Propensity-score-matched analysis of a multi-institutional dataset to compare postoperative complications between Billroth I and Roux-en-Y reconstructions after distal gastrectomy

Abstract

Background Few well-controlled studies have compared postoperative complications between Billroth I (B-I) and Rouxen-Y (R-Y). The aim of the present study was to compare the incidence of overall and severe postoperative complications by reconstruction method after distal gastrectomy. Methods We performed a multi-institutional dataset study of patients who underwent distal gastrectomy with B-I or R-Y reconstruction from 2010 to 2014. Using propensity scores to strictly balance the significant variables, we compared postoperative complications between the techniques. Results After matching, we enrolled 1014 patients (n = 507 in each group). The incidence of postoperative complications in the R-Y group was significantly higher vs the B-I group (29% vs 17%, P < 0.0001). The incidence of intra-abdominal abscess (4.3% vs 1.8%, P = 0.0177), bowel obstruction (2.6% vs 0.6%, P = 0.0203), and delayed gastric emptying (5.3% vs 1.0%, P < 0.0001) in the R-Y group was significantly higher vs the B-I group, respectively; we saw no significant difference in leakage (3.4% vs 4.1%, P = 0.5084). The incidence of grade ≥ III severe postoperative complications in the R-Y group was significantly higher vs the B-I group (13% vs 7.1%, P = 0.0013). Multivariable analysis showed that R-Y reconstruction was a strong independent risk factor for overall postoperative complications (odds ratio 1.58, P = 0.0044) and grade ≥ III severe postoperative complications (odds ratio 1.75, P = 0.0127). A forest plot revealed that R-Y reconstruction was associated with a greater risk of both overall and grade ≥ III severe postoperative complications in any subgroups. Conclusions R-Y reconstruction was associated with increasing overall postoperative complications, as well as severe postoperative complications.

Roux-en-Y Reconstruction Following Distal Gastrectomy Reduced Endoscopic Reflux Esophagitis in Older Adults: Propensity Score–Matching Analysis

“…1,2,6,8,32 However, 2 studies comparing the procedures revealed that RY reconstruction had a significantly higher incidence of DGE, bowel obstruction, internal herniation, and intraabdominal abscess than BI reconstruction. 15,33 Although a previous study has reported a 21% incidence of DGE after RY, 6 it was the most common complication in this study. We diagnosed DGE based on symptoms requiring fasting in patients without gastrointestinal stenosis.…”

“…13 Although RY reconstruction can prevent bile reflux, it causes delayed gastric emptying (DGE) or Roux stasis. 6,9,14,15 RY and BI reconstructions had equivalent surgical outcomes and postoperative quality of life in randomized controlled trials and a meta-analysis. 2,16,17 However, reflux esophagitis and remnant gastritis occur more frequently in BI than in RY reconstruction.…”

“…Previous comparable studies of the reconstruction methods following DG were conducted among patients with a mean or median age ranging from 50 to 60 years. [1][2][3][4][5][6][7][8][9][10][11][12]15 However, no studies have compared these reconstruction methods in older adults following DG. The Japan Gerontological Society and the Japan Geriatrics Society have recommended redefining the elderly as those aged 75 years and older.…”

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

“…In 2019, a RCT study conducted by Ren and Wang 21 showed that the postoperative complications of Billroth I anastomosis were Effects of different gastrointestinal reconstruction techniques on nutrition, anemia, and quality of life in laparoscopic distal gastrectomy for gastric cancer higher than Roux-en-Y anastomosis in laparoscopic radical gastrectomy for gastric cancer. On the contrary, Nakanishi et al 22 conducted a control study on 1,014 patients with distal gastric cancer in 2020 and found that the incidence of postoperative complications of Billroth I anastomosis was lower than that of Roux-en-Y anastomosis. Overall, the incidence of reflux esophagitis in patients with Billroth I anastomosis after distal gastrectomy is higher than that in patients with Roux-en-Y anastomosis 5,23 .…”

Long-term effect of simplified dietary education on the nutritional status of patients after a gastrectomy

“…Several procedures or methods have been used to improve the nutritional status of patients after a gastrectomy, such as the modification of reconstructive methods, increasing the volume of the remnant stomach, supplemental parenteral nutrition, changes in dietary menus or dietary habits, and recommendations for dietary education [9]. Various reconstructive methods, including increasing the volume of the remnant stomach, have not shown substantial benefits in nutritional parameters over those caused by other procedures [9][10][11][12]. Oral nutritional supplementation (ONS) was not effective in improving nutritional status after a gastrectomy [13].…”