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Morbidity and Mortality Results From a Prospective Randomized Controlled Trial Comparing Billroth I and Roux-en-Y Reconstructive Procedures After Distal Gastrectomy for Gastric Cancer

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Abstract

Background

Billroth I (B-I) and Roux-en-Y (R-Y) reconstructions are commonly performed after distal gastrectomy. Which reconstruction procedure is superior remains controversial. We conducted a randomized controlled trial to compare the clinical efficacy of B-I and R-Y.

Methods

Between August 2005 and December 2008, a total of 332 patients with potentially curable gastric cancer enrolled from 18 institutions were intraoperatively randomized to either the B-I group or the R-Y group. Postoperative morbidity and hospital mortality were recorded prospectively in a fixed format and were compared between these two groups.

Results

The operating time was significantly longer in the R-Y group than in the B-I group (214 vs. 180 minutes, P < 0.0001). Regarding clinical symptoms during the postoperative hospital stay, the incidence of nausea, vomiting, and discontinuance of food intake was significantly higher in the R-Y group than in the B-I group (12.4% vs. 3.7%, P = 0.0027; 8.9% vs. 3.1%, P = 0.022; and 12.4% vs. 4.3%, P = 0.0064, respectively). There was no significant difference in the overall operative morbidity rate between the R-Y and B-I groups (13.6% vs. 8.6%, respectively, P = 0.14). Anastomotic leakage occurred in two patients (1.2%) in the B-I group and in none in the R-Y group; the difference did not reach statistical significance (P = 0.09). Postoperative hospital stay was significantly longer in the R-Y group than in the B-I group (16.4 vs. 14.1 days, P = 0.019).

Conclusions

We concluded that B-I reconstruction was superior to R-Y reconstruction in terms of perioperative complications.

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Acknowledgments

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, 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, H. 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).

Conflict of interest

The authors declare that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Sakai Municipal Hospital, Osaka, Japan

    Hiroshi Imamura

  2. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Shuji Takiguchi, Kazuyoshi Yamamoto, Yukinori Kurokawa, Yoshiyuki Fujiwara, Masaki Mori & Yuichiro Doki

  3. Department of Surgery, Osaka National Hospital, Osaka, Japan

    Motohiro Hirao

  4. Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan

    Junya Fujita

  5. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Isao Miyashiro

Authors
  1. Hiroshi Imamura
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  2. Shuji Takiguchi
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  3. Kazuyoshi Yamamoto
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  4. Motohiro Hirao
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  5. Junya Fujita
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  9. Masaki Mori
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  10. Yuichiro Doki
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Corresponding author

Correspondence to Shuji Takiguchi.

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Imamura, H., Takiguchi, S., Yamamoto, K. et al. Morbidity and Mortality Results From a Prospective Randomized Controlled Trial Comparing Billroth I and Roux-en-Y Reconstructive Procedures After Distal Gastrectomy for Gastric Cancer. World J Surg 36, 632–637 (2012). https://doi.org/10.1007/s00268-011-1408-9

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