Isoperistaltic versus antiperistaltic uncut Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a propens
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RESEARCH ARTICLE
Isoperistaltic versus antiperistaltic uncut Roux‑en‑Y anastomosis after distal gastrectomy for gastric cancer: a propensity score matched analysis Cui Hangtian1†, Huang Huabing2†, Luo Tianhang1†, Yin Xiaoyi1 and Fang Guoen1,3*
Abstract Background: The uncut Roux-en-y anastomosis (URYA) has some clinical advantages after distal gastrectomy (DG). Little evidence exists regarding the influence of peristalsis on this anastomosis. We aimed to evaluate short-term outcomes of isoperistaltic URYA (iso-URYA) comparing with antiperistaltic URYA (anti-URYA) after DG. Method: Patients who underwent URYA for gastric cancer (GC) between January 2016 and December 2018 were selected from Shanghai Changhai Hospital, Navy Medical University. Short-term outcomes were compared between iso-URYA group and anti-URYA group after 1:1 propensity score matching (PSM). Result: A total of 612 patients were selected. 392 patients underwent iso-URYA and 220 patients underwent antiURYA. After PSM, 183 patients for each group were included in the final analysis. No differences were found between them in terms of short-term complications, nutritional status and quality of life 1 year after surgery. Endoscopic examination showed that anti-URYA group had more severe gastritis (P = 0.036). In addition, the recanalization rate was significantly higher when the afferent loop was blocked by stapler. Conclusion: The iso-URYA and anti-URYA group present similar results in short term outcomes. Ligation blocking afferent loop leads to lower recanalization rate. Keywords: Distal gastrectomy, Uncut Roux-en-Y anastomosis, Propensity score matching Background Gastric cancer is the fifth common cancer globally and its incidence is increasing [1]. Surgical resection with radical lymphadenectomy is regarded as the basic treatment principle for patients with resectable locally advanced gastric cancer [2], while multiple variations have been detailed in the digestive reconstruction. In recent years, *Correspondence: [email protected] † Cui Hangtian, Huang Huabing and Luo Tianhang contributed equally to this work 3 Department of General Surgery, Changhai Hospital, No.168 Changhai Road, Yangpu District, Shanghai 200433, China Full list of author information is available at the end of the article
many studies indicated that uncut Roux-en-y anastomosis (URYA) after DG had some clinical advantages compared with Billroth I (BI), Billroth II (BII), BII with Braun and Roux-en-Y (RY) reconstruction [3–6]. The reason behind this lies in that URYA can maintain the integrity of the intestinal canal and further preserve myoneural continuity to eliminate Roux stasis syndrome through an occluded but not cut jejunogastric pathway [7, 8]. Despite this consensus, the operative details vary among surgeons, like ligation or stapler for luminal occlusion, site of occlusion, orientation of peristalsis. Actually, as far as we know, there are still no studies to evaluate functional effects of orientation of peristalsis on URYA.
© The Author(s) 2020.
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