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.

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.

• Authors: Hiroshi Imamura, Shuji Takiguchi, Kazuyoshi Yamamoto, Motohiro Hirao, Junya Fujita, Isao Miyashiro, Yukinori Kurokawa, Yoshiyuki Fujiwara, Masaki Mori, Yuichiro Doki
• Journal: World journal of surgery (World J Surg) Vol. 36 Issue 3 Pg. 632-7 (Mar 2012) ISSN: 1432-2323 [Electronic] United States
• PMID: 22270979 (Publication Type: Clinical Trial, Phase II, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Topics

• Aged
• Female
• Gastrectomy
• Gastroenterostomy
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Prospective Studies
• Plastic Surgery Procedures (methods)
• Stomach Neoplasms (mortality, surgery)
• Treatment Outcome