Billroth-I vs Roux-en-Y after distal gastrectomy: A comparison of long-term nutritional status and survival rates from a large-scale multicenter cohort study.
Billroth‐I
Roux‐en‐Y
gastric cancer
nutrition
survival
Journal
Annals of gastroenterological surgery
ISSN: 2475-0328
Titre abrégé: Ann Gastroenterol Surg
Pays: Japan
ID NLM: 101718062
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
19
11
2019
revised:
29
11
2019
accepted:
15
12
2019
entrez:
8
4
2020
pubmed:
8
4
2020
medline:
8
4
2020
Statut:
epublish
Résumé
The optimal standard reconstruction procedure after distal gastrectomy is controversial. No large-scale persuasive clinical studies from long-term perspectives on this topic have yet been conducted. This retrospective multicenter study analyzed a database of 2510 consecutive patients with clinical stage I gastric cancer who underwent distal gastrectomy followed by Billroth-I (B-I) or Roux-en-Y (R-Y) anastomosis from 2006 to 2012. After adjusting for 30 potential confounding factors using propensity score matching, we compared the body weight loss and other nutritional status for 5 years as primary outcomes between the two groups. We also investigated surgical outcomes, endoscopic findings, and long-term survival rates as secondary outcomes. After matching the inclusion criteria, 940 patients (470 in each group) were enrolled. There was no marked difference in the body weight loss and other nutritional indicators. The incidence of grade ≥3 postoperative complications (Clavien-Dindo classification) or the incidence of gallstone formation was not markedly different between the two groups. The postoperative hospital stay after surgery was significantly longer, and the readmission rate was significantly higher in the R-Y group than in the B-I group. An endoscopic examination revealed no trends regarding the incidence and severity of gastritis or residual food in the remnant stomach. The 5-year overall survival rate was 92.6% in the B-I group and 91.8% in the R-Y group, with no significant difference ( Roux-en-Y reconstruction may be nearly equal to Billroth-I with regard to the long-term nutritional perspectives.
Sections du résumé
BACKGROUND
BACKGROUND
The optimal standard reconstruction procedure after distal gastrectomy is controversial. No large-scale persuasive clinical studies from long-term perspectives on this topic have yet been conducted.
STUDY DESIGN
METHODS
This retrospective multicenter study analyzed a database of 2510 consecutive patients with clinical stage I gastric cancer who underwent distal gastrectomy followed by Billroth-I (B-I) or Roux-en-Y (R-Y) anastomosis from 2006 to 2012. After adjusting for 30 potential confounding factors using propensity score matching, we compared the body weight loss and other nutritional status for 5 years as primary outcomes between the two groups. We also investigated surgical outcomes, endoscopic findings, and long-term survival rates as secondary outcomes.
RESULTS
RESULTS
After matching the inclusion criteria, 940 patients (470 in each group) were enrolled. There was no marked difference in the body weight loss and other nutritional indicators. The incidence of grade ≥3 postoperative complications (Clavien-Dindo classification) or the incidence of gallstone formation was not markedly different between the two groups. The postoperative hospital stay after surgery was significantly longer, and the readmission rate was significantly higher in the R-Y group than in the B-I group. An endoscopic examination revealed no trends regarding the incidence and severity of gastritis or residual food in the remnant stomach. The 5-year overall survival rate was 92.6% in the B-I group and 91.8% in the R-Y group, with no significant difference (
CONCLUSIONS
CONCLUSIONS
Roux-en-Y reconstruction may be nearly equal to Billroth-I with regard to the long-term nutritional perspectives.
Identifiants
pubmed: 32258979
doi: 10.1002/ags3.12309
pii: AGS312309
pmc: PMC7105836
doi:
Types de publication
Journal Article
Langues
eng
Pagination
142-150Informations de copyright
© 2020 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery.
Déclaration de conflit d'intérêts
Funding: There is no financial support for this article. Conflict of Interest: Authors declare no conflict of interests for this article. Author Contribution: Takahiro Kinoshita, Michitaka Honda, Atsushi Matsuki, Naoki Enomoto, Masaki Aizawa, Souya Nunobe, Hiroshi Yabusaki, and Naoki Hiki have substantial contributions to the conception and analysis of data for work. Takahiro Kinoshita and Michitaka Honda drafted the manuscript. Takayuki Abe and Michitaka Honda have substantial contributions to the statistical analyses.
Références
Surg Laparosc Endosc Percutan Tech. 2015 Feb;25(1):69-73
pubmed: 24743669
Gastric Cancer. 2014 Jan;17(1):146-51
pubmed: 23558458
Am J Surg. 2015 Jun;209(6):1063-8
pubmed: 25218580
Surg Today. 2012 May;42(5):411-8
pubmed: 22391980
Gastric Cancer. 2002;5(2):83-9
pubmed: 12111583
J Natl Compr Canc Netw. 2010 Apr;8(4):378-409
pubmed: 20410333
Int J Cancer. 2012 Feb 15;130(4):930-6
pubmed: 21425256
J Gastric Cancer. 2015 Mar;15(1):46-52
pubmed: 25861522
Ann Surg. 2008 Jun;247(6):962-7
pubmed: 18520223
Surg Endosc. 2012 Jun;26(6):1539-47
pubmed: 22179454
Gastric Cancer. 2012 Apr;15(2):198-205
pubmed: 21993852
J Gastrointest Surg. 2011 Dec;15(12):2145-52
pubmed: 21948148
J Clin Oncol. 2014 Oct 1;32(28):3200-1
pubmed: 25113754
Ann Surg Oncol. 2013 May;20(5):1591-7
pubmed: 23104705
Gastric Cancer. 2011 Jun;14(2):113-23
pubmed: 21573742
World J Surg. 2005 Nov;29(11):1415-20; discussion 1421
pubmed: 16240061
Ann Surg Oncol. 2014 Jun;21 Suppl 3:S370-8
pubmed: 24590434
Gastric Cancer. 2013 Jan;16(1):67-73
pubmed: 22467062
World J Surg. 2012 Mar;36(3):632-7
pubmed: 22270979
Int J Clin Oncol. 2007 Dec;12(6):433-9
pubmed: 18071862
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542