Long-term functional outcomes of Roux-en-Y versus Billroth I reconstructions after laparoscopic distal gastrectomy for gastric cancer: a propensity-score matching analysis

  • Keisuke Okuno
  • Masatoshi Nakagawa
  • Kazuyuki Kojima
  • Emi Kanemoto
  • Kentaro Gokita
  • Toshiro Tanioka
  • Mikito Inokuchi
Article
  • 17 Downloads

Abstract

Background

Only a few reports discuss long-term functional outcomes and changes observed in patients over several years following a distal gastrectomy. We investigated long-term functional outcomes and changes after laparoscopic distal gastrectomy based on the analysis of postoperative conditions and endoscopic findings observed in patients.

Methods

The study group comprised 159 patients who underwent Roux-en-Y reconstruction following laparoscopic distal gastrectomy (R-Y group) between December 2008 and November 2012 and 78 patients who underwent Billroth I reconstruction (B-I group) between January 2002 and November 2012. To minimize bias between the two groups, propensity scores were calculated using a logistic regression model. The groups were compared with respect to postoperative conditions and endoscopic findings at 1, 3, and 5 years postoperatively.

Results

The B-I group demonstrated more frequent heartburn than the R-Y group at 3 and 5 years postoperatively. No significant differences were found in terms of loss of body weight and food intake. Endoscopic findings showed significantly lesser residual food and remnant gastritis in the R-Y group at each annual postoperative follow-up. The incidence of bile reflux and reflux esophagitis in the B-I group gradually increased over the years and showed a significant difference at the culmination of the 5-year postoperative follow-up, compared to the R-Y group.

Conclusions

Roux-en-Y reconstruction was superior to Billroth I reconstruction in terms of frequency of occurrence of residual food, bile reflux, remnant gastritis, and reflux esophagitis in the long term. Differences between the two methods became more evident as the follow-up period lengthened.

Keywords

Gastric cancer Laparoscopic distal gastrectomy Remnant gastritis Reflux esophagitis Propensity-score matching analysis 

Abbreviations

BMI

Body mass index

B-I

Billroth I

B-II

Billroth II

R-Y

Roux-en-Y

DG

Distal gastrectomy

LADG

Laparoscopic-assisted distal gastrectomy

LDG

Laparoscopic distal gastrectomy

QOL

Quality of life

SD

Standard deviation

Notes

Compliance with ethical standards

Disclosures

Keisuke Okuno, MD, Masatoshi Nakagawa, MD, PhD, Kazuyuki Kojima, MD, PhD, Emi Kanemoto, MD, Kentaro Gokita, MD, Toshiro Tanioka, MD, and Mikito Inokuchi, MD, PhD have no financial conflicts of interest to disclose.

