Comparison of Outcomes of Three Reconstruction Methods for Radical Distal Gastrec-tomy: A Matched Study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIUJin-qiang ^1,2 , ZHANGRui ¹ , ZHOUWei ¹ , ZHANGLei ¹ , MAJiao-jiao ¹ , YANGXue-wen ¹ , XIAOShu-ao ¹ , LIANXiao ¹ , GUOMan ¹ , ZHANGHong-wei ¹ ,  HONGLiu ¹

1. Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China;
2. Xinyang Cadres Sanatorium of Wuhan Military Logistics Base, Xinyang 464000, Henan Province, China;

Corresponding?author：

HONGLiu, Email: hongliu180@126.com

Keywords：

Gastric cancer; Digestive tract reconstruction; Distal gastrectomy; Complication; Prognosis

DOI：

10.7507/1007-9424.20160373

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Objective To investigate the ideal digestive tract reconstruction method for radical distal gastrectomy (DG). Methods Clinical and follow-up data of 862 patients with gastric cancer who underwent DG in Xijing Hospital of Digestive Diseases of The Fourth Military Medical University from January 2010 to January 2013 were analyzed retrospectively. According to reconstruction methods, patients were divided into three groups:Billroth Ⅰ group (B-Ⅰgroup), Billroth Ⅱ (B-Ⅱ)+Braun group (B-Ⅱ+Braun group), and Roux-en-Y group. In order to reduce the difference of clinicopa-thological characteristics, Gmatch method was used to select patients basing on gender, age (±5 years), tumor size (±1 cm), pT staging, and pN staging. The perioperative data, recent (30 days after surgery) complications, gastroscopic results over one year, and postoperative survival rate were compared respectively among the 3 groups. Results ① Perioperative indexes. The operative time, postoperative hospitalization, and semi liquid diet time were significantly different among 3 groups (P < 0.050). As compared with B-Ⅱ+Braun group and Roux-en-Y group, B-Ⅰ group had a significantly shorter operative time (P < 0.012 5), and there was no significant difference between B-Ⅱ+Braun group and Roux-en-Y group (P > 0.012 5). As compared with B-Ⅱ+Braun group, B-Ⅰ group had a significantly shorter semi liquid diet time (P < 0.012 5), but there was no significant difference between B-Ⅱ+Braun group and Roux-en-Y group, as well as Roux-en-Y group and B-Ⅰ group (P > 0.012 5). As compared with B-Ⅰ group and B-Ⅱ+Braun group, Roux-en-Y group had a significantly longer postoperative hospitalization (P < 0.012 5), and there was no significant difference between B-Ⅰ group and B-Ⅱ+ Braun group (P > 0.012 5). ② There was no significant difference in recent complications between Roux-en-Y group (12.5%, 4/32), B-Ⅱ+Braun (6.2%, 2/32), and B-Ⅰ group (3.1%, 1/32), P=0.495. ③ Results of endoscopic examination over 1 year after radical DG showed that there was significant difference among 3 groups (P < 0.050). Compared with B-Ⅰ group and B-Ⅱ+Braun group, the rates of reflux gastritis, bile reflux, and reflux esophagitis of Roux-en-Y group were all lower (P < 0.012 5), but there was no significant difference between B-Ⅰ group and B-Ⅱ+Braun group (P > 0.012 5).④ The 3-year survival rates of Roux-en-Y group, B-Ⅱ+Braun group, and B-Ⅰ group were 70.0% (21/30), 73.3% (22/30), and 75.0% (24/32) respectively, and there was no significant difference in the survival situation (P=0.911). Conclusions The effect of Rouxen-Y anastomosis on resisting gastrointestinal reflux is remarkable. B-Ⅰanastomosis has the advantages of more simple operation, faster recovery, and more similar to the physiological structure. Thus, B-Ⅰ anastomosis and Roux-en-Y anastomosis are recommended for digestive tract reconstruction in DG.

Citation： LIUJin-qiang, ZHANGRui, ZHOUWei, ZHANGLei, MAJiao-jiao, YANGXue-wen, XIAOShu-ao, LIANXiao, GUOMan, ZHANGHong-wei, HONGLiu. Comparison of Outcomes of Three Reconstruction Methods for Radical Distal Gastrec-tomy: A Matched Study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1477-1482. doi: 10.7507/1007-9424.20160373 Copy

