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Review
. 2024 Jan 1;110(1):32-44.
doi: 10.1097/JS9.0000000000000796.

Reappraisal of optimal reconstruction after distal gastrectomy - a study based on the KLASS-07 database

Shin-Hoo Park  1   2 , Hoon Hur  3 , Jong-Hyun Park  1 , Chang-Min Lee  1   4 , Young-Gil Son  5 , Mi Ran Jung  6 , Han Hong Lee  7 , Sun-Hwi Hwang  8 , Moon-Soo Lee  9 , Sang Hyuk Seo  10 , In Ho Jeong  11 , Myoung Won Son  12 , Chang Hyun Kim  13 , Moon-Won Yoo  14 , Sung Jin Oh  15 , Seong Ho Hwang  16 , Sung Il Choi  17 , Hyuk Soon Choi  18 , Bo-Ra Keum  18 , Kyung Sook Yang  19 , Sungsoo Park  1   2
Affiliations
Review

Reappraisal of optimal reconstruction after distal gastrectomy - a study based on the KLASS-07 database

Shin-Hoo Park et al. Int J Surg. .

Abstract

Backgrounds: This study aimed to compare the incidence of bile reflux, quality of life (QoL), and nutritional status among Billroth II (BII), Billroth II with Braun anastomosis (BII-B), and Roux-en-Y (RY) reconstruction after laparoscopic distal gastrectomy (LDG).

Materials and methods: We reviewed the prospective data of 397 patients from a multicentre database who underwent LDG for gastric cancer between 2018 and 2020 at 20 tertiary teaching hospitals in Korea. Postoperative endoscopic findings, QoL surveys using the European Organization for Research and Treatment of Cancer questionnaire (C30 and STO22), and nutritional and surgical outcomes were compared among groups.

Results: In endoscopic findings, bile reflux was the lowest in the RY group ( n =67), followed by the BII-B ( n =183) and BII groups ( n =147) at 1 year (3.0 vs. 67.8 vs. 84.4%, all P <0.05). The anti-reflux capability of BII-B was statistically better than that of BII, but not as perfect as that of RY. From the perspective of QoL, BII-B was not inferior to RY, but better than BII reconstruction in causing fewer STO22 reflux symptoms at 6 and 12 months. However, only RY caused fewer C30 nausea symptoms than BII at 6 and 12 months, but not BII-B. Nutritional status and morbidities were similar among the three groups, and the operative time did not differ between the BII-B and RY groups.

Conclusions: BII-B cannot substitute for RY in preventing bile reflux, shortening the operative time, or reducing morbidities. Regarding short-term QoL, BII-B was sufficient to reduce STO22 reflux symptoms but failed to reduce C30 nausea symptoms postoperatively.

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Conflict of interest statement

All authors have no conflicts of interest.

Figures

None
Graphical abstract
Figure 1
Figure 1
The amount of residual food and degree of gastritis at postoperative 6 and 12 months in the Billroth II group (n=147), Billroth II with Braun group (n=183), and Roux-en-Y reconstruction group (n=67). (A) The amount of residual food at postoperative 6 months. (B) The amount of residual food at postoperative 12 months. (C) The degree of gastritis at postoperative 6 months. (D) The degree of gastritis at postoperative 12 months. (E) The amount of bile reflux at postoperative 6 months. (F) The amount of bile reflux at postoperative 12 months.
Figure 2
Figure 2
Quality of life (QoL) measurements of the Billroth II (BII) group (n=147), Billroth II with Braun anastomosis (BII-B) group (n=183), and Roux-en-Y reconstruction (RY) group (n=67) using the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) questionnaire. (A) C30 nausea. (B) STO22 reflux.
Figure 3
Figure 3
The nutritional status of hemoglobin, total protein, albumin, and body mass index of the Billroth II (BII) group (n=147), Billroth II with Braun anastomosis (BII-B) group (n=183), and Roux-en-Y reconstruction (RY) group (n=67). (A) The serum level of hemoglobin (mg/l). (B) The serum level of protein (mg/dl). (C) The serum level of albumin (mg/dl). (D) The body mass index (kg/m2).
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References

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