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



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.


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



Body mass index


Billroth I


Billroth II




Distal gastrectomy


Laparoscopic-assisted distal gastrectomy


Laparoscopic distal gastrectomy


Quality of life


Standard deviation



The authors have not received Grant support or other forms of assistance.

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.


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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

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