1.	陳萬青, 張思維, 鄭榮壽, 等.中國2009年惡性腫瘤發病和死亡分析.中國腫瘤, 2013, 22(1):2-12.
2.	胡建昆, 陳心足.胃癌遠端胃切除后消化道重建理論與實踐.中國實用外科雜志, 2012, 32(8):613-616.
3.	Hirao M, Takiguchi S, Imamura H, et al. Comparison of Billroth Ⅰ and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer:one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol, 2013, 20(5):1591-1597.
4.	Washington K. 7th edition of the AJCC cancer staging manual:stomach. Ann Surg Oncol, 2010, 17(12):3077-3079.
5.	Kubo M, Sasako M, Gotoda T, et al. Endoscopic evaluation of the remnant stomach after gastrectomy:proposal for a new classification. Gastric Cancer, 2002, 5(2):83-89.
6.	Miwa H, Yokoyama T, Hori K, et al. Interobserver agreement in endoscopic evaluation of reflux esophagitis using a modified Los Angeles classification incorporating grades N and M:a validation study in a cohort of Japanese endoscopists. Dis Esophagus, 2008, 21(4):355-363.
7.	徐成棟, 陳曉明, 喇旭, 等. Roux-en-Y胃空腸吻合術在遠端胃切除消化道重建中的應用.中國普外基礎與臨床雜志, 2014, 21(7):889-891.
8.	中華醫學會外科學分會.胃切除術后消化道重建技術專家共識.中國實用外科雜志, 2014, 34(3):205-212.
9.	Imamura H, Takiguchi S, Yamamoto K, et al. Morbidity and mortality results from a prospective randomized controlled trial comparing Billroth Ⅰ and Roux-en-Y reconstructive procedures after distal gastrectomy for gastric cancer. World J Surg, 2012, 36(3):632-637.
10.	Kang KC, Cho GS, Han SU, et al. Comparison of Billroth Ⅰ and Bill-roth Ⅱ reconstructions after laparoscopy-assisted distal gastrectomy:a retrospective analysis of large-scale multicenter results from Korea. Surg Endosc, 2011, 25(6):1953-1961.
11.	Tran TB, Worhunsky DJ, Squires MH, et al. To roux or not to roux:a comparison between Roux-en-Y and Billroth Ⅱ reconstruction following partial gastrectomy for gastric cancer. Gastric Cancer, 2016, 19(3):994-1001.
12.	Lee MS, Ahn SH, Lee JH, et al. What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc, 2012, 26(6):1539-1547.
13.	胡祥.不斷提高胃癌手術消化道重建規范化水平.中華普外科手術學雜志:電子版, 2014, 8(4):281-284.
14.	Gustavsson S, Ilstrup DM, Morrison P, et al. Roux-Y stasis syndrome after gastrectomy. Am J Surg, 1988, 155(3):490-494.
15.	Osugi H, Fukuhara K, Takada N, et al. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology, 2004, 51(58):1215-1218.
16.	Sato T, Miwa K, Sahara H, et al. The sequential model of Barrett's esophagus and adenocarcinoma induced by duodeno-esophageal reflux without exogenous carcinogens. Anticancer Res, 2002, 22(1A):39-44.
17.	劉錚, 何純, 黃東, 等.畢Ⅱ式吻合加Braun吻合術預防反流性胃炎55例分析.中外醫療, 2013, 32(17):22-23.
18.	Wang F, Zu HL, Jiang H, et al. Clinical investigation of combined Billroth Ⅱ with Braun anastomosis for patients with gastric cancer. Hepatogastroenterology, 2014, 61(134):1812-1816.
19.	Vogel SB, Drane WE, Woodward ER. Clinical and radionuclide evaluation of bile diversion by Braun enteroenterostomy:prevention and treatment of alkaline reflux gastritis. An alternative to Roux-en-Y diversion. Ann Surg, 1994, 219(5):458-466.
20.	In CC, Baek DH, Lee SH, et al. Comparison between Billroth-Ⅱ with Braun and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. J Gastrointest Surg, 2016, 20(6):1083-1090.
21.	Chan DC, Fan M, Lin CK, et al. Roux-en-Y reconstruction after distal gastrectomy to reduce enterogastric reflux and Helicobacter pylori infection. J Gastrointest Surg, 2007, 11(12):1732-1740.
22.	Takiguchi S, Yamamoto K, Hirao M, et al. A comparison of postoperative quality of life and dysfunction after Billroth Ⅰ and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer:results from a multi-institutional RCT. Gastric Cancer, 2012, 15(2):198-205.
23.	Zong L, Chen P. Billroth Ⅰ vs. Billroth Ⅱ vs. Roux-en-Y following distal gastrectomy:a meta-analysis based on 15 studies. Hepatogastroenterology, 2011, 58(19):1413-1424.
24.	Hirao M, Takiguchi S, Imamura H, et al. Comparison of Billroth Ⅰ and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer:one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol, 2013, 20(5):1591-1597.
25.	Namikawa T, Kitagawa H, Okabayashi T, et al. Roux-en-Y reconstruction is superior to Billroth Ⅰ reconstruction in reducing reflux esophagitis after distal gastrectomy:special relationship with the angle of his. World J Surg, 2010, 34(5):1022-1027.