References

  1. 1.
    Kim CH, Song KY, Park CH, Seo YJ, Park SM, Kim JJ (2015) A comparison of outcomes of three reconstruction methods after laparoscopic distal gastrectomy. J Gastric Cancer 15:46–52CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    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 26:1539–1547CrossRefPubMedGoogle Scholar
  3. 3.
    Katai H, Nunobe S, Saka M, Fukagawa T, Sano T (2008) Reconstruction after distal gastrectomy. J Jpn Surg Soc 109:264–268Google Scholar
  4. 4.
    Yoshino K (2000) History of gastric cancer surgery. J Jpn Surg Soc 101:855–860Google Scholar
  5. 5.
    Hirao M, Fujitani K, Tsujinaka T (2005) Delayed gastric emptying after distal gastrectomy for gastric cancer. Hepatogastroenterology 52:305–309PubMedGoogle Scholar
  6. 6.
    Takiguchi S, Yamamoto K, Hirao M, Imamura H, Fujita J, Yano M, Kobayashi K, Kimura Y, Kurokawa Y, Mori M, Doki Y (2012) A comparison of postoperative quality of life and dysfunction after Billroth I and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer: results from a multi-institutional RCT. Gastric Cancer 15:198–205CrossRefPubMedGoogle Scholar
  7. 7.
    Hirao M, Takiguchi S, Imamura H, Yamamoto K, Kurokawa Y, Fujita J, Kobayashi K, Kimura Y, Mori M, Doki Y (2013) Comparison of Billroth I and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol 20:1591–1597CrossRefPubMedGoogle Scholar
  8. 8.
    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 19:1124–1134CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kitagami H, Morimoto M, Nozawa M, Nakamura K, Tanimura S, Murakawa K, Murakami Y, Kikuchi K, Ushigome H, Sato L, Yamamoto M, Shimizu Y, Hayakawa T, Tanaka M, Hirano S (2014) Evaluation of the delta-shaped anastomosis in laparoscopic distal gastrectomy: midterm results of a comparison with Roux-en-Y anastomosis. Surg Endosc 28:2137–2144CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg 247:962–967CrossRefPubMedGoogle Scholar
  11. 11.
    Nashimoto A, Akazawa K, Isobe Y, Miyashiro I, Katai H, Kodera Y, Tsujitani S, Seto Y, Furukawa H, Oda I, Ono H, Tanabe S, Kaminishi M (2013) Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer 16:1–27CrossRefPubMedGoogle Scholar
  12. 12.
    Motoyama K, Kojima K, Hayashi M, Kato K, Inokuchi M, Sugihara K (2014) β-shaped intracorporeal Roux-en-Y reconstruction after totally laparoscopic distal gastrectomy. Gastric Cancer 17:588–593CrossRefPubMedGoogle Scholar
  13. 13.
    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112CrossRefGoogle Scholar
  14. 14.
    Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, Sano T, Katai H (2002) Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer 5:83–89CrossRefPubMedGoogle Scholar
  15. 15.
    Miwa H, Yokoyama T, Hori K, Sakagami T, Oshima T, Tomita T, Fujikawa Y, Saita H, Itou T, Ogawa H, Nakamura Y, Kishi K, Murayama Y, Hayashi E, Kobayashi K, Tano N, Matsushita K, Kawamoto H, Sawada Y, Ohkawa A, Arai E, Nagao K, Hamamoto N, Sugiyasu Y, Sugimoto K, Hara H, Tanimura M, Honda Y, Isozaki K, Noda S, Kubota S, Himeno S (2008) Interobserver agreement in endoscopic evaluation of reflux esophagitis using a modified Los Angeles classification incorporating grades N and M: a validation study in a cohort of Japanese endoscopists. Dis Esophagus 21:355–363CrossRefPubMedGoogle Scholar
  16. 16.
    Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458CrossRefPubMedGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kawahira H, Kodera Y, Hiki N, Takahashi M, Itoh S, Mitsumori N, Kawashima Y, Namikawa T, Inada T, Nakada K (2015) Optimal Roux‑en‑Y reconstruction after distal gastrectomy for early gastric cancer as assessed using the newly developed PGSAS‑45 scale. Surg Today 45:1307–1316CrossRefPubMedGoogle Scholar
  19. 19.
    Nunobe S, Okaro A, Sasako M, Saka M, Fukagawa T, Katai H, Sano T (2007) Billroth 1 versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years. Int J Clin Oncol 12:433–439CrossRefPubMedGoogle Scholar
  20. 20.
    Inokuchi M, Kojima K, Yamada H, Kato K, Hayashi M, Motoyama K, Sugihara K (2013) Long-term outcomes of Roux-en-Y and Billroth-I reconstruction after laparoscopic distal gastrectomy. Gastric Cancer 16:67–73CrossRefPubMedGoogle Scholar
  21. 21.
    Fukuhara K, Osugi H, Takada N, Takemura M, Higashino M, Kinoshita H (2002) Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux. World J Surg 26:1452–1457CrossRefPubMedGoogle Scholar
  22. 22.
    Inoue K, Fuchigami A, Higashide S, Sumi S, Kogire M, Suzuki T, Tobe T (1992) Gallbladder sludge and stone formation in relation to contractile function after gastrectomy. A prospective study. Ann Surg 32:591–601Google Scholar
  23. 23.
    van der Mijle HC, Kleibeuker JH, Limburg AJ, Bleichrodt RP, Beekhuis H, van Schilfgaarde R (1993) Manometric and scintigraphic studies of the relation between motility disturbances in the Roux limb and the Roux-en-Y syndrome. Am J Surg 166:11–17CrossRefPubMedGoogle Scholar
  24. 24.
    Gustavsson S, Ilstrup DM, Morrison P, Kelly KA (1988) Roux-Y stasis syndrome after gastrectomy. Am J Surg 155:490–494CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Keisuke Okuno
    • 1
  • Masatoshi Nakagawa
    • 1
  • Kazuyuki Kojima
    • 1
  • Emi Kanemoto
    • 1
  • Kentaro Gokita
    • 1
  • Toshiro Tanioka
    • 1
  • Mikito Inokuchi
    • 1
  1. 1.Department of Gastric SurgeryTokyo Medical and Dental UniversityTokyoJapan

Personalised recommendations