Comparison of Billroth I and Roux-en-Y Reconstruction after Distal Gastrectomy for Gastric Cancer: One-year Postoperativ
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ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
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 Motohiro Hirao, MD, PhD1, Shuji Takiguchi, MD, PhD2, Hiroshi Imamura, MD, PhD3, Kazuyoshi Yamamoto, MD, PhD2, Yukinori Kurokawa, MD, PhD2, Junya Fujita, MD, PhD4, Kenji Kobayashi, MD, PhD5, Yutaka Kimura, MD, PhD6, Masaki Mori, MD, PhD2, Yuichiro Doki, MD, PhD2 and Osaka University Clinical Research Group for Gastroenterological Study 1
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan; 2Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan; 3Department of Surgery, Sakai Municipal Hospital, Sakai, Japan; 4Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan; 5 Department of Surgery, Kinki Central Hospital of the Mutual Aid Association of Public School Teachers, Itami, Japan; 6 Department of Surgery, NTT West Osaka Hospital, Osaka, Japan
ABSTRACT Purpose. 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. Methods. 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. Results. 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
Ó Society of Surgical Oncology 2012 First Received: 25 March 2012; Published Online: 28 October 2012 S. Takiguchi, MD, PhD e-mail: [email protected]
significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis. Conclusions. 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.
The selection of the reconstruction method after distal or subtotal gastrectomy is still controversial worldwide. Billroth I (BI) reconstruction has conventionally and commonly been performed after distal gastrectomy in Japan because of the physi
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