute after total gastrectomy. Assessments of quality of life were made on seven occasions during a 5-yr period: within 1 wk before surgery, 3 and 12 months after the surgical intervention, and then once/yr. All patients were interviewed by one of two psychiatrists, who rated their symptoms and introduced standardized self-report questionnaires covering both general and specific aspects of life. The raters were blinded for the patients' group affiliations. RESULTS: Survival rates were similar in all treatment groups. Patients who had a total gastrectomy continued to suffer from alimentary symptoms, especially indigestion and diarrhea, during the entire follow-up period. However, patients who underwent subtotal gastrectomy had a significantly better outcome already during the first postoperative yr. Patients given a gastric substitute after gastrectomy improved with the passage of time and had an even better outcome in the long run. CONCLUSIONS: To optimize the rehabilitation after gastrectomy, patients' quality of life must be taken into consideration. When subtotal gastrectomy is clinically feasible, this procedure has advantages in the early postoperative period. However, a pouch reconstruction after total gastrectomy should be considered in patients having a favorable tumor status suggesting a fair chance of long term survival.     

Post-gastrectomy acute pancreatitis in a patient with gastric carcinoma and pancreas divisum

Gastrectomy is commonly performed for both benign and malignant lesions. Although the incidence of post-gastrectomy acute pancreatitis （PGAP） is low compared to other well-recognized post-operative complications, it has been reported to be associated with a high mortality rate. In this article, we describe a 70-year-old man with asymptomatic pancreatic divisum who underwent palliative subtotal gastrectomy for an advanced gastric cancer with liver metastasis. His postoperative course was complicated by acute pancreatitis and intra-abdominal sepsis. The patient eventually succumbed to multiple organ failure despite surgical debridement and drainage, together with aggressive antibiotic therapy and nutritional support. For patients with pancreas divisum or dominant duct of Santorini who fail to follow the normal post-operative course after gastrectomy, clinicians should be alert to the possibility of PGAP as one of the potential diagnoses. Early detection and aggressive treatment of PGAP might improve the prognosis.     

Perioperative artificial nutrition in malnourished gastrointestinal cancer patients

AIM: To investigate the potential role of perioperative nutrition in reducing complications and mortality in malnourished gastrointestinal cancer patients. METHODS: Four hundred and sixty-eight elective moderately or severely malnourished surgical patients with gastric or colorectal cancers defined by the subjective global assessment (SGA) were randomly assigned to 7 d preoperative and 7 d postoperative parenteral or enteral nutrition vs a simple control group. The nutrition regimen included 24.6±5.2 kcal/kg per d non-protein and 0.23±0.04 g nitrogen /kg per d. Control patients did not receive preoperative nutrition but received 600±100 kcal non-protein plus or not plus 62±16 g crystalline amino acids postoperatively. RESULTS: Complications occurred in 18.3% of the patients receiving nutrition and in 33.5% of the control patients (P=0.012). Fourteen patients died in the control group and 5 in those receiving nutrition. There were significant differences in the mortality between the two groups (2.1% vs 6.0%, P=0.003). The total length of hospitalization and postoperative stay of control patients were significantly longer (29 vs 22 d, P = 0.014) than those of the studied patients (23 vs 12 d. P=0.000). CONCLUSION: Perioperative nutrition support is beneficial for moderately or severely malnourished gastrointestinal cancer patients and can reduce surgical complications and mortality.     

Postoperative complications in colorectal surgery in relation to preoperative clinical and nutritional state and postoperative nutritional treatment

The impact of the pre-operative nutritional and clinical state on post-operative morbidity and mortality is not fully known and the effect of total parenteral nutrition (TPN) on the postoperative complication rate has not been established. We have investigated the effects of postoperative TPN on the complication rate in 92 patients after major colorectal surgery for carcinoma of the large bowel or inflammatory bowel disease in a controlled, randomised study. The complication rate was analysed against seven commonly used nutritional (biochemical and anthropometric) variables and against the diagnosis, clinical inflammatory activity and presence of pre-operative septic complication. Patients were randomly allocated to postoperative TPN or conventional fluid and electrolyte support. The results show no correlation between the complication rate and the nutritional and clinical state of the patients as assessed pre-operatively. The complication rate was not significantly reduced by postoperative TPN. This study indicates that biochemical and anthropometric nutritional variables do not identify patients at risk to develop postoperative complications. The presence of pre-operative complications showed a marginal correlation with postoperative morbidity, in agreement with previous experience. The result of this study obviates the use of TPN in routine postoperative care.     

Health-related quality of life after curative resection for gastric adenocarcinoma

BACKGROUNDWith improved survival in gastric cancer patients, health-related quality of life has become an important clinical endpoint alongside primary oncological outcomes.AIMTo investigate health-related quality of life after various surgical procedures for gastric cancer treatment.METHODSThe validated Slovenian version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30) and its gastric cancer-specific module (QLQ STO-22) was sent for self-completion to patients that underwent curative resection for gastric adenocarcinoma between January 2014 and December 2018 at our centre. In total, 116 patients responded. Scores were compared between patients after subtotal distal vs total gastrectomy and patients after subtotal distal gastrectomy with Billroth II vs Roux-en-Y reconstruction.RESULTSInterestingly, the extent of resection did not influence daily functioning; however, more dysphagia and eating restrictions were reported in patients after total gastrectomy when compared to patients after subtotal distal gastrectomy. Moreover, patients with Billroth II reconstruction after subtotal distal resection experienced worse physical and role functioning and reported more pain, fatigue and reflux compared to Roux-en-Y reconstruction.CONCLUSIONBased on our results, Roux-en-Y reconstruction after subtotal distal gastrectomy should be preferred over Billroth II reconstruction. The data obtained from this study will help surgeons when preoperatively informing their patients about expected functional outcomes after gastrectomy and enable them to ensure proper supportive care of their patients in the postoperative period.