Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb 4;4(2):142-150.
doi: 10.1002/ags3.12309. eCollection 2020 Mar.

Billroth-I vs Roux-en-Y after distal gastrectomy: A comparison of long-term nutritional status and survival rates from a large-scale multicenter cohort study

Takahiro Kinoshita  1 , Michitaka Honda  2 , Atsushi Matsuki  3 , Naoki Enomoto  4 , Masaki Aizawa  3 , Souya Nunobe  5 , Hiroshi Yabusaki  3 , Takayuki Abe  6 , Naoki Hiki  7
Affiliations

Billroth-I vs Roux-en-Y after distal gastrectomy: A comparison of long-term nutritional status and survival rates from a large-scale multicenter cohort study

Takahiro Kinoshita et al. Ann Gastroenterol Surg. .

Abstract

Background: The optimal standard reconstruction procedure after distal gastrectomy is controversial. No large-scale persuasive clinical studies from long-term perspectives on this topic have yet been conducted.

Study design: This retrospective multicenter study analyzed a database of 2510 consecutive patients with clinical stage I gastric cancer who underwent distal gastrectomy followed by Billroth-I (B-I) or Roux-en-Y (R-Y) anastomosis from 2006 to 2012. After adjusting for 30 potential confounding factors using propensity score matching, we compared the body weight loss and other nutritional status for 5 years as primary outcomes between the two groups. We also investigated surgical outcomes, endoscopic findings, and long-term survival rates as secondary outcomes.

Results: After matching the inclusion criteria, 940 patients (470 in each group) were enrolled. There was no marked difference in the body weight loss and other nutritional indicators. The incidence of grade ≥3 postoperative complications (Clavien-Dindo classification) or the incidence of gallstone formation was not markedly different between the two groups. The postoperative hospital stay after surgery was significantly longer, and the readmission rate was significantly higher in the R-Y group than in the B-I group. An endoscopic examination revealed no trends regarding the incidence and severity of gastritis or residual food in the remnant stomach. The 5-year overall survival rate was 92.6% in the B-I group and 91.8% in the R-Y group, with no significant difference (P = .379, log-rank test).

Conclusions: Roux-en-Y reconstruction may be nearly equal to Billroth-I with regard to the long-term nutritional perspectives.

Keywords: Billroth‐I; Roux‐en‐Y; gastric cancer; nutrition; survival.

PubMed Disclaimer

Conflict of interest statement

Funding: There is no financial support for this article. Conflict of Interest: Authors declare no conflict of interests for this article. Author Contribution: Takahiro Kinoshita, Michitaka Honda, Atsushi Matsuki, Naoki Enomoto, Masaki Aizawa, Souya Nunobe, Hiroshi Yabusaki, and Naoki Hiki have substantial contributions to the conception and analysis of data for work. Takahiro Kinoshita and Michitaka Honda drafted the manuscript. Takayuki Abe and Michitaka Honda have substantial contributions to the statistical analyses.

Figures

Figure 1
Figure 1
Nutritional status. Rate of change in (A) body weight, (B) serum albumin, (C) serum total protein, and (D) lymphocyte count. B‐I, Billroth‐I; RY, Roux‐en‐Y; postop, postoperative
See this image and copyright information in PMC

References

    1. GLOBOCAN . Estimated cancer incidence, mortality and prevalence. Geneva, Switzerland: GLOBOCAN; 2018. Available from https://onlinelibrary.wiley.com/doi/full/10.3322/caac.2. Accessed October 31, 2019. - DOI
    1. Tanaka M, Ma E, Tanaka H, Ioka A, Nakahara T, Takahashi H. Trends of stomach cancer mortality in Eastern Asia in 1950–2004: comprehensive study of Japan, Hong Kong and Singapore using age, period and cohort analysis. Int J Cancer. 2012;130:930–6. - PubMed
    1. Kumagai K, Shimizu K, Yokoyama N, Aida S, Arima S, Aikou T. Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan. Surg Today. 2012;42:411–8. - PubMed
    1. Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K. A comparison of Roux‐en‐Y and Billroth‐I reconstruction after laparoscopy‐assisted distal gastrectomy. Ann Surg. 2008;247:962–7. - PubMed
    1. Inokuchi M, Kojima K, Yamada H, Kato K, Hayashi M, Motoyama K, et al. Long‐term outcomes of Roux‐en‐Y and Billroth‐I reconstruction after laparoscopic distal gastrectomy. Gastric Cancer. 2013;16:67–73. - PubMed