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

Motohiro Hirao, Shuji Takiguchi, Hiroshi Imamura, Kazuyoshi Yamamoto, Yukinori Kurokawa, Junya Fujita, Kenji Kobayashi, Yutaka Kimura, Masaki Mori, Yuichiro Doki

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Abstract

Purpose: This randomized, controlled trial evaluated the clinical efficacy of Billroth I (BI) and Roux-en-Y (RY) reconstruction at 1 year after distal gastrectomy for gastric cancer. Methods: The primary end point was the amount of body weight lost at 1 postoperative year, and secondary end points included other items related to nutritional status such as serum albumin and lymphocyte count, as well as endoscopic examination findings of the remnant stomach and esophagus. Of the 332 patients enrolled, 163 were assigned to the BI group and 169 were randomized to the RY group. Results: The loss in body weight 1 year after surgery did not differ significantly between the BI and RY groups (9.1 % and 9.7 %, respectively, p = 0.39). There were no significant differences in other aspects of nutritional status between the 2 groups. Endoscopic examination 1 year after gastrectomy showed reflux esophagitis in 26 patients (17 %) in the BI group versus 10 patients (6 %) in the RY group (p = 0.0037), while remnant gastritis was observed in 71 patients (46 %) in the BI group versus 44 patients (28 %) in the RY group (p = 0.0013); differences were significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis. Conclusions: RY reconstruction was not superior to BI in terms of body weight change or other aspects of nutritional status at 1 year after surgery, although RY more effectively prevented reflux esophagitis and remnant gastritis after distal gastrectomy.

Original languageEnglish
Pages (from-to)1591-1597
Number of pages7
JournalAnnals of Surgical Oncology
Volume20
Issue number5
DOIs
Publication statusPublished - May 1 2013

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Gastroenterostomy
Gastrectomy
Stomach Neoplasms
Peptic Esophagitis
Nutritional Status
Gastritis
Body Weight
Gastric Stump
Body Weight Changes
Lymphocyte Count
Serum Albumin
Esophagus
Randomized Controlled Trials
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

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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. / Hirao, Motohiro; Takiguchi, Shuji; Imamura, Hiroshi; Yamamoto, Kazuyoshi; Kurokawa, Yukinori; Fujita, Junya; Kobayashi, Kenji; Kimura, Yutaka; Mori, Masaki; Doki, Yuichiro.

In: Annals of Surgical Oncology, Vol. 20, No. 5, 01.05.2013, p. 1591-1597.

Research output: Contribution to journalArticle

Hirao, Motohiro ; Takiguchi, Shuji ; Imamura, Hiroshi ; Yamamoto, Kazuyoshi ; Kurokawa, Yukinori ; Fujita, Junya ; Kobayashi, Kenji ; Kimura, Yutaka ; Mori, Masaki ; Doki, Yuichiro. / 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. In: Annals of Surgical Oncology. 2013 ; Vol. 20, No. 5. pp. 1591-1597.
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abstract = "Purpose: This randomized, controlled trial evaluated the clinical efficacy of Billroth I (BI) and Roux-en-Y (RY) reconstruction at 1 year after distal gastrectomy for gastric cancer. Methods: The primary end point was the amount of body weight lost at 1 postoperative year, and secondary end points included other items related to nutritional status such as serum albumin and lymphocyte count, as well as endoscopic examination findings of the remnant stomach and esophagus. Of the 332 patients enrolled, 163 were assigned to the BI group and 169 were randomized to the RY group. Results: The loss in body weight 1 year after surgery did not differ significantly between the BI and RY groups (9.1 {\%} and 9.7 {\%}, respectively, p = 0.39). There were no significant differences in other aspects of nutritional status between the 2 groups. Endoscopic examination 1 year after gastrectomy showed reflux esophagitis in 26 patients (17 {\%}) in the BI group versus 10 patients (6 {\%}) in the RY group (p = 0.0037), while remnant gastritis was observed in 71 patients (46 {\%}) in the BI group versus 44 patients (28 {\%}) in the RY group (p = 0.0013); differences were significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis. Conclusions: RY reconstruction was not superior to BI in terms of body weight change or other aspects of nutritional status at 1 year after surgery, although RY more effectively prevented reflux esophagitis and remnant gastritis after distal gastrectomy.",
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T2 - One-year postoperative effects assessed by a multi-institutional RCT

AU - Hirao, Motohiro

AU - Takiguchi, Shuji

AU - Imamura, Hiroshi

AU - Yamamoto, Kazuyoshi

AU - Kurokawa, Yukinori

AU - Fujita, Junya

AU - Kobayashi, Kenji

AU - Kimura, Yutaka

AU - Mori, Masaki

AU - Doki, Yuichiro

PY - 2013/5/1

Y1 - 2013/5/1

N2 - Purpose: This randomized, controlled trial evaluated the clinical efficacy of Billroth I (BI) and Roux-en-Y (RY) reconstruction at 1 year after distal gastrectomy for gastric cancer. Methods: The primary end point was the amount of body weight lost at 1 postoperative year, and secondary end points included other items related to nutritional status such as serum albumin and lymphocyte count, as well as endoscopic examination findings of the remnant stomach and esophagus. Of the 332 patients enrolled, 163 were assigned to the BI group and 169 were randomized to the RY group. Results: The loss in body weight 1 year after surgery did not differ significantly between the BI and RY groups (9.1 % and 9.7 %, respectively, p = 0.39). There were no significant differences in other aspects of nutritional status between the 2 groups. Endoscopic examination 1 year after gastrectomy showed reflux esophagitis in 26 patients (17 %) in the BI group versus 10 patients (6 %) in the RY group (p = 0.0037), while remnant gastritis was observed in 71 patients (46 %) in the BI group versus 44 patients (28 %) in the RY group (p = 0.0013); differences were significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis. Conclusions: RY reconstruction was not superior to BI in terms of body weight change or other aspects of nutritional status at 1 year after surgery, although RY more effectively prevented reflux esophagitis and remnant gastritis after distal gastrectomy.

AB - Purpose: This randomized, controlled trial evaluated the clinical efficacy of Billroth I (BI) and Roux-en-Y (RY) reconstruction at 1 year after distal gastrectomy for gastric cancer. Methods: The primary end point was the amount of body weight lost at 1 postoperative year, and secondary end points included other items related to nutritional status such as serum albumin and lymphocyte count, as well as endoscopic examination findings of the remnant stomach and esophagus. Of the 332 patients enrolled, 163 were assigned to the BI group and 169 were randomized to the RY group. Results: The loss in body weight 1 year after surgery did not differ significantly between the BI and RY groups (9.1 % and 9.7 %, respectively, p = 0.39). There were no significant differences in other aspects of nutritional status between the 2 groups. Endoscopic examination 1 year after gastrectomy showed reflux esophagitis in 26 patients (17 %) in the BI group versus 10 patients (6 %) in the RY group (p = 0.0037), while remnant gastritis was observed in 71 patients (46 %) in the BI group versus 44 patients (28 %) in the RY group (p = 0.0013); differences were significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis. Conclusions: RY reconstruction was not superior to BI in terms of body weight change or other aspects of nutritional status at 1 year after surgery, although RY more effectively prevented reflux esophagitis and remnant gastritis after distal gastrectomy.

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