Impact of the Aboral Pouch in Roux-en-Y Reconstruction after Laparoscopic Total Gastrectomy for Elderly Patients.

Objectives: The number of elderly people with stomach cancer is increasing; therefore, minimally invasive surgical treatments are required. Elderly patients have multiple comorbidities and are prone to postoperative weight loss, nutritional disorders, Postgastrectomy syndrome (PGS), and decreased quality of life (QOL). Total gastrectomy is particularly associated with these complications, although aboral-pouch creation reportedly improves the condition by compensating for lost reservoir capacity. However, there is no consensus regarding its significance. This study aimed to investigate the impact of the aboral pouch on total gastrectomy outcomes in elderly patients.

Materials and methods: Thirty-six patients who met the eligibility criteria, defined as elderly patients aged ≥75 years, were retrospectively analyzed. The patients had undergone Roux-en-Y reconstructions with an aboral pouch in laparoscopic total gastrectomy procedures performed at Juntendo University from July 2016 to June 2022. The main outcomes were postoperative nutritional status, PGS, and QOL.

Results: The average postoperative period was approximately 1 year (12.0 vs. 13.5 months, P=0.536), for 14 elderly and 22 non-elderly patients, respectively. Elderly patients had more comorbidities (78.5% vs. 40.9%, P=0.041). The outcome of nutritional status demonstrated no differences in weight-loss rate (-5.3% vs. -8.6%, P=0.651) or prognostic nutritional status (-7.9% vs. -5.9%, P=0.243). There was no significant difference in PGS and QOL between elderly and non-elderly patients.

Conclusions: Total gastrectomy with an aboral-pouch creation could be beneficial for elderly 43 patients from the perspective of postoperative nutritional status, PGS, and QOL.