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

Abstract

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.

The Development and Future of Digestive Tract Reconstruction after Distal Gastrectomy: A Systemic Review and Meta-Analysis

“…All studies examined at least one of the following outcomes: reflux gastritis, bile reflux, intraoperative blood loss and postoperative hospital stays. Among the trials, 2 constructed pairwise comparisons between BI and BII 16, 28, 4 comparisons of BII and RY 22, 34, 37, 38, 17 comparisons of BI and RY 7, 17-21, 24-27, 29-33, 35, 36, and 1 comparison of BII and URY were included 23. In addition, the only publication of the URY procedure was used to compare the remaining reconstruction skills.…”

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

“…While some institutional studies have described zero percent mortality, database and multi-center collaborative studies consistently report significantly higher patient mortality (9, 11, 22–28). A recent multi-center study from the US Gastric Cancer Collaborative of 447 sub-total resections for gastric cancer between 2000 and 2012 reported a similar 4.9% mortality rate for all patients (29). Mortality rates following total gastrectomy have also varied from as low as zero in single-center studies to >6% in multi-center analyses (24, 30, 31).…”

Randomized controlled trial of uncut Roux-en-Y vs Billroth II reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis?

“…There remains no clear consensus regarding the preferred reconstructive surgical procedure after laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer[ 1 , 2 ]. Compared with Japan[ 3 ] and Korea[ 4 ], early gastric cancer only accounts for a small percentage in China, and most gastric cancer cases are found in advanced stages at the initial diagnosis.…”