Skip to main content
SpringerLink
Log in

Billroth II anastomosis maintains SMI and BMI better than Roux-en-Y anastomosis following totally laparoscopic distal gastrectomy: a propensity score-matched study

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Gastric cancer is a major public health problem around the globe. With the standardization of tumor treatment, surgery continues to be the most important treatment method for gastric cancer. However, changes in body composition and nutrition index parameters in patients with Billroth II and Roux-en-Y anastomosis following totally laparoscopic distal gastrectomy (TLDG) remain unclear.

Methods

This was a single-center retrospective study. A total of 369 patients who underwent TLDG at the First Affiliated Hospital of Soochow University (Suzhou, China) between January 2016 and February 2019 were included and assigned to the Billroth II group or Roux-en-Y group according to the anastomosis method. After propensity score matching, body composition and relevant clinical data were compared between the two groups.

Results

The operation time for the Billroth II group was significantly shorter than for the Roux-en-Y group (174.12 ± 39.33 min vs. 229.19 ± 28.12 min, P < 0.001). In addition, the Billroth II group showed lower skeletal muscle loss. Specifically, the Billroth II group showed a − 4.77 ± 4.88% change in the skeletal muscle index (SMI), whereas the Roux-en-Y group showed a − 11.89 ± 8.68% change (P = 0.001). The Billroth II group also showed a smaller decrease in BMI than the Roux-en-Y group (− 6.67 ± 7.76% vs. − 13.12 ± 10.79%, P = 0.018).

Conclusions

These results suggest that Billroth II anastomosis after TLDG has advantages over Roux-en-Y for maintaining patient body composition, especially in terms of SMI, and may serve as a useful reference when choosing an anastomosis method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108

    Article  PubMed  Google Scholar 

  2. Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Toh Y, Okamura T, Baba H (2009) Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 23(10):2374–2379

    Article  PubMed  Google Scholar 

  3. Lee MS, Ahn SH, Lee JH, Park DJ, Lee HJ, Kim HH, Yang HK, Kim N, Lee WW (2012) What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc 26(6):1539–1547

    Article  PubMed  Google Scholar 

  4. Tran TB, Worhunsky DJ, Squires MH, Jin LX, Spolverato G, Votanopoulos KI, Cho CS, Weber SM, Schmidt C, Levine EA, Bloomston M, Fields RC, Pawlik TM, Maithel SK, Norton JA, Poultsides GA (2016) To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer. Gastric Cancer 19(3):994–1001

    Article  PubMed  Google Scholar 

  5. Lee K, Kim KW, Lee JB, Shin Y, Jang JK, Yook JH, Kim BS, Lee IS (2019) Impact of remnant stomach volume and anastomosis on nutrition and body composition in gastric cancer patients. Surg Oncol 31:75–82

    Article  PubMed  Google Scholar 

  6. Kamarajah SK, Bundred J, Tan BHL (2019) Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis. Gastric Cancer 22(1):10–22

    Article  PubMed  Google Scholar 

  7. Zelnick R, Auguste LJ, Wise L (1989) Nutritional effects of postgastrectomy reconstruction: a clinical evaluation. J Surg Oncol 40(4):219–221

    Article  CAS  PubMed  Google Scholar 

  8. Kiyama T, Mizutani T, Okuda T, Fujita I, Tokunaga A, Tajiri T, Barbul A (2005) Postoperative changes in body composition after gastrectomy. J Gastrointest Surg 9(3):313–319

    Article  PubMed  Google Scholar 

  9. Park HS, Kim HS, Beom SH, Rha SY, Chung HC, Kim JH, Chun YJ, Lee SW, Choe EA, Heo SJ, Noh SH, Hyung WJ, Cheong JH, Kim HI, Son T, Lim JS, Baek SE, Jung M (2018) Marked loss of muscle, visceral fat, or subcutaneous fat after gastrectomy predicts poor survival in advanced gastric cancer: single-center study from the CLASSIC Trial. Ann Surg Oncol 25(11):3222–3230

