The Impact of Different Gastrointestinal Reconstruction Techniques on Gut Microbiota After Gastric Cancer Surgery

Gastric cancer is one of the common malignant tumors in the digestive tract, with high incidence and mortality rates. In the clinical treatment of gastric cancer, radical surgery is considered the most effective treatment intervention, and gastrointestinal reconstruction is an essential procedure in clinical treatment. This study aims to explore the impact of double tract reconstruction (DTR) and Roux-en-Y gastrointestinal reconstruction (R-Y) on the gut microbiota of gastric cancer patients and their potential role in postoperative recovery and long-term health. Through random sampling, patients who underwent gastric cancer surgery at Sichuan Mianyang 404 Hospital were included in the study and randomly divided into the DTR group and the R-Y group. Both groups of patients received the same perioperative management. The study collected fecal and blood samples before and after surgery for 16S rRNA sequencing analysis and blood-related index analysis.The results showed that there was no significant difference in gut microbiota diversity between the two groups. Compared with the R-Y group, the analysis found that the DTR surgical method could significantly change the structure of the gut microbiota, affecting the types, quantities, and ratios of gut bacteria. For instance, after surgery, there was an enrichment of conditional pathogens related to postoperative infection, such as Pseudomonas aeruginosa, Enterococcus gallinarum, Porphyromonas somerae, and Citrobacter freundii. In addition, compared with the R-Y group, the postoperative DTR group had poor nutritional absorption ability, that is, the F/B ratio was low. The R-Y group showed a richer Bacteroidia and lower Proteobacteria abundance after surgery, as well as a higher F/B ratio. These findings provide new insights into the changes in the gut microbiota after gastric cancer surgery and may have important implications for postoperative recovery and long-term health management.

胃癌是消化道常见恶性肿瘤之一，发病率与死亡率均处于较高水平。在胃癌临床治疗中，根治性手术被视为最有效的治疗干预手段，而消化道重建则是临床治疗中不可或缺的关键步骤。本研究旨在探讨双道重建术（Double Tract Reconstruction, DTR）与Roux-en-Y消化道重建术（Roux-en-Y Gastrointestinal Reconstruction, R-Y）对胃癌患者肠道菌群的影响，以及二者在术后康复与长期健康维护中的潜在作用。本研究通过随机抽样法纳入四川绵阳四〇四医院接受胃癌手术的患者，并将其随机分为DTR组与R-Y组。两组患者均接受统一的围手术期管理方案。本研究收集两组患者术前及术后的粪便与血液样本，开展16S rRNA测序分析与血液相关指标检测。研究结果显示，两组患者的肠道菌群多样性无显著差异。与R-Y组相比，分析表明DTR术式可显著改变肠道菌群结构，影响肠道菌群的种类、数量及占比。例如，术后与术后感染相关的条件致病菌丰度出现富集，如铜绿假单胞菌（Pseudomonas aeruginosa）、鸡肠球菌（Enterococcus gallinarum）、索氏卟啉单胞菌（Porphyromonas somerae）以及弗氏柠檬酸杆菌（Citrobacter freundii）。此外，与R-Y组相比，术后DTR组的营养吸收能力较差，即厚壁菌门与拟杆菌门比值（F/B比值）较低。术后R-Y组的拟杆菌纲（Bacteroidia）丰度更高，变形菌门（Proteobacteria）丰度更低，且F/B比值更高。上述研究结果为胃癌术后肠道菌群的变化提供了全新的研究视角，同时对术后康复与长期健康管理具有重要的参考意义。