1. 陳萬青, 張思維, 鄭榮壽, 等.中國2009年惡性腫瘤發病和死亡分析.中國腫瘤, 2013, 22(1):2-12.
2. 胡建昆, 陳心足.胃癌遠端胃切除后消化道重建理論與實踐.中國實用外科雜志, 2012, 32(8):613-616.
3. Hirao M, Takiguchi S, Imamura H, et al. Comparison of Billroth Ⅰ and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer:one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol, 2013, 20(5):1591-1597.
4. Washington K. 7th edition of the AJCC cancer staging manual:stomach. Ann Surg Oncol, 2010, 17(12):3077-3079.
5. Kubo M, Sasako M, Gotoda T, et al. Endoscopic evaluation of the remnant stomach after gastrectomy:proposal for a new classification. Gastric Cancer, 2002, 5(2):83-89.
6. Miwa H, Yokoyama T, Hori K, et al. Interobserver agreement in endoscopic evaluation of reflux esophagitis using a modified Los Angeles classification incorporating grades N and M:a validation study in a cohort of Japanese endoscopists. Dis Esophagus, 2008, 21(4):355-363.
7. 徐成棟, 陳曉明, 喇旭, 等. Roux-en-Y胃空腸吻合術在遠端胃切除消化道重建中的應用.中國普外基礎與臨床雜志, 2014, 21(7):889-891.
8. 中華醫學會外科學分會.胃切除術后消化道重建技術專家共識.中國實用外科雜志, 2014, 34(3):205-212.
9. Imamura H, Takiguchi S, Yamamoto K, et al. Morbidity and mortality results from a prospective randomized controlled trial comparing Billroth Ⅰ and Roux-en-Y reconstructive procedures after distal gastrectomy for gastric cancer. World J Surg, 2012, 36(3):632-637.
10. Kang KC, Cho GS, Han SU, et al. Comparison of Billroth Ⅰ and Bill-roth Ⅱ reconstructions after laparoscopy-assisted distal gastrectomy:a retrospective analysis of large-scale multicenter results from Korea. Surg Endosc, 2011, 25(6):1953-1961.
11. Tran TB, Worhunsky DJ, Squires MH, et al. To roux or not to roux:a comparison between Roux-en-Y and Billroth Ⅱ reconstruction following partial gastrectomy for gastric cancer. Gastric Cancer, 2016, 19(3):994-1001.
12. Lee MS, Ahn SH, Lee JH, et al. What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc, 2012, 26(6):1539-1547.
13. 胡祥.不斷提高胃癌手術消化道重建規范化水平.中華普外科手術學雜志:電子版, 2014, 8(4):281-284.
14. Gustavsson S, Ilstrup DM, Morrison P, et al. Roux-Y stasis syndrome after gastrectomy. Am J Surg, 1988, 155(3):490-494.
15. Osugi H, Fukuhara K, Takada N, et al. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology, 2004, 51(58):1215-1218.
16. Sato T, Miwa K, Sahara H, et al. The sequential model of Barrett's esophagus and adenocarcinoma induced by duodeno-esophageal reflux without exogenous carcinogens. Anticancer Res, 2002, 22(1A):39-44.
17. 劉錚, 何純, 黃東, 等.畢Ⅱ式吻合加Braun吻合術預防反流性胃炎55例分析.中外醫療, 2013, 32(17):22-23.
18. Wang F, Zu HL, Jiang H, et al. Clinical investigation of combined Billroth Ⅱ with Braun anastomosis for patients with gastric cancer. Hepatogastroenterology, 2014, 61(134):1812-1816.
19. Vogel SB, Drane WE, Woodward ER. Clinical and radionuclide evaluation of bile diversion by Braun enteroenterostomy:prevention and treatment of alkaline reflux gastritis. An alternative to Roux-en-Y diversion. Ann Surg, 1994, 219(5):458-466.
20. In CC, Baek DH, Lee SH, et al. Comparison between Billroth-Ⅱ with Braun and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. J Gastrointest Surg, 2016, 20(6):1083-1090.
21. Chan DC, Fan M, Lin CK, et al. Roux-en-Y reconstruction after distal gastrectomy to reduce enterogastric reflux and Helicobacter pylori infection. J Gastrointest Surg, 2007, 11(12):1732-1740.
22. Takiguchi S, Yamamoto K, Hirao M, et al. A comparison of postoperative quality of life and dysfunction after Billroth Ⅰ and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer:results from a multi-institutional RCT. Gastric Cancer, 2012, 15(2):198-205.
23. Zong L, Chen P. Billroth Ⅰ vs. Billroth Ⅱ vs. Roux-en-Y following distal gastrectomy:a meta-analysis based on 15 studies. Hepatogastroenterology, 2011, 58(19):1413-1424.
24. Hirao M, Takiguchi S, Imamura H, et al. Comparison of Billroth Ⅰ and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer:one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol, 2013, 20(5):1591-1597.
25. Namikawa T, Kitagawa H, Okabayashi T, et al. Roux-en-Y reconstruction is superior to Billroth Ⅰ reconstruction in reducing reflux esophagitis after distal gastrectomy:special relationship with the angle of his. World J Surg, 2010, 34(5):1022-1027.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of Outcomes of Three Reconstruction Methods for Radical Distal Gastrec-tomy: A Matched Study

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