    Article  PubMed  Google Scholar 

  10. Distrutti E, Monaldi L, Ricci P, Fiorucci S (2016) Gut microbiota role in irritable bowel syndrome: new therapeutic strategies. World J Gastroenterol 22(7):2219–2241

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Shizgal HM (1985) Body composition of patients with malnutrition and cancer Summary of methods of assessment. Cancer 55(1 Suppl):250–253

    Article  CAS  PubMed  Google Scholar 

  12. Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, Baracos VE (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9(7):629–635

    Article  PubMed  Google Scholar 

  13. Yip C, Dinkel C, Mahajan A, Siddique M, Cook GJ, Goh V (2015) Imaging body composition in cancer patients: visceral obesity, sarcopenia and sarcopenic obesity may impact on clinical outcome. Insights Imaging 6(4):489–497

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yip C, Dinkel C, Mahajan A, Siddique M, Cook GJR, Goh V (2015) Imaging body composition in cancer patients: visceral obesity, sarcopenia and sarcopenic obesity may impact on clinical outcome. Insights Imaging 6(4):489–497

    Article  PubMed  PubMed Central  Google Scholar 

  15. Seeruttun SR, Yuan S, Qiu H, Huang Y, Li Y, Liang Y, Guan Y, Zhan Y, Li W, Chen Y, Sun X, Xu D, Zhou Z (2017) A comprehensive analysis comparing the eighth AJCC gastric cancer pathological classification to the seventh, sixth, and fifth editions. Cancer Med 6(12):2804–2813

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yang D, He L, Tong WH, Jia ZF, Su TR, Wang Q (2017) Randomized controlled trial of uncut Roux-en-Y vs Billroth II reconstruction after distal gastrectomy for gastric cancer: which technique is better for avoiding biliary reflux and gastritis? World J Gastroenterol 23(34):6350–6356

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ma Z, Wang Z, Zhang J (2001) Carcinogenicity of duodenogastric reflux juice in patients undergoing gastrectomy. Zhonghua Wai Ke Za Zhi 39(10):764–766

    CAS  PubMed  Google Scholar 

  18. Shimoda M, Kubota K, Katoh M, Kita J (2013) Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study. Ann Surg 257(5):938–942

    Article  PubMed  Google Scholar 

  19. So JB, Rao J, Wong AS, Chan YH, Pang NQ, Tay AYL, Yung MY, Su Z, Phua JNS, Shabbir A, Ng EKW (2018) Roux-en-Y or Billroth II reconstruction after radical distal gastrectomy for gastric cancer: a multicenter randomized controlled trial. Ann Surg 267(2):236–242

    Article  PubMed  Google Scholar 

  20. Johnsson F, Joelsson B, Gudmundsson K, Greiff L (1987) Symptoms and endoscopic findings in the diagnosis of gastroesophageal reflux disease. Scand J Gastroenterol 22(6):714–718

    Article  CAS  PubMed  Google Scholar 

  21. Xiong JJ, Altaf K, Javed MA, Nunes QM, Huang W, Mai G, Tan CL, Mukherjee R, Sutton R, Hu WM, Liu XB (2013) Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol 19(7):1124–1134

    Article  PubMed  PubMed Central  Google Scholar 

  22. Taylor PR, Mason RC, Filipe MI, Vaja S, Hanley DC, Murphy GM, Dowling RH, Mccoll I (1991) Gastric carcinogenesis in the rat induced by duodenogastric reflux without carcinogens - morphology, mucin histochemistry, polyamine metabolism, and labeling index. Gut 32(12):1447–1454

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Gustavsson S, Ilstrup DM, Morrison P, Kelly KA (1988) Roux-Y stasis syndrome after gastrectomy. Am J Surg 155(3):490–494

    Article  CAS  PubMed  Google Scholar 

  24. Mathias JR, Fernandez A, Sninsky CA, Clench MH, Davis RH (1985) Nausea, vomiting, and abdominal pain after Roux-en-Y anastomosis: motility of the jejunal limb. Gastroenterology 88(1 Pt 1):101–107

