Comparison of the Long-term Outcome Between Billroth-I and Roux-en-Y Reconstruction Following Distal Gastrectomy for Gas
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ORIGINAL ARTICLE
Comparison of the Long-term Outcome Between Billroth-I and Roux-en-Y Reconstruction Following Distal Gastrectomy for Gastric Cancer Chia-Hung Wu 1,2 & Kuo-Hung Huang 1,2 & Ming-Huang Chen 2,3 & Wen-Liang Fang 1,2 Anna Fen-Yau Li 2,5 & Chew-Wun Wu 1,2 & Yi-Ming Shyr 1,2
&
Yee Chao 2,3 & Su-Shun Lo 2,4 &
Received: 18 July 2020 / Accepted: 6 November 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Various reconstruction methods have been performed following distal gastrectomy; however, each reconstruction method has its own advantages and disadvantages. This study aims to compare the long-term outcomes between Billroth-I (B-I) and Roux-en-Y (RY) reconstruction after distal gastrectomy for gastric cancer. Methods A total of 459 patients who underwent distal gastrectomy (B-I: 166, RY: 293) were included. Postoperative endoscopic findings and biliary tract stone formation were compared between the two groups. Results At 1 year and 2 years postoperatively, gastric residue was more common in the RY group, gastritis was similar between groups, and bile reflux was more common in the B-I group. At 5 years postoperatively, gastric residue was similar between the groups, while gastritis and bile reflux were more common in the B-I group. Gastroesophageal reflux was more common in the B-I group at 1 year postoperatively, but gastroesophageal reflux became not significantly different between the groups at 2 and 5 years postoperatively. Gallstone formation was more common in the RY group and in patients aged ≥ 65 years. Conclusion During long-term follow-up, RY reconstruction was associated with lower incidence of bile reflux and gastritis, and higher incidence of gallstone formation than B-I reconstruction. The incidence of gastric residue was more common in the RY reconstruction group in the early postoperative period and became not significantly different between the two groups over time. For aged patients with RY reconstruction, cholecystectomy is recommended concurrently as gastrectomy. Keywords Billroth-I . Roux-en-Y . Bile reflux . Gastritis . Gallstone
Introduction Gastric cancer (GC) is the sixth most common cancer and the second most common cause of cancer-related death
* Wen-Liang Fang [email protected] 1
Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei 11217, Taiwan
2
School of Medicine, National Yang-Ming University, Taipei, Taiwan
3
Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
4
National Yang-Ming University Hospital, Yilan, Taiwan
5
Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
worldwide.1 Surgical intervention remains the only curative treatment for GC. After distal gastrectomy for tumors located in the lower two-thirds of the stomach, three widely used reconstruction methods are Billroth-I (B-I), Billroth-II (B-II), and Roux-enY (RY) anastomosis. B-I reconstruction is common
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