Total gastrectomy for gastric cancer

Stomach cancer is one of the leading causes of cancer-related death worldwide. Although progress has been made in non-surgical treatments, with the advent of perioperative chemotherapy, surgery remains central to the management of these tumours and is currently the only curative option. Total gastrectomy exposes the patient to three main types of sequelae: postprandial functional disturbances, diarrhoea and, later on, metabolic effects. Following total gastrectomy, the creation of a Y-shaped loop is the technically simplest solution, yielding very satisfactory functional results. The duodenal bypass, which appears more physiological, is no more advantageous than the Roux-en-Y reconstruction in most comparative studies involving long-term patient follow-up. Variations of the Roux-en-Y procedure involve creating a pouch, which appears to offer a better quality of life with less reflux, a lower incidence of dumping syndrome, a lower incidence of gallstones, improved food intake capacity and less weight loss.