    Article  CAS  PubMed  Google Scholar 

  25. Ongaro E, Buoro V, Cinausero M, Caccialanza R, Turri A, Fanotto V, Basile D, Vitale MG, Ermacora P, Cardellino GG, Nicoletti L, Fornaro L, Casadei-Gardini A, Aprile G (2017) Sarcopenia in gastric cancer: when the loss costs too much. Gastric Cancer 20(4):563–572

    Article  PubMed  Google Scholar 

  26. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE (2012) Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 107(6):931–936

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Tegels JJ, van Vugt JL, Reisinger KW, Hulsewe KW, Hoofwijk AG, Derikx JP, Stoot JH (2015) Sarcopenia is highly prevalent in patients undergoing surgery for gastric cancer but not associated with worse outcomes. J Surg Oncol 112(4):403–407

    Article  PubMed  Google Scholar 

  28. Li XT, Tang L, Chen Y, Li YL, Zhang XP, Sun YS (2015) Visceral and subcutaneous fat as new independent predictive factors of survival in locally advanced gastric carcinoma patients treated with neo-adjuvant chemotherapy. J Cancer Res Clin Oncol 141(7):1237–1247

    Article  CAS  PubMed  Google Scholar 

  29. Antoun S, Bayar A, Ileana E, Laplanche A, Fizazi K, di Palma M, Escudier B, Albiges L, Massard C, Loriot Y (2015) High subcutaneous adipose tissue predicts the prognosis in metastatic castration-resistant prostate cancer patients in post chemotherapy setting. Eur J Cancer 51(17):2570–2577

    Article  PubMed  Google Scholar 

  30. Janssen I, Heymsfield SB, Allison DB, Kotler DP, Ross R (2002) Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr 75(4):683–688

    Article  CAS  PubMed  Google Scholar 

  31. Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Nagatsuma Y, Nakayama T, Tanikawa S, Maeda S, Uemura M, Miyake M, Hama N, Miyamoto A, Ikeda M, Nakamori S, Sekimoto M, Fujitani K, Tsujinaka T (2016) Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy. Gastric Cancer 19(3):986–993

    Article  PubMed  Google Scholar 

  32. Wang SL, Zhuang CL, Huang DD, Pang WY, Lou N, Chen FF, Zhou CJ, Shen X, Yu Z (2016) Sarcopenia adversely impacts postoperative clinical outcomes following gastrectomy in patients with gastric cancer: a prospective study. Ann Surg Oncol 23(2):556–564

    Article  PubMed  Google Scholar 

  33. Zhuang CL, Huang DD, Pang WY, Zhou CJ, Wang SL, Lou N, Ma LL, Yu Z, Shen X (2016) Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: analysis from a large-scale cohort. Medicine (Baltimore) 95(13):e3164

    Article  Google Scholar 

  34. Thirlby RC, Bahiraei F, Randall J, Drewnoski A (2006) Effect of Roux-en-Y gastric bypass on satiety and food likes: the role of genetics. J Gastrointest Surg 10(2):270–277

    Article  PubMed  Google Scholar 

  35. Lin XH, Huang KH, Chuang WH, Luo JC, Lin CC, Ting PH, Young SH, Fang WL, Hou MC, Lee FY (2018) The long term effect of metabolic profile and microbiota status in early gastric cancer patients after subtotal gastrectomy. PLoS One 13(11):e0206930

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Furet JP, Kong LC, Tap J, Poitou C, Basdevant A, Bouillot JL, Mariat D, Corthier G, Dore J, Henegar C, Rizkalla S, Clement K (2010) Differential adaptation of human gut microbiota to bariatric surgery-induced weight loss: links with metabolic and low-grade inflammation markers. Diabetes 59(12):3049–3057

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Graessler J, Qin Y, Zhong H, Zhang J, Licinio J, Wong ML, Xu A, Chavakis T, Bornstein AB, Ehrhart-Bornstein M, Lamounier-Zepter V, Lohmann T, Wolf T, Bornstein SR (2013) Metagenomic sequencing of the human gut microbiome before and after bariatric surgery in obese patients with type 2 diabetes: correlation with inflammatory and metabolic parameters. Pharmacogenomics J 13(6):514–522

