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
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This randomized, controlled trial evaluated the clinical efficacy of Billroth I (BI) and Roux-en-Y (RY) reconstruction at 1 year after distal gastrectomy for gastric cancer.
The primary end point was the amount of body weight lost at 1 postoperative year, and secondary end points included other items related to nutritional status such as serum albumin and lymphocyte count, as well as endoscopic examination findings of the remnant stomach and esophagus. Of the 332 patients enrolled, 163 were assigned to the BI group and 169 were randomized to the RY group.
The loss in body weight 1 year after surgery did not differ significantly between the BI and RY groups (9.1 % and 9.7 %, respectively, p = 0.39). There were no significant differences in other aspects of nutritional status between the 2 groups. Endoscopic examination 1 year after gastrectomy showed reflux esophagitis in 26 patients (17 %) in the BI group versus 10 patients (6 %) in the RY group (p = 0.0037), while remnant gastritis was observed in 71 patients (46 %) in the BI group versus 44 patients (28 %) in the RY group (p = 0.0013); differences were significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis.
RY reconstruction was not superior to BI in terms of body weight change or other aspects of nutritional status at 1 year after surgery, although RY more effectively prevented reflux esophagitis and remnant gastritis after distal gastrectomy.
KeywordsReflux Esophagitis Distal Gastrectomy Delay Gastric Emptying Remnant Stomach Prognostic Nutritional Index
The authors thank Dr. Tomoyuki Sugimoto at Osaka University for help with the statistical analysis. Participating institutions and chief participants: Sakai Municipal Hospital (H. Furukawa, H. Imamura), Osaka University (Y. Doki, S. Takiguchi), Osaka National Hospital (T. Tsujinaka, K. Fujitani), Toyonaka Municipal Hospital (J. Fujita, K. Kawanishi), Osaka Medical Center for Cancer and Cardiovascular Diseases (M. Yano, I. Miyashiro), Kinki Central Hospital of the Mutual Aid Association of Public School Teachers (K. Kobayashi), NTT West Osaka Hospital (Y. Kimura), Yao Municipal Hospital (Y. Fukushima, J. Matsuyama), Hyogo Prefectural Nishinomiya Hospital (H. Yano, H. Taniguchi), Kansai Rosai Hospital (S. Tamura, H. Miki), Ikeda Municipal Hospital (K. Shibata, T. Hirao), Belland General Hospital (K. Demura), SEMPOS Seamen’s Insurance hospital (Y. Tsukahara), Saiseikai Senri Hospital (H. Fukunaga), Nishinomiya Municipal Hospital (H. Oka), Suita Municipal Hospital (C. Ebisui, K. Okada), Itami Municipal Hospital (M. Hiratsuka), and Mino Municipal Hospital (S. Iijima, Y. Makari).
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