Selection and assessment of digestive tract reconstruction patterns for gastric cancer

With the improvement of survival outcome by modern surgical treatment, more and more attention has been paid to the postoperative quality of life. As known, the most related factor of postoperative quality of life is the pattern of digestive tract reconstruction. Current evidences indicate that  Roux-en-Y esophagojejunostomy+jejunal pouch has some advantages in total gastrectomy and Roux-en-Y gastrojejunostomy might be most suitable reconstruction in distal gastrectomy. Pylorus-preserving gastrectomy and proximal gastrectomy are only considered in early gastric cancer, i.e. predictive cT1cN0. Pylorus-preserving gastrectomy does not exactly superior to distal gastrectomy. Total gastrectomy with RouxenY esophagojejunostomy is superior to proximal gastrectomy with esophagogastrostomy. For unresectable lower tumor with gastric outlet obstruction, gastric cancer Devine exclusion+gastrojejunostomy might be better than simple gastrojejunostomy, while stent placement is safer and suitable for  predictively short-term survival, poor performance status or senility  patients. However, the current available evidences of reconstruction in gastric cancer surgery is still poor in quality and more high-quality large-scale multi-center randomized controlled trials are required to resolve the controversies.