    Article  CAS  PubMed  Google Scholar 

  38. Kong LC, Tap J, Aron-Wisnewsky J, Pelloux V, Basdevant A, Bouillot JL, Zucker JD, Dore J, Clement K (2013) Gut microbiota after gastric bypass in human obesity: increased richness and associations of bacterial genera with adipose tissue genes. Am J Clin Nutr 98(1):16–24

    Article  CAS  PubMed  Google Scholar 

  39. Clemente-Postigo M, Roca-Rodriguez Mdel M, Camargo A, Ocana-Wilhelmi L, Cardona F, Tinahones FJ (2015) Lipopolysaccharide and lipopolysaccharide-binding protein levels and their relationship to early metabolic improvement after bariatric surgery. Surg Obes Relat Dis 11(4):933–939

    Article  PubMed  Google Scholar 

  40. Cani PD, Everard A, Duparc T (2013) Gut microbiota, enteroendocrine functions and metabolism. Curr Opin Pharmacol 13(6):935–940

    Article  CAS  PubMed  Google Scholar 

  41. Long SL, Gahan CGM, Joyce SA (2017) Interactions between gut bacteria and bile in health and disease. Mol Aspects Med 56:54–65

    Article  CAS  PubMed  Google Scholar 

  42. Lin JX, Lin JP, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu R, Zheng CH, Huang CM, Li P (2019) Prognostic value and association of sarcopenia and systemic inflammation for patients with gastric cancer following radical gastrectomy. Oncologist 24(11):e1091–e1101

    Article  PubMed  PubMed Central  Google Scholar 

  43. Fukuda T, Seto Y, Yamada K, Hiki N, Fukunaga T, Oyama S, Yamaguchi T (2008) Can immune-enhancing nutrients reduce postoperative complications in patients undergoing esophageal surgery? Dis Esophagus 21(8):708–711

    Article  CAS  PubMed  Google Scholar 

  44. Harada K, Ida S, Baba Y, Ishimoto T, Kosumi K, Tokunaga R, Izumi D, Ohuchi M, Nakamura K, Kiyozumi Y, Imamura Y, Iwatsuki M, Iwagami S, Miyamoto Y, Sakamoto Y, Yoshida N, Watanabe M, Baba H (2016) Prognostic and clinical impact of sarcopenia in esophageal squamous cell carcinoma. Dis Esophagus 29(6):627–633

    Article  CAS  PubMed  Google Scholar 

  45. Wagner D, DeMarco MM, Amini N, Buttner S, Segev D, Gani F, Pawlik TM (2016) Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery. World J Gastrointest Surg 8(1):27–40

    Article  PubMed  PubMed Central  Google Scholar 

  46. Heymsfield SB (2008) Development of imaging methods to assess adiposity and metabolism. Int J Obes (Lond) 32(Suppl 7):S76-82

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Linhua Jiang and Jiawen Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu Province, China

    Linhua Jiang, Jiawen Zhang & Xinguo Zhu

Authors
  1. Linhua Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jiawen Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xinguo Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xinguo Zhu.

Ethics declarations

This study was not funded. Author Jiawen Zhang declares that he has no conflict of interest. Author Linhua Jiang declares that he has no conflict of interest. Author Xinguo Zhu declares that he has no conflict of interest. The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University. This project was conducted as a retrospective observational study; the study protocol involved minimal risk and did not threaten the health of the subjects. And, all participating patients signed informed consents. This project was conducted in compliance with the spirit of the “Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects” (as amended in Fortaleza, October 2013).

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiang, L., Zhang, J. & Zhu, X. Billroth II anastomosis maintains SMI and BMI better than Roux-en-Y anastomosis following totally laparoscopic distal gastrectomy: a propensity score-matched study. Langenbecks Arch Surg 407, 1441–1450 (2022). https://doi.org/10.1007/s00423-022-02459-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-022-02459-y

Keywords

Search

Navigation