Inclusion Criteria:

- Patient 18 years of age or older

- Pathologically confirmed gastric adenocarcinoma at MSKCC (biopsy may be performed at
other institutions but slides must be confirmed at MSKCC, as is routine care at our
institution)

- No evidence of metastases(a)

- Total gastrectomy performed(b)

- Pouch reconstruction is technically feasible(c)

- Patients will be registered and consent obtained, if the surgeon believes there
is no evidence of metastases. If metastatic disease is identified at the time of
operation, the patient will not be randomized.

- Patients will be conditionally enrolled, and consent obtained, if the surgeon
believes the patient may need a total gastrectomy at the time of operation. If a
total gastrectomy is not performed, the patient will not be randomized.

- Patients will be excluded if, at the time of surgery, the surgeon feels that
creation of a pouch is not technically feasible. This may be due to prior
abdominal surgery, anatomic variants, or anything else at the surgeon's
discretion.

Exclusion Criteria:

- Not expected to be able to provide follow-up over 2 years (due to geographic or other
limitations)

- Not able to complete HRQOL instruments on their own (non-English speaking or physical
status)