Effects of different gastrointestinal reconstruction techniques on nutrition, anemia, and quality of life in laparoscopic distal gastrectomy for gastric cancer

Abstract

To explore the effect of different gastrointestinal reconstruction techniques on laparoscopic distal gastrectomy of gastric cancer on the nutritional and anemia status, and quality of life (QoL) of patients. Methods: Eligible patients were randomly divided into three groups (n=36/group): Billroth I anastomosis group, Billroth II combined with Braun anastomosis group, and Roux-en-Y anastomosis group. Related indicators were compared and analyzed. Results: The general data were comparable among the three groups (all P>0.05). Among the surgical-related indicators and postoperative recovery indicators, only the comparison of the operation time was statistically significant (P=0.004). The follow-up time was 5~36 months (average 27.9 months). In terms of nutritional and anemia indicators, only the differences in the levels of prealbumin, hemoglobin and serum ferritin in 24 months after operation showed significant differences (P=0.015, P=0.003, P=0.005, respectively). There were no significant differences in hospital readmission rate, overall survival, and QoL among the three groups (all P>0.05). Conclusion:In laparoscopic gastrectomy for stage II~III distal gastric cancer, Billroth I anastomosis has shorter operation time than Billroth II combined with Braun anastomosis and Roux-en-Y anastomosis and advantages in the improvement of nutritional status and anemia recovery.

Comparison of Billroth II with Braun and Roux‐en‐Y reconstructions after distal gastrectomy for gastric cancer: A meta‐analysis

“…Among the two studies reporting anastomosis time 18,20 anastomosis time was lower in the BB group (WMD, −8.65 min; 95% CI, −9.20 to −8.10; p < 0.00001; Figure 2B). Eight studies [14][15][16][17][18][19][20][21] reported intraoperative blood loss and the meta-analysis revealed the value was similar in the two groups (WMD, −13.44 mL; 95% CI, −28.67 to 1.78; p = 0.08; Figure 2C). The number of harvested lymph nodes was reported in seven studies [15][16][17][18][19][20][21] and was similar between the two groups (WMD, 0.50; 95% CI, −1.71 to 2.71; p = 0.66; Figure 2D).…”

“…Eight studies [14][15][16][17][18][19][20][21] reported intraoperative blood loss and the meta-analysis revealed the value was similar in the two groups (WMD, −13.44 mL; 95% CI, −28.67 to 1.78; p = 0.08; Figure 2C). The number of harvested lymph nodes was reported in seven studies [15][16][17][18][19][20][21] and was similar between the two groups (WMD, 0.50; 95% CI, −1.71 to 2.71; p = 0.66; Figure 2D). No significant difference was observed between the two groups in terms of hospital stay (WMD, −0.02; 95% CI, −0.19 to 0.14; p = 0.77; Figure 2E) and time to first flatus or defecation (WMD, −0.09; 95% CI, −0.27 to 0.09; p = 0.35; Supporting Information: Figure S1A).…”

“…Of these, three papers did not meet the criteria and were excluded. Finally, one randomized controlled trial (RCT) 14 and seven nonrandomized observational clinical studies (OCS) [15][16][17][18][19][20][21] with a total of 910 patients were considered for the meta-analysis (Figure 1). The population characteristics of each study are shown in Table 1.…”

“…Studies were conducted in South Korea (four studies) [14][15][16][17] and China (four studies). [18][19][20][21] Quality scores of each included article were between 6 and 9, indicating sufficient study quality (Table 1).…”

“…To compare the feasibility of BB and RY, perioperative outcomes including operation time, anastomosis time, intraoperative blood loss, harvested lymph nodes, length of hospital stay, and time to first flatus or defecation were evaluated (Table 2). Eight studies [14][15][16][17][18][19][20][21] reported operation time and the metaanalysis showed operation time was lower in the BB group (weighted mean difference [WMD], −21.06 min; 95% confidence interval [CI], −31.50 to −10.63; p < 0.0001; Figure 2A). Among the two studies reporting anastomosis time 18,20 anastomosis time was lower in the BB group (WMD, −8.65 min; 95% CI, −9.20 to −8.10; p < 0.00001; Figure 2B).…”