Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: A meta-analysis

Xiong, Junjie; Altaf, Kiran; Javed, Muhammad Ahsan; Nunes, Quentin; Huang, Wei; Mai, Gang; Tan, Chunlu; Mukherjee, Rajarshi; Sutton, Robert; Hu, Weiming; Liu, Xu-Bao

doi:10.3748/wjg.v19.i7.1124

Cited by 65 publications

(46 citation statements)

References 34 publications

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“…Although Rouxen-Y has been associated with significant reduction in the complications rate [2] and DGE as well, our study finds it as a significant risk factor. This finding does conflict with some previous investigations [2,11]. Dong et al and Kung et al [10] did cite Roux-en-Y reconstruction as a risk factor [13].…”

Section: Discussioncontrasting

confidence: 49%

“…Hirao M et al also found a strong association between DGE and Roux-en-Y reconstruction [24]. The Roux-en-Y is however, the ideal choice of reconstruction after total gastrectomy [2]. Completion or subtotal gastrectomy with Rouxen-Y gastrojejunostomy has been recommended for treatment of persisting or unresolved DGE [5,6,25].…”

Section: Discussionmentioning

confidence: 99%

“…A surgical resection: gastrectomy is the only available standard and definitive treatment [1,2] With recent developments, early diagnosis of the disease has led to a substantial improvement in the survival rate and quality of life.…”

Section: Introductionmentioning

confidence: 99%

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An Analysis of Possible Risk Factors Contributing to Delayed Gastric Emptying after Distal Gastrectomy for Gastric Cancer

Sulav¹,

Shi²,

Ahmad³

et al. 2017

J Gastrointest Dig Syst

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Gastric cancer is a worldwide epidemic. The standard and definitive treatment for gastric cancer is surgical resection: gastrectomy. Surgery is a common trigger for gastroparesis. DGE is arguably the most common of the post-gastrectomy syndromes, accounting for 5-20% of all cases. A clear etiology still remains unidentified. The purpose of the study is to analyze the possible risk factors contributing to development of DGE after distal gastrectomy for gastric cancer.A retrospective study of 252 patients, who underwent distal gastrectomy for gastric cancer, was conducted from January 2010 to December 2015. 18 patients developed DGE with an occurrence rate of 7.1%. The incidence of DGE was found to be significantly higher in patients with 1) Gastric outlet obstruction (P=0.031), 2) Roux-en-Y reconstruction surgery (P=0.041), 3) Side to end gastrojejunostomy (P=0.03), 4) Tumor in the lower 1/3 rd (P= 0.027) and 5) Ulcerative lesion (P=0.001). DGE continues to affect a considerable number of patients after gastric surgery. Proper preoperative preparation and postoperative management can considerably reduce the incidence of DGE.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

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An Analysis of Possible Risk Factors Contributing to Delayed Gastric Emptying after Distal Gastrectomy for Gastric Cancer

Sulav¹,

Shi²,

Ahmad³

et al. 2017

J Gastrointest Dig Syst

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“…A meta‐analysis concentrating on the comparison of B‐I vs R‐Y for reconstruction after distal gastrectomy for gastric cancer combined four RCTs and nine non‐randomized observational clinical studies (OCS) involving 478 and 1 402 patients, respectively . The meta‐analysis of the RCTs showed that R‐Y reconstruction was associated with a reduced bile reflux ( P < 0.001) and remnant gastritis ( P < 0.001), however required a longer operative time ( P = 0.003).…”

Section: Treatmentmentioning

confidence: 99%

Differences in the multimodal treatment of gastric cancer: East versus west

Russo

Strong

2017

Journal of Surgical Oncology

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There has been a great deal of interest about varying treatment paradigms of gastric cancer in Eastern and Western countries. Differences in tumor biology, screening initiatives, surgical approach, extent of lymphadenectomy, and neoadjuvant versus adjuvant chemotherapy regimens have been studied and documented in the literature. The purpose of this review is to give an updated report on the current status and management differences in the treatment of gastric cancer between Eastern and Western countries.

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“…Although B1 and RY reconstruction are preferable reconstruction techniques in Eastern countries [6,7], B2 and RY reconstruction appear more prevalent choices in Western countries [8]. There has been no study from the West comparing surgical outcomes on the basis of the type of reconstruction after resection of gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer

et al. 2015

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Background Although the extent of resection frequently dictates the method of reconstruction following distal subtotal gastrectomy, it is unclear whether Roux-en-Y gastrojejunostomy compared with Billroth II gastrojejunostomy is associated with superior perioperative outcomes. Methods Patients who underwent resection for gastric cancer with Roux-en-Y or Billroth II reconstruction between 2000 and 2012 in seven academic institutions (US Gastric Cancer Collaborative) were identified. Patients who underwent total gastrectomy, gastric wedge, or palliative resections (metastatic disease or R2 resections) were excluded.Results Of a total of 965 patients, 447 met the inclusion criteria. A comparison between the Roux-en-Y (n = 257) and Billroth II (n = 190) groups demonstrated no differences in patient and tumor characteristics, except for Billroth II patients having a higher proportion of antral tumors (71 % vs. 50 %, p \ 0.001). Roux-en-Y operations were slightly longer (244 min vs. 212 min, p \ 0.001) and associated with somewhat higher blood loss (243 ml vs. 205 ml, p = 0.033). However, there were no significant differences in the length of hospital stay (8 days vs. 7 days), readmission rate (17 % vs. 18 %), 90-day mortality (5.1 % vs. 4.7 %), incidence (39 % vs. 41 %) and severity of complications, dependency on jejunostomy tube feeding at discharge (13 % vs. 12 %), same-patient decrease in serum albumin level from the preoperative to the postoperative value at 30, 60, and 90 days, receipt of adjuvant therapy (50 % vs. 53 %), or 5-year survival (44 % vs. 41 %). Conclusions Although long-term quality-of-life parameters were not compared, this study did not show an advantage of Roux-en-Y gastrojejunostomy over Billroth II gastrojejunostomy in short-term perioperative outcomes. Both techniques should be regarded as equally acceptable reconstructive options following partial gastrectomy for gastric cancer.

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Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: A meta-analysis

Abstract: This systematic review point towards some clinical advantages that are rendered by R-Y compared to B-I reconstruction post DG. However there is a need for further adequately powered, well-designed RCTs comparing the same.

Cited by 65 publications

References 34 publications

An Analysis of Possible Risk Factors Contributing to Delayed Gastric Emptying after Distal Gastrectomy for Gastric Cancer

An Analysis of Possible Risk Factors Contributing to Delayed Gastric Emptying after Distal Gastrectomy for Gastric Cancer

Differences in the multimodal treatment of gastric cancer: East versus west

To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer

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