Long-term functional outcomes of Roux-en-Y versus Billroth I reconstructions after laparoscopic distal gastrectomy for gastric cancer: a propensity-score matching analysis
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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.
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.
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.
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.
KeywordsGastric cancer Laparoscopic distal gastrectomy Remnant gastritis Reflux esophagitis Propensity-score matching analysis
Body mass index
Laparoscopic-assisted distal gastrectomy
Laparoscopic distal gastrectomy
Quality of life
Compliance with ethical standards
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.
- 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.Yoshino K (2000) History of gastric cancer surgery. J Jpn Surg Soc 101:855–860Google Scholar
- 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.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
- 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
- 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
- 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
- 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