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Features of the complications for intracorporeal Billroth-I and Roux-en-Y reconstruction after laparoscopic distal gastrectomy for gastric cancer

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Abstract

Purpose

Recently, the Roux-en-Y procedure (R-Y) and delta-shaped Billroth-I anastomosis (DB-I) have become prevalent as intracorporeal gastroenteric anastomosis methods after laparoscopic distal gastrectomy (LDG) for gastric cancer. However, the differences in postoperative outcomes between the two methods have not been clarified. Hence, this retrospective study aimed to reveal the features of the complications of the R-Y versus DB-I after LDG.

Methods

The study cohort comprised patients with gastric cancer who underwent DB-I or R-Y after LDG from January 2013 to May 2016. Patient characteristics and surgical and postoperative variables were analyzed. To compensate for intergroup differences in baseline characteristics, estimated propensity scores were used to perform one-on-one matching between the groups.

Results

A total of 564 patients were included, and propensity score matching created a matched cohort of 149 pairs in the DB-I and R-Y groups. The incidence of short-term complications such as gastrointestinal fistula classified as Clavien-Dindo grade IIIa or above was significantly greater in the DB-I group than the R-Y group (14.1% versus 4.7%, p=0.004). In contrast, the R-Y was associated with long-term complications such as internal hernia and tended to result in a slightly higher readmission rate in the R-Y group compared with the DB-I group (2.7% versus 6.0%, p=0.128).

Conclusion

DB-I after LDG was associated with a significantly higher rate of short-term complications compared with the R-Y, whereas characteristic long-term complications tended to be observed after the R-Y. These differences should be considered during the selection of the reconstruction method and postoperative management of LDG.

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Acknowledgements

We thank Kelly Zammit, BVSc, from Edanz Group (https://en-author-services.edanzgroup.com/) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Yoshiaki Shoji, Koshi Kumagai, Satoshi Ida, Manabu Ohashi, Takeshi Sano & Souya Nunobe

  2. Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

    Naoki Hiki

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  1. Yoshiaki Shoji
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  2. Koshi Kumagai
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  6. Takeshi Sano
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  7. Souya Nunobe
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Contributions

All authors contributed to the study conception and design. Y.S. and K.K. performed data acquisition and manuscript preparation. Y.S. participated in the statistical analysis. All authors contributed to the critical revision of the manuscript.

Corresponding author

Correspondence to Souya Nunobe.

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Ethics approval

This retrospective study was conducted in accordance with the International Conference on Harmonization of Guidelines for Good Clinical Practice and was approved by the Ethics Committee of the Cancer Institute Hospital of JFCR (approval number: 2017-1168). Treatment was performed after obtaining informed consent from each patient.

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The authors declare no competing interests.

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Shoji, Y., Kumagai, K., Ida, S. et al. Features of the complications for intracorporeal Billroth-I and Roux-en-Y reconstruction after laparoscopic distal gastrectomy for gastric cancer. Langenbecks Arch Surg 406, 1425–1432 (2021). https://doi.org/10.1007/s00423-021-02136-6

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  • DOI: https://doi.org/10.1007/s00423-021-02136-6

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