Comparison the clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer patients

Abstract

Purpose:To compare the clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer patients. Method:A retrospective cohort study was performed. clinical data of 200 patients whounderwent laparoscopic distal gastrectomy at the Department of Gastrointestinal Surgery of the Second People's Hospital of Hefei from January 2018 to January 2021 were collected. Of the 200 patients,100 underwent uncut Roux-en-Y anastomosis and 100 underwent Billroth II with Braun anastomosis. The general data, intraoperative and postoperative conditions, complications, and endoscopic evaluation 1-year postoperative were compared. Besides, the quality of life of two groups was also compared using the Chinese version of the European Organization For Research and Treatment of Cancer (EORTC) quality of life questionnaire-Core 30 (QLQ-C30) and quality of life questionnaire-stomach 22 (QLQ -STO22).Results: There were no significant differences in characteristics between the two groups ( P>0.05). All the 200 patients successfully underwent laparoscopic distal gastrectomy without intraoperative complications, conversion to open surgery or perioperative death. There were no significant differences between two groups in operative time, intraoperative blood loss, postoperative complications, time to flatus,time to liquid diet and postoperative hospital stay (P>0.05). Endoscopic evaluation was conducted 1-year postoperative .Compared to Billroth II with Braun group, the uncut Roux-en-Y group had a significantly lower incidences of gastric stasis [(18.6%,16/86) vs. (32.8%,27/82), χ2 =3.76, P=0.042], gastritis [11.6% (10/86) vs.30.5% (25/82), χ2=9.053, P=0.003] and bile reflux [1.2% (1/86) vs. 25.6% (21/82), χ2=22.044, P<0.001], and the differences were statistically significant. The EORTC questionnaire was performed 1-year postoperative, there were no significant differences in the scores of QLQ-C30 scale between the two groups (P>0.05), while the scores of QLQ-STO22 compared to the Billroth II with Braun group, the uncut Roux-en-Y group had a lower pain score (median:8.3 vs 16.7, P=0.029) and reflux score (median: 0 vs5.6, P=0.012), and the differences were statistically significant (P<0.05), indicating milder symptoms. Conclusion: Both the two anastomosis are safe and reliable in laparoscopic distal gastrectomy for gastric cancer , compare to the Billroth II with Braun anastomosis , the uncut Roux-en-Y anastomosis can reduce the incidences of gastric stasis, gastritis and bile reflux, and improve the quality of life