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Total Laparoscopic Uncut Roux-en-Y for Radical Distal Gastrectomy: An Interim Analysis of a Randomized, Controlled, Clinical Trial

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The traditional Billroth II and Roux-en-Y anastomosis after laparoscopic distal gastrectomy for gastric cancer are associated with bile reflux gastritis and roux stasis syndrome, respectively. The uncut Roux-en-Y gastrojejunostomy can decrease the incidence of these complications by blocking the entry of bile and pancreatic juice into the residual stomach and retaining the impulses originating from the duodenum. The purpose of the present study was to compare the short-term outcomes of uncut Roux-en-Y (URY) and Billroth II combined Braun (BB) anastomosis.

Methods

In this prospective, multi-center, two-arm randomized controlled trial, 124 patients with advanced distal gastric cancer were randomized into two groups: URY (n = 62) and BB (n = 62) groups.

Results

The mean gastric juice pH was significantly lower in the URY group compared with the BB group (3.94 ± 0.71 vs. 5.83 ± 0.91, P < 0.0001). The bile reflux gastritis at 3 months (P < 0.0001) and 6 months (P = 0.002) was significantly more frequent in the BB group. No recanalization occurred in the URY group, and no significant difference was found between the two groups in terms of mean operative time (P = 0.69), mean time to perform anastomosis (P = 0.86), mean estimated blood loss (P = 0.77), mean number of harvested lymph nodes (P = 0.90), time to first passage of flatus or defecation (P = 0.87), postoperative hospital stay (P = 0.83), and the incidence of postoperative complications (P = 0.70).

Conclusions

URY anastomosis is associated with a significantly lower incidence of bile reflux gastritis and roux stasis syndrome compared with BB anastomosis.

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Data Availability

The datasets generated and analyzed during the present study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the grant from the National Natural Science Foundation of China (Key Program 81502401 and 31670828) and Wu Jie-Ping Medical Foundation (320.6750.17508).

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Author notes

  1. Juan Wang, Quan Wang and Junqiang Dong have been contributed equally to this work.

Authors and Affiliations

  1. Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China

    Juan Wang MD, Quan Wang MD & Gang Ji MD

  2. Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China

    Junqiang Dong BSc

  3. Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China

    Kelu Yang BSc

  4. Henan Cancer Hospital and Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou, China

    Sheqing Ji MD & Qi Ma MD

  5. Department of Minimally Invasive Surgery, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou, China

    Yong Fan MD, Chen Wang BSc & Qiuya Wei MD

Authors
  1. Juan Wang MD
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  2. Quan Wang MD
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  3. Junqiang Dong BSc
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  7. Chen Wang BSc
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  8. Qi Ma MD
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  10. Gang Ji MD
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Contributions

JW, QW, and GJ planned and designed the research; GJ, YF, CW, and S-QJ, as the main surgeon, who performed each operations in each center; JW, QW, K-LY, QM, and Q-YW as the main investigators and data recorders; K-LY and J-QD tested the feasibility of the study; JW wrote the manuscript; All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Gang Ji MD.

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Wang, J., Wang, Q., Dong, J. et al. Total Laparoscopic Uncut Roux-en-Y for Radical Distal Gastrectomy: An Interim Analysis of a Randomized, Controlled, Clinical Trial. Ann Surg Oncol 28, 90–96 (2021). https://doi.org/10.1245/s10434-020-08710-4

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  • DOI: https://doi.org/10.1245/s10434-020-08710-4

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