A comparison of postoperative quality of life and dysfunction after Billroth I and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer: results from a multi-institutional RCT

Abstract

Background Both Billroth I (B-I) and Roux-en-Y (R-Y) reconstructions are commonly performed as standard procedures, but it has yet to be determined which reconstruction is better for patients. A randomized prospective phase II trial with body weight loss at 1 year after surgery as a primary endpoint was performed to address this issue. The current report delivers data on the quality of life and degree of postoperative dysfunction, which were the secondary endpoints of this study.Methods Gastric cancer patients who underwent distal gastrectomy were intraoperatively randomized to B-I or R-Y. Postsurgical QOL was evaluated using the EORTC QLQ-C30 and DAUGS 20. Results Between August 2005 and December 2008, 332 patients were enrolled in a randomized trial comparing B-I versus R-Y. A mail survey questionnaire sent to 327 patients was completed by 268 (86.2%) of them. EORTC QLQ-C30 scores were as follows: global health status was similar in each group (B-I 73.5 ± 18.8, R-Y 73.2 ± 20.2, p = 0.87). Scores of five functional scales were also similar. Only the dyspnea symptom scale showed superior results for R-Y than for B-I (B-I 13.6 ± 17.9, R-Y 8.6 ± 16.3, p = 0.02). With respect to DAUGS 20, the total score did not differ significantly between the R-Y and B-I groups (24.8 vs. 23.6, p = 0.41). Only reflux symptoms were significantly worse for B-I than for R-Y (0.7 ± 0.6 vs. 0.5 ± 0.6, p = 0.01). Conclusions The B-I and R-Y techniques were generally equivalent in terms of postoperative QOL and dysfunction. Both procedures seem acceptable as standard reconstructions after distal gastrectomy with regard to postoperative QOL and dysfunction.

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

“…Miyagaki et al [12] reported the reduction (13.5 %) after distal gastrectomy in their study was larger than in other studies (range, 9.1-10.5 %). In our study, the reduction after distal gastrectomy was 11.4 % on average (data not shown), which was also slightly larger than in other studies [13,14]. Weight loss is considered a risk factor for internal hernia in RYGBP [15,16].…”

Improving the outcomes in gastric cancer surgery

“…These findings persist in long-term follow-up [83] . However, patients did not differ in terms of quality of life [84] . Morbidity and mortality were similar between Billroth Ⅰ and Roux-en-Y technique, but the latter was associated with longer length-of-stay and discontinuance of food intake [85] .…”

Characteristics and clinical relevance of postgastrectomy syndrome assessment scale (PGSAS)-45: newly developed integrated questionnaires for assessment of living status and quality of life in postgastrectomy patients

“…This goal is particularly important in the Far East where gastric cancer is often found at early clinical stages so that more patients manage to survive their cancer and consequently need to face the PGS in the long term [9]. It is known that the type of gastrectomy affects the incidence and severity of PGS [10][11][12][13][14][15][16][17][18][19][20][21], and various procedures to preserve or reconstruct gastric function have been proposed to confront these problems [7,8]. To gain deeper understanding of the PGS, a group of iatrogenic disorders, and treat them appropriately, it is important to grasp the impact of various symptoms, along with feeding problems and body weight loss, to the living status and QOL of the patients.…”

“…Therefore, there are possibilities that a large proportion of these studies have overlooked several important postgastrectomy symptoms that actually affect the living status of the patients but cannot be evaluated by conventional scales. More recently, Nakamura et al reported on DAUGS, a questionnaire designed to measure symptoms after upper gastrointestinal surgery, and the actual attempt to use this in the clinical setting [16,21]. However, items concerning living status or QOL of the patients rather than the symptoms were lacking in the DAUGS.…”